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The Student with Diabetes

The Student with Diabetes. Agenda. Types of diabetes Management Hypoglycemia Hyperglycemia Responsibilities. What is Diabetes. Much of the food eaten becomes a sugar called glucose The pancreas makes a hormone called insulin Insulin allows the body to use the glucose for energy.

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The Student with Diabetes

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  1. The Student with Diabetes

  2. Agenda • Types of diabetes • Management • Hypoglycemia • Hyperglycemia • Responsibilities

  3. What is Diabetes • Much of the food eaten becomes a sugar called glucose • The pancreas makes a hormone called insulin • Insulin allows the body to use the glucose for energy

  4. Types of Diabetes Type 1 Auto-immune illness Pancreas not producing enough insulin Requires insulin injections Must test blood glucose (BG) at school Usually diagnosed at a younger age Chronic condition Cannot be prevented Type 2 Most common type of diabetes Can often control with diet, exercise or pills May also take insulin Usually diagnosed at an older age – infrequent in school age child May not need to test BG sugars at school

  5. Each Student with Diabetes is an Individual – Individual Plan of Care

  6. General Diabetes Management Goals • Keep student safe from extreme lows and highs • Balance of food choices, exercise, & insulin • Aim for majority of blood glucose levels in target – this is challenging • Normal school routines for student • Optimal learning at school • Promote normal growth & development

  7. Target Blood Glucose (BG) Range • < 5 years: 6-12 range • 5-10 years old: 4-10 range • >10 years: 4-7 range • Hypoglycemia < 4 (must treat) • Hyperglycemia > 15 (additional information needed)

  8. Blood Glucose (BG) Testing • Tool to assess BG (meter) • Done routinely before meals and if a low is suspected • Must treat immediately if < 4 • Avoid placing “judgment value” i.e. good or bad on high or low blood glucose readings

  9. Insulin Delivery Systems • Most children get insulin before breakfast, supper and bedtime • Some children get insulin at lunch • Syringe • Insulin pen • Pump • Insulin Pump provides an almost continuous flow of insulin

  10. Insulin Action – around the clock coverage

  11. Some Children Wear Insulin Pumps

  12. School Nurse Considerations • Assess the level of assistance the student requires • Support with the development of independence • School Nurse Role • Assist with BG testing if needed • Assist with insulin administration via pen or syringe • Assist with entering BG and carb amount into pump for pump bolus • Ideal is to bolus/give insulin pre food • Hypoglycemia: identify and treat • Prompt contact with care givers if concerns

  13. Age Appropriate Expectations • Pre-Schooler • washes hands before testing • offers finger to be picked • School Age • chose injection site • identifies food groups • tests independently - caregiver supervises • younger child may need more direction • Teen • independent with insulin, food choices, testing • BUT - caregiver still involved to monitor and support

  14. Nutrition Basics • Main nutrient that increases BG is carbohydrate • grains, fruits, milk, sugars • Protein & Fat do not increase BG • Nutritious choices are encouraged, not always made! • No Forbidden Foods • Normalize with same eating times /routines/ food choices as other students • Allow child to eat all food as provided by caregivers

  15. Special Occasions at School • Children with diabetes can and should participate in all school activities • With advanced planning, diabetes can be managed around all special events and treats • If uncertain how to proceed, contact caregiver for management advice or send the treat home

  16. Exercise • Children with diabetes can be involved in all school activities with some additional precautions • Exercise can lower BG • Consider checking BG levels before, during and after activity • May need additional glucose or carbohydrate • Important for school staff to be aware of impact of exercise on diabetes • Medical Alert Bracelet

  17. HypoglycemiaLow Blood Glucose • Treat every BG less than 4 • Causes • Too much insulin • Too little Food • Delayed, inadequate or skipped meal or snack • Extra exercise without extra food or a decrease in insulin

  18. Hypoglycemia Symptoms • Fatigue • Irritability • Blurred vision • Slurred speech • Decreased level of • consciousness • Shaking • Headache • Stomach ache • Pale skin • Hunger • Important to understand students individual symptoms • If unsure if student is low, do a BG test. • If unable to test, always treat. • Occurrence of a severe low is rare in the school setting

  19. HypoglycemiaTreatment for Mild or Moderate Hypoglycemia • Junior juice (125 ml) • 3-4 dex glucose tablets • 2 rolls of rockets • 2 tsp. honey • 3 tsp. sugar • 1/3 cup regular soda

  20. HyperglycemiaHigh Blood Glucose • Above 15 is considered warning of hyperglycemia • Causes • Too much food • Too little insulin • Inaccurate BG test result • Decreased activity • Illness/infection • Stress If BG is > 15mmol/L and child is feeling unwell (flu like symptoms) notify caregivers.

  21. Hyperglycemia Mild - Moderate Symptoms Increased urination Increased thirst Blurry vision Increased hunger Recommendations Fluids and washroom access Inform parent Contact parent if unwell Severe Symptoms Fruity breath Vomiting Stomach cramps or pain Extreme weakness Sleepiness Difficulty breathing Coma Medical emergency Contact parent and/or 911

  22. Hyperglycemia Management • If the BG > 15mmol and the child feels unwell with flu like symptoms, contact the caregivers immediately • If the BG is > 15mmol and the child is well (able to eat, drink, and be involved in school routines) • contact the caregivers if part of plan of care • continue with the usual school activities of meals and snacks as provided by caregivers • continue with usual activity plan (no additional activity required) • encourage water intake if child is agreeable • expect increased use of the washroom • document BG and any concerns in agenda or planner

  23. Emergency Situations • If at any time a student experiences a decreased level of consciousness, call 911

  24. Psychosocial Aspects • Challenging regimen with limitations & restrictions • How you can help • treat diabetes matter-of-factly • BG variability is common – diabetes is hard to control • appreciate no one makes ideal food choices at all times • provide encouragement & understanding • accommodate diabetes management within classroom routines as much as possible

  25. School’s Responsibility • Learn about diabetes • Ensure all meals and snacks, as provided by parents, are completed on time • Know symptoms and management of hypo/ hyperglycemia • Communicate regularly with parents • Provide space for testing and storage of diabetes supplies in the classroom • Know when to contact parents/guardians • Educate other students • Consider best location for diabetes care – may prefer privacy • Update annually using Trillium website: http://www.trilliumhealthcentre.org/programs_services/womens_childrens_services/childrensHealth/familyCareCentre/paediatricDiabetesClinic.html

  26. Student’s Responsibility • Notify teacher when feeling unwell • Accurately document BG in planner/agenda • Take sharps home for safe disposal • Eat all food provided by parents in a timely manner • Educate other students • Participate in all school activities • Tell adults - parents, teacher – when supplies are low • Wear medic alert

  27. Caregiver’s Responsibilities • Establish positive relationship with school • Take sharps home for safe disposal • Provide nutritious lunch and snack choices • Ensure extra supplies are stored at school • Communicate as needed with school and educate as required • Advocate for child’s best care • Update school staff each year: http://www.trilliumhealthcentre.org/programs_services/womens_childrens_services/childrensHealth/familyCareCentre/paediatricDiabetesClinic.html

  28. Diabetes Websites For additional information on Type 1 diabetes: Canadian Diabetes Association www.diabetes.ca Juvenile Diabetes Research Foundation www.jdrf.ca Trillium Health Centre //www.trilliumhealthcentre.org/programs_services/womens_childrens_services/childrensHealth/familyCareCentre/paediatricDiabetesClinic.html

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