Evaluation of the Impact of a Diabetes Education Curriculum for School Personnel on Disease Knowledge and Confidence in Caring for Students

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1 Cedarville University Pharmacy Practice Faculty Publications Department of Pharmacy Practice - Evaluation of the Impact of a Diabetes Education Curriculum for School Personnel on Disease Knowledge and Confidence in Caring for Students C. T. Smith Aleda M.H. Chen Cedarville University, amchen@cedarville.edu K. S. Plake C. L. Nash Follow this and additional works at: pharmacy_practice_publications Part of the Education Commons, and the Pharmacy and Pharmaceutical Sciences Commons Recommended Citation Smith, C. T.; Chen, Aleda M.H.; Plake, K. S.; and Nash, C. L., "Evaluation of the Impact of a Diabetes Education Curriculum for School Personnel on Disease Knowledge and Confidence in Caring for Students" (). Pharmacy Practice Faculty Publications.. This Article is brought to you for free and open access by DigitalCommons@Cedarville, a service of the Centennial Library. It has been accepted for inclusion in Pharmacy Practice Faculty Publications by an authorized administrator of DigitalCommons@Cedarville. For more information, please contact digitalcommons@cedarville.edu.

2 Journal of School Health Evaluation of the Impact of a Diabetes Education Curriculum for School Personnel on Disease Knowledge and Confidence in Caring for Students Journal: Journal of School Health Manuscript ID: JOSH-0--RA-.R Manuscript Type: Research Article Keywords: Child & Adolescent Health, Chronic Diseases, School Health Services Research Skill Set : Quantitative Research Settings: School Health Services, Primary Care Content: Chronic Diseases, Child & Adolescent Health Article Type: Research Article

3 Page of Journal of School Health 0 0 ABSTRACT Background: Type diabetes is a common childhood illness. School personnel may lack knowledge of diabetes and be unprepared to address the needs of students with type diabetes. This project evaluated the effectiveness of a type diabetes education program for school personnel on increasing knowledge of diabetes and confidence in caring for students with diabetes. Methods: Two types of diabetes education programs were created for school personnel. The basic program provided a 0 minute overview of diabetes. The expanded program, intended for volunteer health aides, provided participants with a more in-depth overview of diabetes during a 0 minute session, including demonstrations of how to assist students with insulin injections. Instruments were created to assess changes in diabetesrelated knowledge and confidence in caring for students. Separate knowledge instruments were created for the basic and expanded programs. Knowledge instruments were administered pre- and post-education in both groups. Confidence instruments were administered pre- and post-education for individuals who completed the expanded program. Results: A total of school personnel participated in the basic (N=) or expanded programs (N=). Overall knowledge regarding diabetes significantly increased in both the basic and expanded programs from baseline (p<.00). Confidence in caring for students with diabetes also increased from pre-test to post-test, both for overall confidence and each individual item (p<.00).

4 Journal of School Health Page of 0 0 Conclusions: Educational programs offered for school personnel can lead to increased knowledge and increased confidence in caring for students with diabetes, which may assist school personnel in addressing the needs of students with diabetes.

5 Page of Journal of School Health 0 0 Typically diagnosed in children and young adults, type diabetes is a chronic condition in which the pancreas no longer produces the insulin necessary to control blood glucose levels. Approximately,000 individuals younger than years old are diagnosed with some form of diabetes,, and. of every 00 children have type diabetes. Long-term, serious outcomes associated with diabetes can include heart disease, neuropathy, nephropathy, and retinopathy. Children with diabetes must effectively manage their medications, diet, exercise, and blood glucose levels to prevent serious outcomes, such as heart disease., They must be able to attend to diabetes care needs at home and at school and often experience difficulty maintaining glycemic control as these settings may have different flexibility for children to address care needs. Difficulty managing glycemic control is associated with more depressive symptoms, and stress. Academic outcomes also are affected by chronic disease management, since students with diabetes have difficulty concentrating and poorer academic achievement., Protection at school exists for students with diabetes to ensure they receive the same education as their peers under Section 0 of the Rehabilitation Act of, the Individuals with Disabilities Education Act (originally the Education for All Handicapped Children Act of ), and the Americans with Disabilities Act, which considers diabetes as a disability., Any school receiving federal funding must ensure that the health-related needs of students with diabetes are met without compromising their education. These accommodations should be documented in written diabetes care plan, such as a Section 0 Plan or an Individual Education Plan (IEP).,

