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Diabetes 101

Diabetes 101. For School Employees. Purpose:. To ensure a safe,. therapeutic learning environment for the. student with diabetes.*. *and to comply with state law. Diabetes is a chronic. illness caused when the. pancreas doesn’t make any or enough insulin. (Type I).

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Diabetes 101

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  1. Diabetes101 ForSchoolEmployees

  2. Purpose: Toensureasafe, therapeuticlearning environmentforthe studentwithdiabetes.* *andtocomplywithstatelaw

  3. Diabetesisachronic illnesscausedwhenthe pancreasdoesn’tmakeanyor enoughinsulin.(TypeI) Type II DiabetesInsulinisproduced bythepancreasbutthebody’scells resistinsulinfunction.

  4. CausesofDiabetes •Inherited(genetic) •Autoimmune(selfallergy) •Environmental(viral/chemical)

  5. Youdon’toutgrowit! Diabetesisnotcontagious!

  6. Thisisalife- threatening health condition!

  7. Glucose=Sugar

  8. NormalInsulinFunction Foodweeat…. …isdigestedbythestomach andconvertedtoglucose…

  9. …glucoseisabsorbedbythe intestineintotheblood. Thepancreasmakesinsulinandreleases itintothebloodstream.

  10. Insulinisthekey… …that“unlocks”thebody’s cellssoglucosecanenter thecellsandbeburned forenergy. Withoutinsulin,thebody’scellscan’tburn glucoseforenergyandsugaraccumulatesintheblood.

  11. ManagementofDiabetes Diet Normal Bloodsugar Insulin Exercise Desirablebloodsugarforchildrenwithdiabetes:70-150mg/dl

  12. Toomuchfood… Diet Bloodsugar Insulin …bloodsugarrises. Exercise

  13. Toomuchexercise… Diet Bloodsugar falls Insulin Exercise …bloodsugarfalls

  14. Toomuchinsulin….. Diet Bloodsugar falls Insulin …..bloodsugarfalls. Exercise

  15. Insulin •Hormone •Takenbymultiple injectionsthroughout thedayorbyapump •Lowersbloodsugar •Manydifferenttypes

  16. TypesofInsulin Rapid acting (Humalog) onset15minutes peaks30-90minutes Intermediate (NPH, Lente) onset1-4hours peaks6-12hours durationabout3.5hrs duration12-24hours Short acting (Regular) onset30-60minutes peaks2-4hours duration4-8hours Long Acting (Ultra Lente) onset4-6hours peaks8-15hours duration18-24hours Long Acting (Lantus) given1x/day Slower,prolongedabsorption Nopeak

  17. Insulin •Additionalpoints •Allinsulinlowersbloodsugarbutpeaks(hasitsmaximum effect)atdifferenttimes. •Rapidactinginsulinstartstoworkveryquicklyandleaves thebodyquickly.Mealsmustbeeatenimmediatelyafter injectingthisinsulin. •Shortactingisideallyinjected30minutesbeforeeating. •Moststudentsareona“slidingscale”thatallowsthe dosageofrapid-actingorshortactinginsulintobe adjustedaccordingtobloodsugarlevelandfoodintake.

  18. MealPlanning •Studentmayneed2-3snacks/day. •Studentmaybecountingcarbohydrates eatentocalculateinsulindosage. •Sugarisokandsmallorcalculated amountsareacceptableinadiabetes mealplan.

  19. Carbohydrates Mostimportantaspectofthemealplan Includebreadandstarches,andfruit Mainsourceofbloodglucose–approx.90- 100%entersthebloodstreamasglucose 15min.-2hoursaftereating

  20. Proteins Approx.50-60%ofdietaryproteinis convertedtoglucoseandreleasedintothe bloodstream2-5hoursaftermeal Includesmeat,fish,poultry,eggs,peanut butter,cheese,andmeatalternatives Adds‘stayingpower’tothemeal

  21. Fats Negligible(lessthan10%)effecton bloodsugarlevels. Delays/slowsthedigestiveprocess. Thefatinfattyfoods,i.e.,french friesorchocolate,delaysthe absorptionofthesugar.

  22. SuggestionsforExercise/Sports •Organizedsportsandotherformsofactive playareagreatwayforachildtostay physicallyfit. •Mayneedsnackbeforeintensiveexercising (p.e.). •Haveextrasnacksavailableduringexercise. •Schoolstaffsupervisingtheexercise/sports activitiesmustfollowtheemergencyactionplan.

  23. BloodSugarTesting •Researchhasshownthatmaintaining goodcontrolofbloodsugarlevelscan preventlong-termcomplicationsof diabetes •Testingisoftenperformed3-4times daily •Helpsdetermineappropriate treatment

  24. Procedure 1.Studentornurseobtainsadrop ofbloodwhichisthenplacedona teststrip. 2.Stripisplacedinmonitorandit givesadigitalreadoutofcurrent bloodsugarlevel. BLOODBORNE PATHOGEN PRECAUTIONSARE REQUIRED!

  25. DiabeticEquipmentand SuppliesProvidedbyParent MayInclude: •Bloodsugartestingkit •Insulinandinjectionsupplies •Snacks •Quicksugarsources •Ketonetestingsupplies

  26. FIELDTRIPREMINDERS •TaketheEmergencyActionPlan •Takeemergencysupplies(snack,quicksugar source,bloodtestingequipment,etc) •Planahead,determinehowtocontact emergencyservices,toandfromlocation. •Takecellphonebutconfirmcoveragearea fortrip •Traineddistrictstafforparentmustbe availabletoassiststudent.

