CHILDREN WITH DIABETES AT SCHOOL

1. CHILDREN WITH DIABETES AT SCHOOL Diabetes Specialist Nurses

2. What is diabetes? • Diabetes is a condition in which the level of glucose or sugar in the blood is higher than normal because the body is unable to use it properly. • This is because the body’s method of converting glucose into energy is not working as it should

3. Insulin • This is a hormone that is made in the Pancreas (which is a gland that lies behind the stomach) • Insulin helps the glucose or sugar that we eat to enter the cells where it is used by the body to give us energy

4. Children With Diabetes Most children will have type 1 diabetes • They can no longer produce insulin because the cells of the pancreas that produce insulin are destroyed • Without insulin the child’s body cannot use glucose and the blood glucose level rises.

5. Eats a meal Blood sugar rises Insulin is released Blood sugar falls Eats a meal Blood sugar rises No insulin/insufficient insulin is released Blood sugar does not fall Person with diabetes Person without diabetes

6. Symptoms of diabetes • Increased thirst • Going to the toilet frequently • Extreme tiredness • Weight loss • Blurred vision Teachers are often in a position to notice the signs that a child may have diabetes

7. Treating diabetes • Most children are treated with a combination of insulin and a balanced diet • Insulin has to be injected – it is a protein that would be broken down in the stomach if it was swallowed like a medicine

8. Treating diabetes • Majority of children take 4 injections per day and will need to inject insulin at school. This is not because their diabetes is “worse” or harder to control. • Taking more injections allows more flexibility in lifestyle, better concentration and better behaviour. • Some children may be on an insulin pump.

9. Administering insulin at school The children that are on four injections or an insulin pump will have to administer insulin at lunchtime. The treatment regimen will be documented in their individual care plan. The Diabetes Specialist Nurse and parents will visit individual schools to discuss diabetes care when • the child is newly diagnosed • requires a change to their treatment • moves to a new school • problem with diabetes at school

10. Administering insulin at school • The school will need to identify an appropriate area where administration of insulin and blood glucose monitoring can be carried out • In some circumstances the child may require assistance with the administration of insulin and/or blood glucose monitoring. • If a lunch time injection is required the parent will contact the school to identify appropriate staff to administer the insulin.

11. Once the school has identified the appropriate people, a training programme will be provided. • This will be discussed at the individual meeting and documented in the child’s care plan.

12. Diet • The diet for children with diabetes is based on the balanced varied diet which is recommended for every child – low in fat and sugar & high in fibre • The child and family will have seen a Dietitian, who will have advised on suitable food choices and discussed any particular needs to staff.

13. Eating Times • Meals and snacks should be eaten at regular intervals – following a plan discussed by the family and their Dietitian • A missed or delayed meal could lead to “low blood sugar” Hypoglycaemia. The child should eat all of their lunch to prevent a hypo occuring.

14. Eating times • It may be necessary on occasions to allow the child to have a snack in class, but it is best eaten at break time to avoid any fuss. • If you feel the class should understand why the child is having a snack first ask the child how they feel about their diabetes being discussed with the class.

15. Snacks The choice of food will depend on the individual child but should include • Sandwich • Cereal bar • Portion of fruit • Two biscuits

16. Hypoglycaemia (Hypo) • Hypoglycaemia is the most common short-term complication in diabetes – and occurs when the blood sugar is too low • The symptoms can be different for each child and are documented on their individual care plan • Most children recognise a “hypo” and will take appropriate action themselves

17. Possible causes of Hypoglycaemia • Too little food for the insulin taken • Not enough food to fuel an activity • A missed or delayed snack

18. Sweating Trembling/shakiness Drowsiness Headache Lack of concentration Hunger Pallor Glazed eyes Mood changes especially angry or aggressive behaviour Signs and symptoms of hypoglycaemia Each child will have their particular signs and symptoms and these will be documented on the individual care plan

19. Treating a hypo • It is VERY important that a hypo is treated quickly. • If left untreated the blood glucose levels will continue to fall and the child could become unconscious. • The child should not be left alone during a hypo nor sent of to get food to treat it. Recovery treatment must be brought to the child.

20. What To Do • Immediately – give something sugary e.g. Lucozade, Fresh Fruit Juice, Glucose Tablets, Non Diet Fizzy Drink • The exact amount may vary from person to person – parents or carer will advise and it will be documented in the care plan • Glucogel, honey or jam may be massaged into child’s cheek if they are too drowsy to take anything themselves

21. Follow With Starchy food to prevent blood sugar dropping again • snack eg sandwich, cereal bar, portion of fruit, 2 biscuits • or lunch time meal if due If the child is unconscious do not give anything to eat or drink call an ambulance

22. Following treatment • Following treatment for hypo the child should continue with normal school activities.

23. Physical activity • Diabetes should not stop children from enjoying any kind of physical activity or being selected to represent their school providing they have made simple preparations • Preparations are needed because all forms of physical activity use up glucose

24. Physical activity The more strenuous and prolonged the activity the more food will be needed, before, and possibly during and afterwards. It may also be beneficial to test during exercise. BEFORE ACTIVITY • The child may require an extra snack

25. Physical activity DURING ACTIVITY • There should be glucose tablets or sugary drink nearby. AFTER ACTIVITY • The child may require some starchy food eg packet of crisps – but this will depend on how strenuous the activity was.

26. Other Considerations • Sickness • If child is unwell blood sugars may rise, it may happen even with a simple cold. • The child may become thirsty and run to the toilet frequently • This should be reported to parent/carer as insulin adjustments may be necessary

27. Blood Glucose Monitoring • Most children with diabetes will need to test their blood glucose levels on a regular basis. They may need to do this at school. • Blood glucose testing involves pricking the finger, using a special finger-pricking device and a blood glucose meter. • If tests are required at school the parents can advise how often they should be done.

28. School Trips • Should not cause any real problem • Child should take their injection kit and blood glucose monitoring kit in case of delay • Extra snacks should be taken

29. Overnight Stays No problem as long as • Child is able to do own injection and blood glucose monitoring • A member of staff is willing to take the responsibility of helping with this in the younger/less able child

30. Going Abroad • It is important that travel insurance will cover pre-existing conditions such as diabetes • Travel and diabetes – Individual advice provided by Diabetes Specialist Nurse. Diabetes UK publication gives advice on managing diabetes away from home

31. Points of Contact for Diabetes Specialist Nursing Service • Armagh & Dungannon Locality • Olivia Creaney Tel No: (028) 87713526 • Craigavon & Banbridge Locality • Pauline Ingram Tel No: (028)38398238 • Newry & Mourne Locality • Janette Newell Tel No: (028) 30834365