6 Journal of School Health Page of 0 0 However, school personnel may not be fully prepared to meet student needs. Parents often are concerned with diabetes-related care at school and are not aware whether their child s school has a written diabetes care plan. School nurses also may feel that all school personnel need additional education regarding diabetes in order to provide greater support to students. Indeed, a study surveying school counselors found that the majority of counselors had no diabetes-related education and felt unprepared to assist children with diabetes. Educating school personnel is important, as students who attend a school where employees and classmates are educated about diabetes have improved glycemic control. According to Bandura s Social Cognitive Theory, the confidence, or selfefficacy, individuals possess influences their willingness to perform a behavior. Therefore, it is also important to improve school personnel s confidence in their ability to assist students, so they are more likely to provide assistance. Few researchers have examined the impact of educational programs on school personnel s knowledge of diabetes and their confidence in assisting students. Educating teachers has been shown to significantly improve aspects of diabetes knowledge. - Educating both teachers and nurses regarding diabetes has also been found to improve knowledge. Teachers completing a self-study program on diabetes, however, did not show improvements in knowledge but indicated improvements in confidence in addressing students diabetes-related needs. With limited research examining the outcomes associated with educating school personnel about diabetes, a pilot educational program was developed. A discussion with a local school nurse indicated a need for educating all school personnel regarding diabetes. Particularly, there was a need to train volunteer health aides who would assist students

7 Page of Journal of School Health 0 0 with diabetes-related needs. The goal of this program was to improve knowledge in local school personnel and improve knowledge and confidence in caring for students with diabetes among volunteer health aides. METHODS Participants The New Albany-Floyd County Consolidated School Corporation in Indiana serves a population of 0,000 residents and consists of nine elementary schools, three middle schools, two high schools, and one vocational school. Nearly,000 students are enrolled in the school corporation. Health services in these schools are coordinated by four registered nurses. There are an estimated 0 students in the county school system with diabetes. Volunteer health aides at each school must be trained to assist with the diabetes-management and treatment needs of students when a nurse is unavailable. School personnel who were at least years of age and employed by the New Albany-Floyd County Consolidated School Corporation were invited to participate in the project. Procedure Approval was obtained by the Purdue University Institutional Review Board and the New Albany-Floyd Consolidated School Corporation Board. School personnel who met the inclusion criteria were invited to attend a voluntary, after-hours educational program on type diabetes. Two different educational programs were created utilizing the American Association of Diabetes Educators (AADE) statement regarding the management of children with diabetes in the school setting and the AADE TM Self-Care Behaviors. Five of the seven self-care behaviors were selected for inclusion within the educational

8 Journal of School Health Page of 0 0 programs: healthy eating, being active, diabetic monitoring, taking medication, and problem-solving. These five behaviors were deemed applicable for school personnel. Reducing risks associated with diabetes (preventive care) and healthy coping (behavior change) were excluded due to time constraints of the programs and the extensive prior knowledge of diabetes required. A school nurse within the county also was consulted to assist in identifying the educational needs of school personnel. The basic program was intended to provide school personnel with an introduction to diabetes. Knowledge of diabetes was assessed pre- and post-education. The 0 minute educational session had four main components: ) overview of diabetes pathology, ) monitoring and treating diabetes and hypoglycemia, ) dietary considerations in diabetes, and ) exercise and blood glucose. Problem-solving skills related to diabetes were emphasized throughout all four content areas using case-studies. The expanded program, intended for volunteer health aides, provided more indepth information of the basic program content during a three hour session. Participants completed five activity stations related to student care: ) counting school lunch carbohydrates, ) administering insulin, ) assessing and treating hyperglycemia and hypoglycemia, ) using a blood glucose meter, and ) using written diabetes care plans. These five activity stations corresponded to care tasks volunteer health aides could provide to students. Diabetes knowledge and confidence in caring for students with diabetes were assessed pre- and post-education. Instruments Instruments were created to assess diabetes-related knowledge. Review of publicly-available questionnaires and discussions with a school nurse assisted in

