for school staff Developed for Chicago Public Schools by: LaRabida Children s Hospital and Children s Memorial Hospital November 18, 2011
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1 1 Diabetes Education for school staff Developed for Chicago Public Schools by: LaRabida Children s Hospital and Children s Memorial Hospital November 18, 2011 Chicago Public Schools Office of Special Education and Supports 125 South Clark Street; Suite 800. Chicago, Illinois Telephone: Fax:
2 The information presented is 2 intended to Provide you with basic knowledge on Diabetes and its impact on students. Layout best practices in managing the treatment of diabetes. Provide tips to working with students who have diabetes Show signs and symptoms of Hyperglycemia and Hypoglycemia. Explain how to respond in an emergency. Provide resources
3 What is Diabetes? 3 Diabetes is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both and is the seventh leading cause of death in the United States. Most cases of diabetes among children and adolescents are type 1, which develops when the body can no longer make insulin, a hormone that controls the amount of blood glucose.
4 Everyone needs to know: 9 How to prevent a Diabetic emergency How to recognize a Diabetic reaction recognize high risk times and situations know common signs and symptoms How to respond to a Diabetic reaction know your school s resources/policies know how to follow an Diabetes Emergency Plan
5 Basics of Diabetes Care 4 Blood sugar monitoring needs to be done frequently throughout the day, especially before meals Carbohydrates (bread, fruit and milk) need to be counted at meal and snack time Insulin needs to be administered for most before lunch with a syringe, prefilled pen or an insulin pump Carbohydrates and the pre meal blood sugar need to be entered into the pump, or used to calculate the pre meal insulin dose
6 Best Practices in Managing the Treatment of Diabetes 4 Technique matters: call 800# on the back of the meter Perform quality control procedures, set code, exp. date on strips and control solution, battery indicator Wash hands with soap and water, always use a new lancet Rotate fingers Alternative sites can be used once you establish a working insulin dose Obtain enough blood Dispose of sharps in a proper container Record results; Check meter memory and current date/time Provide supportive supervision; neutral reaction to result
7 Checking Blood Sugars 4 Before meals and snacks Before or after exercise Ifsignsorsymptoms symptoms of high or low blood glucose May need to check 2 hours after meal
8 How to Manage High and Low 4 blood sugar High blood sugar What is it? What are the signs and symptoms? Low blood sugar What is it? What are the signs and symptoms? How is it treated? How is it treated? t
9 High Blood Sugar: 4 Hyperglycemia What is it? Definition varies by child, but generally any value > 180 is high What to watch for? Look for extreme thirst, need to urinate often, stomach ache, weakness, fatigue, nausea, vomiting What to do? Follow the student s Diabetes Action Plan Allow free access to water and restroom If >300 check the urine for ketones Call the school nurse immediately if ketones are positive, if untreated the student can become critically ill
10 10
11 Low Blood Sugar: 4 Hypoglycemia What is it? Definition varies by child but generally when <80 Can happen suddenly Requires immediate treatment Impairs cognitive abilities Can be mistaken for misbehavior What to watch for? Shaking, sweating, anxious, dizzy, hungry, headache, irritability, personality change, some students have no signs at all What to do? Follow the student s Diabetes Action Plan Check the bg and give 15 grams of a fast acting carbohydrate, wait 15 minutes and re-check the bg again If untreated or missed, child could have a seizure
12 12
13 Best Practices: the Meal Plan 35 Individualized to meet child s nutritional needs, appetite, eating habits and activity level Goal: Achievement of normal blood glucose, lipid levels and growth Nutritional needs are no different from their peers without diabetes Families are taught how to count carbohydrates: the child is given a target range for carb intake at meals and snacks Child can eat the same food as a child without diabetes
14 Carbohydrate Containing Foods 35 Breads, grains, and cereals Fruits and fruit juices Starchy vegetables potatoes, corn, peas, beans Milk and yogurt Sweets and sugary foods/drinks
15 Carbohydrate Counting 35 3 Most popular meal plan Involves calculating number of grams of carbohydrate the student will eat Insulin dose based on how many carbohydrates to be eaten (insulin:carb)
16 Tips for Eating at School 35 3 Contact Nutrition Support Services personnel e to discuss nutrition related accommodations e.g. lunch menus and carbohydrate content Parent needs to write the amount of carbs in meals/snacks brought from home Notify parent in advance about school parties and food treats Lunch time is an important social event in the day of a student
17 Insulin 353 Used to cover food eaten at meals and snacks Used to correct high blood glucose H lth l h ld if d Health care plan should specify dosage, delivery method, and schedule
18 Basal/Bolus Insulin Plan 353 Mimics the way a normally functioning pancreas produces insulin Given by multiple daily injections or insulin pump Basal = long acting insulin, controls blood glucose overnight and between meals Bolus = rapid acting insulin, covers food and lowers blood glucose if over target
19 Ways to Give Insulin 35 3 Syringes Pens Pumps
20 353 Insulin Pens
21
22 Administering Insulin 35 3 Some students are independent Some students need supervision Some students t need total t assistance
23 4 Working with Students who have Diabetes Allow the child to use the restroom and drink water as needed It s o.k. for them to eat in class Allow time to fully recover after treating lows All teachers, bus drivers, PE instructors, Coaches need to know the student has diabetes and what needs to be done Student needs to have access to supplies at all times Keep supplies stocked (provided by the parents) Communicate regularly with the school nurse Student will need continued reminding Get consent to talk to the health care provider in the event the child is ill and you can not reach the parent/guardian
24 When to call the school nurse for 4 help Anytime you are unsure of what to do. When you need to make a decision about the diabetes management If you are unable to get the blood sugar to come up after 2 treatments If the urine is positive for ketones If the child is sick If the child is not thinking clearly or seems confused.
25 What to do in an Emergency 4 In the event emergency response measures outlined in a student's Diabetes Action Plan are undertaken but not effective, 911 will be called immediately. If Glucagon is given call 911 and stay with student until help arrives. Glucagon can cause nausea and vomiting Notify parent/guardian after 911 has been called
26 28 29 Identifying Students with Diabetes: Parent Submissions When a diagnoses of Diabetes is reported, parent/guardian must submit: 1. Written authorization to obtain detailed medical information 2. Written Consent to share diagnosis i with school personnel 3. Written consent to administer or self administer medication 4. Physician s s Diabetes Care Plan, completed and signed by their child s licensed health care provider and signed by the parent/guardian 5. Any Medications necessary to prevent/treat t along with relevant prescription and dosage information 6. Current emergency contact information 7. Other information will also be requested specific to the development of a 504/IEP Plan.
27 First Step in Documentation Principals shall request parents/guardians to report information about their child s diagnosed Diabetes using the Student Medical Information form on an annual basis.
28 Online Resources 35 American Diabetes Association look under Living with diabetes Safe at School School Staff Training Training Resources Children With Diabetes com great sample 504 plans Juvenile Diabetes Research Foundation: National Diabetes Education Program additional diabetes resources and guide on caring for students
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