Diabetes Care Tasks at School: What Key Personnel Need to Know

1. Diabetes Care Tasks at School: What Key Personnel Need to Know DIABETESBASICS Gregory E. Peterson, DO, FACP

2. Gregory E Peterson, DO, FACP Medical Director, Diabetes Center American Diabetes Association Recognition Program since 1993 Adjunct Professor Internal Medicine Des Moines University Health Policy Fellow and Advisor Governor’s Council on Fitness and Nutrtion Chairman DIABETESBASICS

3. Diabetes Care in the School • Description: Diabetes care in the school setting is necessary for the child’s immediate safety, long-term well being, and optimal academic performance. The DCCT (The Diabetes Control and Complications Trial), proved that normalization of blood glucose (glycemic) control would reduce the complications of diabetes. • DCCT/EDIC (The Epidmiology of Diabetes Interventions and Complications) the 17 year follow up demonstrated dramatic differences • In order to achieve the most optimal glycemic control, a child must monitor blood glucose frequently, follow a meal plan, and take medications., like insulin, which is usually taken in multiple daily injections or through an infusion pump.

4. Objectives • Blood glucose monitoring, including the frequency and circumstances requiring blood glucose checks. • Insulin administration (if necessary), including doses/injection times prescribed for specific blood glucose values and the storage of insulin. • Meals and snacks, including food content, amounts, and timing. • Symptoms and treatment of hypoglycemia (low blood glucose), including the administration of glucagon if recommended by the student’s treating physician. • Symptoms and treatment of hyperglycemia (high blood glucose). • Checking for ketones and appropriate actions to take for abnormal ketone levels, if requested by the student’s health care provider.

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

6. Learning Objectives Participants will learn: • What is diabetes? • Why care at school is required • Basic components of diabetes care at school • Short and long term consequences of diabetes

7. 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

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

9. SYMPTOMS: increased urination tiredness weight loss Type 1 Diabetes ONSET: relatively quick increased thirst hunger blurred vision uncertain, likely both genetic and environmental factors CAUSE:

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

11. Type 2 Diabetes some children show no symptoms at diagnosis in children variable timeframe ONSET: tired, thirsty, hunger, increased urination SYMPTOMS:

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

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

14. Diabetes Management Proactive • keep juggling the balls Reactive • a response is indicated • corrective actions for highs or low • emergency intervention

15. Assistance in Diabetes Management Routine Care: • Many students will be able to handle all or almost all routine diabetes care by themselves • Some students, because of age, developmental level, or inexperience, will need help from school staff. Urgent Care: • Any student with diabetes may need help with emergency medical care.

16. Care in the Schools: School Nurses and Others Nurse most appropriate to: • Supervise diabetes care • Provide direct care (when available) However, a nurse is not always available. Non-medical school staff can be trained to assist students • For both routine and emergency care • Including insulin and glucagon injections

17. Diabetes Medical Management Plan • A Diabetes Medical Management Plan (DMMP) should be implemented for every student with diabetes. • DMMP is • developed by the student’s personal health care team and family and signed by a member of student’s personal health care team • implemented collaboratively by the school diabetes team, including: • school nurse • the student • parents/guardians • other school personnel

18. Elements of a DMMP • Date of diagnosis • Emergency contact information • Student’s ability to perform self-management tasks at school • List of diabetes equipment and supplies • Specific medical orders for blood glucose monitoring, insulin, glucagon, and other medications to be given at school • Meal and snack plan • Exercise requirements • Actions to be taken in response to hypoglycemia and hyperglycemia

19. Quick Reference Plan • Development based on information from students DMMP • Summarizes how to recognize and treat hypoglycemia and hyperglycemia • Distribute to all personnel who have responsibility for students with diabetes

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