9 Page of Journal of School Health 0 0 development of the knowledge questionnaires regarding important concepts for school personnel. Specific items were developed to address the five AADE TM criteria utilized in the programs: healthy eating, being active, diabetic monitoring, taking medication, and problem-solving. Separate knowledge questionnaires were created for the basic program ( items) and the expanded program ( items). The additional expanded program questions corresponded to the material presented and the five activity stations. The confidence questionnaire was developed to measure volunteer health aides confidence in caring for students with diabetes. Nine items were created to measure confidence in performing care tasks related to the five activity stations. Participants were asked to respond to their level of confidence on a seven-point Likert scale ( = Strongly Disagree to = Strongly Agree). Information regarding participants employment positions within the school system, whether participants had family or friends with diabetes, and whether participants had received prior diabetes education was obtained for the expanded program. Data Analysis Statistical analyses were conducted using SPSS software for Windows (version.0; SPSS Inc, Chicago, Illinois). An a priori value of alpha = 0.0 was set for statistical significance. Frequencies and percentages were calculated for demographic information from the expanded program and for the individual knowledge items from the basic program. Means, standard deviations, and change in knowledge were calculated for the pre- and post-tests of overall knowledge. Basic program data were not linked by identifiers; however, expanded program data were linked by identifiers. For the expanded

10 Journal of School Health Page of 0 0 program, change in overall knowledge between pre- and post-tests was assessed using a paired t-test. Item-specific changes in knowledge were assessed using McNemar s test. Means and standard deviations were calculated for each confidence item in the preand post-test. Since the data were linked by identifiers, item-specific changes in confidence between the pre- and post-tests were assessed using a paired t-test. Chi-square analyses were conducted to identify differences between demographic variables and overall knowledge, item-specific knowledge, and item-specific confidence. RESULTS Basic and expanded programs were offered after-hours from February to December. A total of school personnel participated in either the basic or the expanded program. Basic Program A total of school personnel participated in the basic program. Knowledge improved between the pre- and post-tests assessments (Table ). Eleven of the questions improved from the pre-test to the post-test assessment (Table ). No improvement was seen in question three, which assessed knowledge about insulin and missing a meal. Expanded Program A total of school personnel (who also were volunteer health aides) participated in the expanded program (Table ). A significant difference in overall knowledge was found between the pre-test assessment and the post-test assessment (p<.00, Table ). Six questions on the knowledge test showed significant improvement (p<.0, Table ). All

11 Page of Journal of School Health 0 0 confidence items in caring for students with diabetes improved significantly between the pre-test assessment and the post-test assessment (p<.00, Table ). No statistically significant differences in overall or item-specific knowledge were found between participants with or without family members with diabetes. Individuals who had family members with diabetes had greater pre-test confidence in their understanding of diabetes (Question, p=.0), ability to measure blood glucose (Question, p=.00), and knowledge of the effects of diabetes on children (Question, p=.0). No other differences in confidence were found between those who have family members with diabetes and those with none. Individuals who had prior diabetes education had greater pre-test knowledge of diabetes (p=.0). These individuals also were more likely to answer questions (desired range of blood glucose, p=.00) and (effect of high blood glucose on thinking, p=.0) correctly on the pre-test and question on the post-test (type of insulin used in pumps, p=.0). Confidence for all items on the pre- and post-assessments were significantly higher for those individuals with prior diabetes education (p<.0). Regardless of prior diabetes education, all participants had a significant increase in confidence (p<.0) between the pre- and post-assessments. DISCUSSION A pilot educational program was designed to increase school personnel s knowledge of diabetes and confidence in caring for students with diabetes resulted in significant gains in knowledge in both programs and confidence in the expanded program. This program s results are similar to other diabetes-related educational programs that increased teachers overall knowledge regarding diabetes - and confidence in addressing children with

