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Diabetes EducationDiabetes Education for school staff

Developed for Chicago Public Schools by:LaRabida Children’s Hospital and Children’s Memorial Hospital

November 18, 2011

Chicago Public SchoolsOffice of Special Education and Supports125 South Clark Street; Suite 800. Chicago, Illinois 60603. Telephone: 773-553-1830. Fax: 773-553-1883

2The information presented is intended to …• Provide you with basic knowledge on Diabetes andProvide you with basic knowledge on Diabetes and

its impact on students.• Layout best practices in managing the treatment of

diabetes.• Provide tips to working with students who have

di b tdiabetes• Show signs and symptoms of Hyperglycemia and

HypoglycemiaHypoglycemia.• Explain how to respond in an emergency.• Provide resources• Provide resources

What is Diabetes?3

Diabetes is a group of diseases marked byDiabetes is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both and is the seventh leading cause of death in the United States. Most cases of di b t hild d d l tdiabetes among children and adolescents are type 1, which develops when the body can no longer make insulin a hormone thatcan no longer make insulin, a hormone that controls the amount of blood glucose.

Everyone needs to know:9

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• How to prevent a Diabetic emergencyHow to prevent a Diabetic emergency• How to recognize a Diabetic reaction

– recognize high risk times and situationsg g– know common signs and symptoms

• How to respond to a Diabetic reaction– know your school’s resources/policies– know how to follow an Diabetes Emergency Plan

Basics of Diabetes Care4

• Blood sugar monitoring needs to be done g gfrequently throughout the day, especially before meals

• Carbohydrates (bread fruit and milk) need to be• Carbohydrates (bread, fruit and milk) need to be counted at meal and snack time

• Insulin needs to be administered for most before l h ith i fill d i lilunch with a syringe, prefilled pen or an insulin pump

• Carbohydrates and the pre meal blood sugarCarbohydrates and the pre meal blood sugar need to be entered into the pump, or used to calculate the pre meal insulin dose

Best Practices in Managing the Treatment of Diabetes

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Treatment of Diabetes• Technique matters: call 800# on the back of the meter q• Perform quality control procedures, set code, √ exp. date

on strips and control solution, battery indicator • Wash hands with soap and water, always use a new lancetp , y• Rotate fingers • Alternative sites can be used once you establish a working

insulin doseinsulin dose• Obtain enough blood• Dispose of sharps in a proper container

Record results; Check meter memory and current• Record results; Check meter memory and current date/time

• Provide supportive supervision; neutral reaction to result

Checking Blood Sugars4

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• Before meals and• Before meals and snacks

• Before or after• Before or after exercise

• If signs or symptomsIf signs or symptoms of high or low blood glucose

• May need to check 2 hours after meal

How to Manage High and Low blood sugar

4blood sugar

• High blood sugar– What is it?

• Low blood sugar– What is it?

– What are the signs and symptoms?

– What are the signs and symptoms?H i it t t d?– How is it treated? – How is it treated?

High Blood Sugar: Hyperglycemia

4HyperglycemiaWhat is it? Definition varies by child, but generally any y g y y

value > 180 is “high”What to watch for? Look for extreme thirst, need to

urinate often, stomach ache, weakness, fatigue, , , , g ,nausea, vomiting

What to do? Follow the student’s Diabetes Action PlanAllow free access to water and restroomAllow free access to water and restroomIf >300 check the urine for ketonesCall the school nurse immediately if ketones are ypositive, if untreated the student can become critically ill

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Low Blood Sugar: Hypoglycemia

4HypoglycemiaWhat is it? Definition varies by child but generally when <80

Can happen suddenlyRequires immediate treatmentImpairs cognitive abilitiesImpairs cognitive abilitiesCan be mistaken for misbehavior

What to watch for? Shaking, sweating, anxious, dizzy, hungry, headache, irritability, personality change, some students have no signs at all

What to do? Follow the student’s Diabetes Action PlanCheck the bg and give 15 grams of a fast acting carbohydrate, wait 15 minutes and re-check the bg again

If untreated or missed child could have a seizureIf untreated or missed, child could have a seizure

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Best Practices: the Meal Plan

35Plan• Individualized to meet child’s nutritional needs, appetite, pp

eating habits and activity level• Goal: Achievement of normal blood glucose, lipid levels

and growthand growth• Nutritional needs are no different from their peers

without diabetes• Families are taught how to count carbohydrates: the

child is given a target range for carb intake at meals and snacks

• Child can eat the same food as a child without diabetes

Carbohydrate Containing Foods

35Foods• Breads grains and cerealsBreads, grains, and cereals• Fruits and fruit juices• Starchy vegetables• Starchy vegetables

potatoes, corn, peas, beansMilk d t• Milk and yogurt

• Sweets and sugary foods/drinks

Carbohydrate Counting35

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• Most popular meal planMost popular meal plan