  27. LowBloodSugar (Hypoglycemia) •Isgenerallydefinedasbloodsugar lessthan60mg/dl(seestudent’sIHP). •Alowbloodsugarepisodedoesnot feelgoodanditmaybefrighteningto thestudent. •Studentmayfeel“low”andshowany ofthefollowingsymptoms:

  28. Hypoglycemia (Lowbloodsugar, insulinreaction) * * Symptoms * *causedbyreleaseofadrenalin

  29. Additionalsymptoms •Paleskincolor •Inabilitytoconcentrate •Personalitychange

  30. CausesofLowBloodSugar •Lateortoolittlefood •Toomuchexercise •Toomuchinsulin

  31. Treatment of Mild Low Blood Sugar Followstudent’semergencyactionplan.Studenttreats selfbyingestingquicksugarsourcesuchas: Glucosetablets Juice4-8oz. Regularsoda(nondiet):1/2can 4or5piecesof hardcandy

  32. Follow-up Treatment of Mild Hypoglycemia •Wait10-15minutesandretest. •Ifbloodsugarremains<60orifsymptoms persistrepeatquicksugarsource. •Followwithsnackofcomplex carbohydratesandproteins(cheeseand crackers)ifnextmealis>½hraway.

  33. Ifbloodsugarcontinuestofall youmaysee: •Behaviorchanges •Poorcoordination •Complaintofheadache •Confusion •Blurryvision •Weakness •Slurredspeech *treatthesameasmildbloodsugar

  34. Severe Low Blood Sugar Seizure LossofConsciousness Call911

  35. Treatmentof SevereLowBloodSugar •Followthestudent’semergencyaction plan. •Call911. •Positiononsideifpossible. •Don’tattempttogiveanythingby mouth.

  36. EMERGENCYALERT Lowbloodsugarcandevelop withinminutesandrequires immediateattention. Neversendastudentwith suspected“lowbloodsugar” anywherealone.

  37. SchoolBusConsiderations •NEVERputastudentwithlowbloodsugar onthebus. •Contactparentifalowbloodsugarepisode occurswithin30minutespriortodeparture (includesstudentswalkinghome). •Studentshavingsignsoflowbloodsugar andabletoswallowshouldbeallowedtoeat asnackonthebus.

  38. IfYouHaveaWaytoCheck BloodSugar,DoSo. *BUTALWAYS,WHENIN DOUBT,TREATWITHQUICK- ACTINGSUGARSOURCE

  39. HighBloodSugar Hyperglycemia •Bloodsugargreaterthan240mg/dl. •Occursovertime(hourstodays). •Studentsnotyetdiagnosedmayexhibit someorallofthesymptoms,including weightloss. •Studentmayfeelhighandshowanyof thefollowingsymptoms:

  40. Hyperglycemia (highbloodsugar) Symptoms

  41. TreatmentofHyperglycemia •Followemergencyactionplan •Drinkzero-caloriefluids,(i.e.,water ordietsoda) •Checkketones,ifteststripsavailable (manystudentswillnottestfor ketonesatschool) •Decreaseactivityifketonesare present

  42. SevereHyperglycemia •Veryweak •Confused •Laboredbreathing •Unconscious •Coma •Call911

  43. Treatmentof SevereHighBloodSugar •Followthestudent’semergencyaction plan. •Call911. •Positiononsideifpossible. •Don’tattempttogiveanythingby mouth.

  44. LongTermEffectsofHyperglycemia •Visionproblems blindness •Nervoussystemproblems •Kidneyfailure dialysis heart •Vascularchanges disease,amputations

  45. TheLawandDiabetes •Diabetesisconsideredadisabilityunder federallaw(504). •Allstudentswithdiabetesmusthavea healthcareplaninplace. Childrenwithdiabetesmusthavefull accesstoallactivities,services,orbenefits providedbypublicschools.

  46. IndividualHealthCarePlans/ HCPOrders •HealthCarePlansareindividualizedforeach student. •Eachstudentwillhaveanemergencyactionplanthat specifieswhattolookforandwhattodoinan emergency. •Priortoschoolentry,ordersshouldhavebeen receivedfromthechild’shealthcareprovider(HCP). •Checkwithyourschoolnurseorofficepersonnelfor locationofhealthcareplans.

  47. What is unlicensed diabetes care assistant (UDCA)? The principal must identify school employees (other than health care professionals) to serve as unlicensed diabetes care assistants, who will be trained to assist with daily or emergency care of students with diabetes if/when a school nurse is not available. •

  48. What is unlicensed diabetes care assistant (cont.) The principal must ensure that the school has at least one unlicensed assistant if the school has a full-time nurse; if there is no full-time nurse, the school must have at least three unlicensed assistants. A school employee may not be subject to any penalty or disciplinary action for refusing to serve as an unlicensed diabetes care assistant.

  49. Suggested Accommodations •Locationforbloodsugarmonitoring and/orinsulininjectionwillbedetermined bytheSchoolNurse,parents,and student. •Allowbloodglucosemonitoringasneeded. •Studentmayalsoneedtochecksugaron fieldtripsorduringspecialevents.

  50. •Allowstudenttosnackwhenandwhere necessarytomaintainadequateblood sugarlevels. •Parentsareresponsibletosupplysnacks forschool. •Atleastonesnackshouldbereadily availableforemergencyconsumption. •Ifnoresponsetothesnackand/or symptomsworsen,accompanystudentto Nurse’s office orcallforhelpinclassroom.

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