12 Journal of School Health Page of 0 0 diabetes needs. These programs used similar methods of educating teachers, such as educational programs and in-depth self-study educational materials. - Other programs have been unsuccessful in improving diabetes-related knowledge in teachers while using different educational methods than this project, such as as video tutorials, pamphlets, and CD-ROMs., Some individual items on this program s knowledge questionnaire did not show improvement after the basic and expanded education programs. In the basic program, the only one item (question three) did not improve, which related to the insulin and missing a meal. Six items in the expanded program knowledge questionnaire showed a statistically significant improvement. Of the remaining items that did not show a statistically significant improvement, nine items were answered correctly on the pre-test (Questions,,,, -,, ) by at least 0 percent of participants which left little opportunity for a statistically significant improvement. Future programs should address the knowledge items that did not improve significantly in their educational content. Other programs likewise found that some knowledge items did not improve and needed further education. This program also addressed concerns indicated by parents, teachers, and school nurses in prior studies that school personnel, such as aides, lack information about diabetes., An identified need within New Albany-Floyd County school system was the education of school personnel, and in particular, volunteer health aides who assist students in their daily health needs when nurses are unavailable. While available to all school personnel, participation by volunteer health aides was higher since these individuals needed training prior to assisting students with their diabetes-related care. This program

13 Page of Journal of School Health 0 0 was successful in increasing both the knowledge and confidence of these volunteer health aides who will be providing care for students. Individuals who indicated previously receiving education or training related to diabetes had greater pre-test knowledge of diabetes, particularly with regard to items assessing glucose and insulin knowledge. Despite prior knowledge, participants still positively benefited as their knowledge increased significantly even after controlling for prior knowledge. These participants also exhibited greater confidence in their ability to care for students. Despite having greater confidence initially, their confidence in caring for students increased significantly after completing the expanded program. Husband and colleagues also found that education regarding diabetes improved teachers overall confidence in responding to the diabetes-related needs of students regardless of their knowledge prior to or after the educational intervention. The majority of participants also had family members with diabetes and had greater confidence regarding certain aspects related to diabetes knowledge and measuring blood glucose. There are several limitations to this study. Since many school districts and counties have time and budget constraints due to the current economic climate, resources and time of school personnel are limited. Therefore, the educational program was held after hours and may have resulted in fewer school personnel attending than if offered during school hours. Despite this limitation, individuals participated in the basic (N=) and expanded programs (N=). Demographic data, such as age, gender, race, income, and educational attainment were not obtained for participants. Time was limited for participants to complete the knowledge and confidence assessments; therefore, questions regarding family members with diabetes and prior education regarding diabetes were

14 Journal of School Health Page of 0 0 considered the most important demographic items to obtain. Pre- and post-assessments of knowledge in the basic program were not linked by identifiers, which limited the ability to determine if the increase in knowledge was statistically significant. Despite this limitation, improvements in knowledge were seen for of the items (.%). In order to assess participant improvement in knowledge and confidence, it was necessary to utilize identical questionnaires in the pre- and post-tests, which may have introduced a testing bias. Measurements used in the study were not validated, but were created to match the educational objectives based upon a literature review and a needs assessment with a school nurse. This diabetes educational program successfully improved knowledge and confidence among participants, even when participants had prior knowledge of and family members with diabetes. Since. out of every 00 children have type diabetes, it is conceivable that most school personnel will encounter a child with diabetes at some point in their career. They must be able to ensure that the child s health-related needs are met. In order to do so, they must be educated on the disease and feel confident in their ability to assist the student. Similar programs may be useful for schools to implement and improve knowledge of diabetes and confidence in caring for students, with changes made to address the individual items that did not show improvement in knowledge. Future work should expand the program to other school personnel, including teachers and principals, as well as validate the measures of knowledge and confidence utilized in this program. IMPLICATIONS FOR SCHOOL HEALTH This study found that a diabetes education program for school personnel resulted in improved knowledge of diabetes and confidence in caring for students with diabetes. Key