• Involves calculating number of grams of• Involves calculating number of grams of carbohydrate the student will eat

• Insulin dose based on how many carbohydrates to be eaten (insulin:carb)carbohydrates to be eaten (insulin:carb)

Tips for Eating at School35

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• Contact Nutrition Support Services personnel to Co ac u o Suppo Se ces pe so e odiscuss nutrition related accommodations e.g. lunch menus and carbohydrate content

f• Parent needs to write the amount of carbs in meals/snacks brought from home

• Notify parent in advance about school parties• Notify parent in advance about school parties and food treats

• Lunch time is an important social event in theLunch time is an important social event in the day of a student

Insulin353

• Used to cover food eaten at meals and snacksUsed to cover food eaten at meals and snacks

• Used to correct high blood glucose• Used to correct high blood glucose

H lth l h ld if d• Health care plan should specify dosage, delivery method, and schedule

Basal/Bolus Insulin Plan353

• Mimics the way a normally functioning pancreas

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Mimics the way a normally functioning pancreas produces insulin

• Given by multiple daily injections or insulinGiven by multiple daily injections or insulin pump

• Basal = long acting insulin, controls blood g g ,glucose overnight and between meals

• Bolus = rapid acting insulin, covers food and glowers blood glucose if over target

Ways to Give Insulin35

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• SyringesSyringes

• Pens• Pens

P• Pumps

Insulin Pens353

Administering Insulin35

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• Some students are independentSome students are independent

• Some students need supervision• Some students need supervision

S t d t d t t l i t• Some students need total assistance

Working with Students who have Diabetes

4Diabetes

• Allow the child to use the restroom and drink water as d dneeded

• It’s o.k. for them to eat in class• Allow time to fully recover after treating lowsy g• All teachers, bus drivers, PE instructors, Coaches need to

know the student has diabetes and what needs to be done• Student needs to have access to supplies at all times• Student needs to have access to supplies at all times• Keep supplies stocked (provided by the parents)• Communicate regularly with the school nurse• Student will need continued reminding• Get consent to talk to the health care provider in the event

the child is ill and you can not reach the parent/guardian

When to call the school nurse for help

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• Anytime you are unsure of what to do.4

Anytime you are unsure of what to do.• When you need to make a decision about the

diabetes managementIf bl t t th bl d t• If you are unable to get the blood sugar to come up after 2 treatments

• If the urine is positive for ketonesIf the urine is positive for ketones• If the child is sick• If the child is not thinking clearly or seems

confused.

What to do in an Emergency4

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• In the event emergency response measures4

In the event emergency response measures outlined in a student's Diabetes Action Plan are undertaken but not effective, 911 will be ,called immediately.

• If Glucagon is given call 911 and stay with student until help arrives.– Glucagon can cause nausea and vomiting– Notify parent/guardian after 911 has been called

Identifying Students with Diabetes: Parent Submissions

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Parent Submissions

When a diagnoses of Diabetes is reported, parent/guardian must 28

g p , p gsubmit:

1. Written authorization to obtain detailed medical information2 W itt C t t h di i ith h l l2. Written Consent to share diagnosis with school personnel3. Written consent to administer or self administer medication4 Physician’s Diabetes Care Plan completed and signed by their4. Physician s Diabetes Care Plan, completed and signed by their

child’s licensed health care provider and signed by the parent/guardian

5 A M di ti t t/t t l ith l t5. Any Medications necessary to prevent/treat along with relevant prescription and dosage information

6. Current emergency contact information7. Other information will also be requested specific to the

development of a 504/IEP Plan.

First Step in Documentation28

• Principals shall27

Principals shall request parents/guardians to

treportinformation about their child’s diagnosedchild s diagnosed Diabetes using the “Student Medical Information” form on an annual basis.

Online Resources 35

• American Diabetes Association35

www.diabetes.org look under Living with diabetes→ Safeat School→ School Staff Training→ Training ResourcesChildren With Diabetes www childrenwithdiabetes comChildren With Diabetes www.childrenwithdiabetes.comgreat sample 504 plans

J il Di b t R h F d ti• Juvenile Diabetes Research Foundation:www.JDRF.org

• National Diabetes Education Programwww.yourdiabetesinfo.org additional diabetes resources

and guide on caring for studentsg g