Diabetes for Educators

1. Diabetes for Educators Prepared by Rhonda Philliber, RN

2. Overall Goal: Optimal Student Health and Learning Hypoglycemia & Hyperglycemia Monitoring Blood Glucose Ketones Health & Learning Legal Rights Glucagon Administration Exercise Insulin Regimen Nutrition

3. What is Diabetes? Body does not make or properly use insulin: • no insulin production • insufficient insulin production • resistance to insulin’s effects No insulin to move glucose from blood into cells: • high blood glucose means: • fuel loss. • cells starve • short and long-term complications

4. Type 1 Diabetes • auto immune disorder • insulin-producing cells destroyed • daily insulin replacement necessary • age of onset: usually childhood, young adulthood • most prevalent type in children and adolescents

5. Type 2 Diabetes • Insulin resistance – first step • Age at onset: • Most common in adults • Increasingly common in children • overweight • inactivity

6. Diabetes is Managed,But it Does Not Go Away GOAL: To maintain target blood glucose

7. Diabetes Management 24/7 Constant Juggling: Insulin/medication with: Exercise Food intake BG BG & BG

8. Vocabulary Glucose - a simple sugar found in the blood; the fuel that all body cells need to function. HYPOglycemia - a LOW level of glucose in the blood. Quick-acting glucose - foods containing simple sugar that raises blood glucose levels Glucose tablets or gel - special products that deliver a pre-measured amount of pure glucose; a fast-acting form of glucose used to counteract hypoglycemia Glucagon - a hormone given by injection that raises the level of glucose in the blood Carbohydrate - source of energy for the body

9. Vocabulary HYPERglycemia - too high a level of glucose in the blood Ketones - (ketone bodies) Chemicals that the body makes when there is not enough insulin in the blood and the body must break down fat for its energy Diabetic ketoacidosis (DKA) -the build up of ketones in the body that can lead to serious illness and coma Ketone testing - a procedure for measuring the level of ketones in the urine or blood

10. Hypoglycemia:Possible Signs & Symptoms Mild Symptoms Hunger Sleepiness Shakiness Changed behavior Weakness Sweating Paleness Anxiety Blurry vision Dilated pupils Increased heart rate/palpitations Moderate to Severe Symptoms Yawning Confusion Irritability/frustration Restlessness Extreme tiredness/fatigue Dazed appearance Inability to swallow Unconsciousness/coma Sudden crying Seizures

11. Hypoglycemia: Risks & Complications • Greatest immediate danger • Not always preventable • Impairs cognitive and motor functioning • Early recognition and intervention can prevent an emergency

12. Hypoglycemia: Possible Causes • Too much insulin • Too little food or delayed meal or snack • Extra physical activity • Illness • Medications

13. Mild Hypoglycemia: What to do • Intervene promptly! Have student eat or drink fast acting carbs (15g) • Test blood glucose 10-15 minutes after treatment • Repeat treatment if blood glucose level remains low or if symptoms persist • Duration of symptoms depends on how low the blood glucose was and for how long • If symptoms continue, call school nurse or parents

14. Quick Acting Glucose for Hypoglycemia Treatment for Lows: 15 g Carbohydrate • 4 oz. fruit juice • 15 gm glucose tablets (2-3 tablets) • 1 tube of glucose gel • 4-6 small hard candies • 1-2 tablespoons of honey • 6 oz. regular (not diet) soda (about half a can) • 3 tsp. table sugar • One-half tube of cake mate

15. Severe Hypoglycemia Symptoms Rare, but life threatening, if not treated promptly: • Convulsions (seizures) • Loss of consciousness • Inability to swallow • What to do: • Place student on his or her side • Lift chin to keep airway open • Never attempt to give food or put anything in the student’s mouth • Call School Nurse and 911, then parent/guardian • Remain with the student until help arrives

16. Hypoglycemia: Prevention • Keep a quick-acting sugar source with the student ALWAYS • Treat at onset of symptoms • Eat, Insulin, Test, Exercise ON TIME • Ensure reliable insulin dosing • Ensure insulin dosing matches food eaten • Watch picky eaters • Provide nutritional information to families • May give insulin after eating if intake uncertain

17. Hypoglycemia: Prevention Monitor blood-glucose variations on gym days, an extra snack may be required ½ hour before gym or during prolonged vigorous exercise. • A student should never be unattended when a low blood glucose is suspected. Maintain adult supervision.

18. Hyperglycemia:Possible Signs &Symptoms Dry mouth Vomiting Stomach cramps Nausea Mild Symptoms Lack of concentration Thirst Frequent urination Blurred vision Flushing of skin Increased hunger Sweet, fruity breath Weight loss Fatigue/sleepiness Stomach pains

19. Hyperglycemia: Risks & Complications • Hyperglycemia due to inadequate insulin can lead to DKA and/or coma or death (mainly in type 1). • Interferes with a student’s ability to learn and participate. • Serious complications develop when glucose levels remain above target range over time or are recurring.

20. Hyperglycemia: Possible Causes • Late, missed or too little insulin • Expired insulin • Food not covered by insulin • Decreased physical activity • Illness, injury • Stress • Other hormones or medications • Menstrual periods • Any combination of the above

21. Hyperglycemia: What to do Goal: lower the blood glucose to a target range • Verify with blood glucose test • Allow free use of bathroom and access to water • Administer insulin • Recheck blood glucose • Notify nurse, call parents • Note patterns: may need a change in regimen

22. Hyperglycemia: Prevention • Eat, insulin, check BG, exercise ON TIME • Reliable and accurate insulin dosing • Ensure that food eaten matches insulin dosing: • Monitor food intake • Report binge eating • Teachers consult parent/guardian prior to extra snacks • Consult with parent/guardian when snack, meal, or exercise times must be changed

23. Hyperglycemia: Prevention • Take appropriate action if a missed dose is suspected or if an insulin pump malfunctions • Avoid “over treating” low blood sugar reactions • Respect the students; realize their limits • Exercise on a regular basis

24. Practical Implications for Educators • Students with hyperglycemia or hypoglycemia often do not concentrate well. • During academic testing: • Check blood glucose before and during testing, per educational plan. • Access to food/drink and restroom. • If a serious high or low blood glucose episode occurs, students should be excused with an opportunity for retake. • Students should have adequate time for taking medication, checking blood glucose, and eating.

25. Practical Implications for Educators • “Make the right choice the easy choice” by eliminating barriers to: • snacking • blood glucose checks • access to water and bathrooms • insulin administration • Avoid making judgments based on individual blood glucose readings.

26. Needs Addressed by IEP Plan • Location and timing of blood glucose monitoring • Identity of trained diabetes personnel • Location of diabetes supplies • Free access to water and restroom • Nutritional needs, meals and snacks • Full participation in all school-sponsored activities • Alternative times for academic exams if student is experiencing hypoglycemia or hyperglycemia • Absences without penalty for doctors’ appointments and diabetes-related illness • Maintenance of confidentiality and student’s right to privacy

27. Where to Get More Information American Diabetes Association 1-800- DIABETES www.diabetes.org National Diabetes Education Program/NIH www.ndep.nih.gov