15 Page of Journal of School Health 0 0 school-related components of diabetes-related knowledge and care were addressed in this program, including diabetes pathology, monitoring and treatment, and dietary considerations. Federal laws require schools to accommodate the health-related needs of students with diabetes without compromising their education. Therefore, school personnel who may come in contact with children who have diabetes must understand the disease and be able to assist the child with disease management and emergencies. They also need to have confidence in their ability to assist students. Without educating school personnel regarding care of students with diabetes, school personnel may not be fully prepared to meet student needs. Educating school personnel regarding diabetes can enable them to effectively assist students, ensure that federal requirements are met, and allow students to address diabetes care-related needs during the school day, thus improving their glycemic control, diabetes-related outcomes, and academic performance. Schools should consider implementing a similar diabetes education program that includes basic pathology, monitoring and treatment, and dietary considerations to ensure that all school personnel understand diabetes and are prepared to assist children with their health-related needs. Human Participants Approval Statement Human participants and Institutional Review Board (IRB) approval was obtained from Purdue University.

16 Journal of School Health Page of 0 0 REFERENCES. Centers for Disease Control and Prevention. National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 0. Atlanta, GA: U.S. Department of Health and Human Services. 0.. Centers for Disease Control and Prevention. National Diabetes Fact Sheet: National Estimates and General Information on Diabetes and Prediabetes in the United States. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention;.. Search for Diabetes in Youth Study Group. The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for Diabetes in Youth Study. Pediatrics. 0;():-.. American Association of Diabetes Educators. Management of children with diabetes in the school setting. Diabetes Educ. 0;():-.. McGrady ME, Laffel L, Drotar D, Repaske D, Hood KK. Depressive symptoms and glycemic control in adolescents with type diabetes. Diabetes Care. 0;():0-0.. Stewart SM, Rao U, White P. Depression and diabetes in children and adolescents. Curr Opin Pediatr. 0;():-.. Hains AA, Berlin KS, Davies WH, Parton EA, Alemzadeh R. Attributions of adolescents with type diabetes in social situations. Diabetes Care. 0;():-.. Dahlquist G, Källén B. School performance in children with type diabetes a population-based register study. Diabetologia. 0;0():-.

17 Page of Journal of School Health 0 0. Kovacs M, Goldston D, Iyengar S. Intellectual development and academic performance of children with insulin-dependent diabetes mellitus: a longitudinal study. Dev Psychol. ;():-.. American Diabetes Association. Diabetes care in the school and day care setting. Diabetes Care. 0;(Supplement ):S-S.. Jacquez F, Stout S, Alvarez-Salvat R, et al. Parent perspectives of diabetes management in schools. Diabetes Educ. 0;():-0.. Nabors L, Troillett A, Nash T, Masiulis B. School nurse perceptions of barriers and supports for children with diabetes. J Sch Health. 0;():-.. Wagner J, James A. A pilot study of school counselor s preparedness to serve students with diabetes: relationship to self-reported diabetes training. J Sch Health. 0;():-.. Wagner J, Heapy A, James A, Abbott G. Brief report: glycemic control, quality of life, and school experiences among students with diabetes. J Pediatr Psychol. 0;():-.. Bandura A. Self efficacy: toward a unifying theory of behavioral change. Psychol Rev. ;():-.. Nichols PJ, Norris SL. A systematic literature review of the effectiveness of diabetes education of school personnel. Diabetes Educ. 0;():-.. Husband A, Pacaud D, Grebenc K, McKiel E. The effectiveness of a CD-ROM in educating teachers who have a student with diabetes. Canadian Journal of Diabetes Care. 0;():-0.

