Diabetes Management at School

1. Diabetes Management at School http://www.childrenwithdiabetes.com

2. General guidelines for the care of the child in the school • Diabetes Medical Management Plan • Responsibilities of the various care providers • Expectations of the student in diabetes care

3. Diabetes education must be targeted to • Teachers • Day care providers • School administrators • Coaches • School nurses • Health aides • Bus drivers • Secretaries

4. Expectations of the student in Diabetes care • The child should be expected to cooperate in all diabetes tasks at school. • By age 8 years: able to perform BG testing • By age 10 years: able to administer Insulin with supervision • Adolescents should be able to perform BG testing under usual circumstances and administer Insulin without supervision

5. Responsibilities of the care providersThe parent should provide: • All materials & equipment necessary for diabetes care tasks: BG and Ketones testing, Insulin • Supplies to treat hypoglycemia • Information about Diabetes • Emergency phone numbers • Information about the student’s meal plan • Signed release of confidentiality form

6. Responsibilities of the care providersThe school provider should provide: • Training to all adults, who provide education on the symptoms and treatment of hypo and hyperglycemia and other emergency procedures • Immediate accessibility to the tx of hypoglycemia • Back-up adults trained in Insulin and Glucagon administration & responsible for the meals • Appropriate location to provide privacy for BG testing & Insulin administration • Appropriate location for Insulin and Glucagon storage

7. A management program needs to contain • A plan for communicating with parents and the student's medical providers • School policies and procedures for administering medications, and handling equipment such as meters and pumps • Specific actions for school personnel to perform in the management program • An action plan for each student who has DM

8. Responsibilities of the care providersThe school provider should provide: Permission for the student • To see school medical personnel upon request • To eat a snack anywhere • To miss school without consequences for required medical appointments to monitor Diabetes • To use the restroom and have access to fluids

9. Diabetes Medical Management plan • Blood glucose monitoring • Insulin administration • Meals and snacks • Symptoms and treatment of Hypoglycemia • Symptoms and treatment of Hyperglycemia • Testing for urine ketones

10. Actions for the Teacher Meet with the family, principal, school nurse, playground supervisors, and food service workers • Collectively develop an understanding of diabetes and the diabetes related needs of the individual student.

11. Actions for Coaches and Physical Education Teachers • Encourage exercise and participation in sports for students with diabetes. • Encourage students with diabetes to take responsibility by trying to prevent low blood sugar reactions. • Low blood sugar prevention guidelines need to be discussed with the parents and established as part of the student's individual diabetes management program. • Be familiar with the signs, symptoms and treatment of low blood sugar • Develop a plan of action for managing low blood sugar and emergencies. • Refer to the parents and school nurse if you have questions about the student's ability to fully participate in physical education.

12. The following areas may need to be addressed • Recognizing the signs and symptoms of low blood sugar (insulin reaction) • When it is most likely to occur • How to prevent it • How to treat it • Developing a plan of action for emergencies • Recognizing the signs and symptoms of high blood sugar • Identifying food and snack requirements and routines • Identifying blood sugar monitoring needs • Routine • Privacy • School safety procedures • Communicating with the family

13. The diabetes action plan needs to • Identify the student's meal and snack times, including additional appropriate snack foods to have on hand for low blood sugar prevention • Describe a specific plan of action for handling high and low blood sugar episodes, including the appropriate treatment foods and medications to have available • List any medications the student receives, noting which ones need to be taken during school hours • Describe emergency procedures and list phone members

14. Appropriate Diabetes Care in school is necessary for • Immediate safety of the child • Long term well being • Optimal academic performance School personnel must have an understanding of Diabetes and must be trained in Diabetes management and treatment of Diabetes emergencies Position statement, ADA, Diabetes Care 2004

15. One-Page Instruction Sheet for Teachers

16. Guidelines for Caring for [child's name] • When to do a blood sugar check • She says "I'm low," especially if during or after exercise. • If she has symptoms of low blood sugar, including: • Irritability • Erratic responses to questions • Sleepiness

17. What to do based on her blood sugar reading • Under 60 Give two Glucose Tablets, followed immediately by food containing 30 grams of carbohydrates. If she doesn't respond within 10 minutes, telephone her mother/father, [name/name], at [phone number] for further instructions. • 61 to 100 Give one Glucose Tablets. If a meal or snack is within 30 minutes, she can wait, otherwise give her a snack including carbohydrates and protein, such as cheese crackers with peanut butter or cookies and milk. • 101 to 125 She is fine. If exercise is planned before a meal or snack, she must have a snack before participating. This includes recess. • 126 to 200 She's fine. She could feel low if she was previously high and is dropping. • 201 to 240 She's a bit high, but this is not uncommon for her, especially in the early morning. • Over 240 Her blood sugar is too high. She must be given access to water or other non-caloric fluids. Use of the bathroom must be allowed as needed. She needs to check her urine for ketones. If ketones are present, the parents or the diabetes team should be called for advice. • Note: She may confuse being this high with being low, since many of the symptoms are similar.

18. When giving sugar, the following are roughly equivalent: • Four ounces of fruit juice • 1/2 to 1 cup of milk • Two glucose tablets (some are different: 10-15 grams of sugar are recommended) • One-half tube of Cake Mate (should be placed between the cheek and the gums if unable to swallow) • One-half of a can of soda (regular, NOT diet!) • Chocolate candy is not to be used unless there is no other source of sugar available. It is often not absorbed quickly enough, due to fats in the candy. • If the blood sugar remains low despite treatment and the student is not thinking clearly, the parents or the diabetes team should be called for advice. • Following an episode of low sugar, it can take several hours to fully recover. Hence, the student should not be expected to perform at optimal levels. However, diabetes should never be allowed to become an excuse for school performance.

19. With proper planning and training of school personnel, children with diabetes can fully participate in the school experience.The family, the health care team and the school should work together to ensure a safe learning environment

20. http://www.childrenwithdiabetesuk.org/diabetes-at-school/