18 Journal of School Health Page of 0 0. Gesteland HM, Sims S, Lindsay RN. Evaluation of two approaches to educating elementary schoolteachers about insulin-dependent diabetes mellitus. Diabetes Educ. ;():-.. Henderson JM. Teacher training and children with type diabetes. Diabet Med. ;():-.. Jarrett L, Hillam K, Bartsch C, Lindsay R. The effectiveness of parents teaching elementary school teachers about diabetes mellitus. Diabetes Educ. ;():-.. Radjenovic D, Wallace FL. Computer-based remote diabetes education for school personnel. Diabetes Technol Ther. 0;():0-0.. Siminerio LM, Koerbel G. A diabetes education program for school personnel. Practical Diabetes International. 00;():-.. Andrea Tanner, MSN, RN, Coordinator of Health Services, New Albany-Floyd County Schools. January.. Indiana Accountability System for Academic Progress. New Albany-Floyd County Consolidated Schools Corporation Snapshot.. Available at: Accessed January,.. American Association of Diabetes Educators. AADE TM Self-Care Behaviors. Available at: Accessed January,.

19 Page of Journal of School Health TABLES Table. Basic (N=) and Expanded (N=) Program Knowledge Change Program Knowledge Pre-Test Mean ± SD Knowledge Post-Test Mean ± SD Pre-Post Change t p-value Basic a. ±.. ±.. ±. N/A N/A Expanded b. ±..0 ±.. ±. -.0 <.00 atotal possible score for the basic program knowledge questionnaire is points. btotal possible score for the expanded program knowledge questionnaire is points.

20 Journal of School Health Page of Table. Basic Program Knowledge Change (N=) Item Pre-Test Post-Test Correct Answer Correct Answer N (%) N (%). What effect does unsweetened fruit juice have on blood glucose? (.%) (.%) A) Lowers it, B) Raises it, C) Has no effect. Signs of diabetic ketoacidosis, or DKA, include: (.%) (.%) A) Shakiness, B) Sweating, C) Vomiting, D) Low blood glucose. If you take your morning insulin but skip breakfast your blood glucose level will usually: A) Increase, B) Decrease, C) Remain the same (.%) (.%). After treating hypoglycemia, how long should you wait before rechecking the blood glucose? A) seconds, B) minute, C) minutes, D) hour. Which one of the following will most likely cause a decrease in blood glucose: A) Heavy exercise, B) Infection, C) Overeating, D) Not taking your insulin. How many grams of carbohydrates are equal to serving of carbohydrates? A) grams, B) grams, C) grams, D) grams (.%) (.%) (.%) (.%) (.%) (.%)

21 Page of Journal of School Health. Which of the following blood sugar readings is not within the desired range for a student? (.%) (.%) A) mg/dl, B) mg/dl, C) mg/dl, D) All are outside of the desired range. What is the best site to use when testing blood glucose? (.%) (.%) A) Fingertips, B) Arm, C) Thigh, D) Stomach. Insulin is produced and released by the: A) Stomach, B) Kidneys, C) Pancreas, D) The body does not make insulin, it is obtained through (0.0%) (.%) your diet. When making snack and meal choices, someone with diabetes should be most aware of what (.%) (.%) part of a nutrition label? A) Sugars, B) Total carbohydrates, C) Total fat, D) Protein. Having very high blood glucose has no effect on someone s ability to think clearly. (.%) (.%) A) True, B) False. A glucagon injection will decrease high blood glucose in less than minutes. A) True, B) False (.%) (.%)

22 Journal of School Health Page of Table. Expanded Program Demographic Information (N=) Demographic Item N (%) Family member with diabetes Yes (.) No (.) Prior diabetes education Yes (.) No (.) Job Aide/assistant (.) Clerk (.) Nurse (.) Other (.)

23 Page of Journal of School Health Table. Expanded Program Knowledge Change (N = ) Item Pre-Test Post-Test p- Correct Answer Correct Answer value a N (%) N (%). Which is the best method for testing blood glucose? (.%) (.%). A) Urine testing, B) Blood testing, C) Saliva testing, D) All are equally good. Glycosylated hemoglobin, or hemoglobin Ac, is a test that is a measure of your (.%) (.%) <.00 average blood glucose level for the past: A) days, B) weeks, C) months, D) year. What effect does unsweetened fruit juice have on blood glucose? A) Lowers it, B) Raises it, C) Has no effect (.%) (.%).. For a person in good control, what effect does exercise have on blood glucose? A) Lowers it, B) Raises it, C) Has no effect B. Raises it. Signs of diabetic ketoacidosis, or DKA, include: A) Shakiness, B) Sweating, C) Vomiting, D) Low blood glucose (.%) (..%).000 (.%) (0.%) <.00. If you take your morning insulin but skip breakfast your blood glucose level will (.%) (.%).00

24 Journal of School Health Page of usually: A) Increase, B) Decrease, C) Remain the same. After treating hypoglycemia, how long should you wait before rechecking the (.%) (.%).000 blood glucose? A) seconds, B) minute, C) minutes, D) hour. Which one of the following will most likely cause a decrease in blood glucose: (.%) (.%).0 A) Heavy exercise, B) Infection, C) Overeating, D) Not taking your insulin. Which of the following foods will not likely affect blood glucose? (.%) (.%).000 A) Rice, B) Fruit, C) Broccoli, D) Corn. How many grams of carbohydrates are equal to serving of carbohydrates? (.%) (.%).000 A) grams, B) grams, C) grams, D) grams. Being sick, having an infection, or experiencing stress is likely to cause: (.%) (.%).0 A) An increase in blood glucose, B) A decrease in blood glucose, C) No change in blood glucose. Which of the following blood sugar readings is not within the desired range for a student? A) mg/dl, B) mg/dl, C) mg/dl, D) All are outside of the desired (.%) (.%).0

25 Page of Journal of School Health range. What is the best site to use when testing blood glucose? (.%) (.%). A) Fingertips, B) Arm, C) Thigh, D) Stomach. Insulin is produced and released by the: A) Stomach, B) Kidneys, C) Pancreas, D) The body does not make insulin, it is obtained through your diet. Which of the following is not associated with uncontrolled diabetes? A) Kidney problems, B) Nerve problems, C) Eye problems, D) Lung problems. When making snack and meal choices, someone with diabetes should be most aware of what part of a nutrition label? A) Sugars, B) Total carbohydrates, C) Total fat, D) Protein. Insulin pumps use only fast acting insulin. A) True, B) False. Having very high blood glucose has no effect on someone s ability to think clearly. A) True, B) False (.%) (0.0%).00 (.%) (.%).000 (.%) (0%).0 (.0%) (.%).00 (.%) (.%).000. A glucagon injection will decrease high blood glucose in less than minutes. (.%) (.%).0

26 Journal of School Health Page of A) True, B) False. Students with diabetes may feel isolated from their peers due to their disease. (.%) (.%). A) True, B) False ap-values obtained using McNemar s test

27 Page of Journal of School Health Table. Expanded Program Confidence Change (N=) a Item Pre-Test Mean ± SD Post Test Mean ± SD Pre-Post Change t p-value. I am confident in my understanding of diabetes.. I am confident in my ability to properly care. ±.0. ± 0.. ±. -. <.00. ±.. ± 0.. ±. -. <.00 for a child with diabetes in my classroom.. I am confident in my ability to properly. ±.. ± 0..0 ±. -. <.00 obtain a blood sugar reading using a blood sugar meter.. I am confident in my ability to assess a blood. ±.. ± 0..0 ±. -. <.00 sugar reading.. I am confident in my ability to treat a child with diabetes who has low blood sugar.. I am confident in my ability to treat a child with diabetes who has high blood sugar..0 ±.. ± 0.. ±. -. <.00. ±.. ± 0.. ±. -. <.00. I am confident in my ability to properly care. ±.. ±.. ±.0 -. <.00

28 Journal of School Health Page of for a child with diabetes in my classroom in an emergency situation (i.e. low blood sugar).. I am confident in my knowledge of diabetes..00 ±.. ± 0.. ±. -. <.00. I am confident in my knowledge of how diabetes affects a child in my classroom.. ±.. ± 0.. ±. -. <.00 alikert-type scale, where = Strongly Disagree, = Disagree, = Slightly Disagree, = Undecided, = Slightly Agree, = Agree, = Strongly Agree