HALTON CATHOLIC DISTRICT SCHOOL BOARD SECONDARY SCHOOL ADMINISTRATOR TYPE 1 DIABETES

Transcription

1 HALTON CATHOLIC DISTRICT SCHOOL BOARD SECONDARY SCHOOL ADMINISTRATOR TYPE 1 DIABETES RESPONSIBILITIES CHECKLIST JUNE 2009

2 SECONDARY SCHOOL ADMINISTRATORS RESPONSIBILITIES CHECKLIST FOR STUDENT S WITH TYPE 1 DIABETES Become informed about type 1 diabetes and how to manage students in the school, diagnosed with type 1 diabetes, by accessing and becoming familiar with the content of the following resources: HCDSB Protocol: Type 1 Diabetes Management A Protocol for Schools 2009 A Survival Guide diabetes in children and teens (booklet) (Supporting students with type 1 diabetes in the classroom) A Survival Guide diabetes in children and teens (DVD) School is to follow Board protocol for identifying students with type 1 diabetes: School Registration form Notification (survey) home to parents Provide parents /guardians with information on Board s Diabetes protocol, school s responsibilities, parent responsibilities, child s responsibilities and forms to be completed: Delivery system: PARENT/GUARDIAN TYPE 1 DIABETES PACKAGE Package provided to parents/guardians on day of registration or last week of June. The following forms to be completed and returned to the school prior to the students first day of school (e.g. last week of August): Diabetes Hypoglycemia Emergency Action Plan Parent Request and Consent for Type 1 Diabetes Interventions Parent/Guardian Diabetes Package accessible from Staff Net. Collect DIABETES forms e.g. as soon as possible after registration or last week of August: Develop a Diabetes binder where copies of each the following forms are kept. Diabetes Hypoglycaemia Emergency Action Plan Post a copy of the form with child s picture in a high traffic area for staff (e.g. staff room) Provide a copy to the classroom teachers for reference and to be provided to Occasional Teacher and/or on call teachers as per school protocol. Parent Request and Consent for Type 1 Diabetes Interventions Kept in Diabetes binder. Where appropriate school administrator arranges a meeting to gather medical information related to the diabetic condition and may include: Principal/designate Parent/Guardian Paediatric Diabetes Educator (Parents provide contact) Classroom teacher (coaches other staff where relevant) 1.

3 IN SERVICE STAFF prior to student s first day in September (e.g. in June): Provide staff with the following resources: Viewing of the DVD - A Survival Guide diabetes in children and teens Provide classroom teachers (with student diagnosed with type 1 diabetes) with access to copies of: HCDSB Secondary Classroom Teacher (with type 1 diabetes student in their class) Responsibility Checklist. Go over contents with Classroom Teachers. A booklet from Trillium Health Centre Paediatric Diabetes Centre: A Survival Guide diabetes in children and teens Provide staff members with access to copies of: HCDSB Secondary Staff Member Responsibility Checklist. Go over contents with Staff Members Location (School library) of the booklet from Trillium Health Centre Paediatric Diabetes Centre: A Survival Guide diabetes in children and teens Provide identity of students with type 1 diabetes to school staff. Identify location(s) of student s fast acting sugar supplies on the school site. STUDENT SELF MANAGING PROTOCOLS: In the majority of cases secondary students can self manage their type 1 diabetes without the assistance of school staff. However, encouragement and support from administrators and teachers can provide an important safety net for the students. Be familiar with and provide the appropriate support for students when they are self managing the following protocols. When in servicing classroom teachers and school staff emphasize their responsibilities to the following protocols which is outlined in their Responsibility Checklists. BLOOD SUGAR TESTING: When at school student tests their blood sugar usually before meals, before/during physical activity and when feeling low. The student tests his/her blood sugar with a test kit containing a small meter, which runs on batteries; test strips; lancet device; lancets and a log book. School Support: Provide a safe and appropriate location (e.g. quiet location in the classroom). The blood sugar testing kit should always be readily accessible to the student s location (e.g. gym) If student s behaviour seems out of character ask them to check their blood sugar, if no meter is available assume that they have a low blood sugar and stay with them until they take some fast acting sugar and feel well again. Students experiencing low blood sugar should be allowed to test their blood sugar and eat and drink where they are located at the time (e.g. during exams) Have a process in place for safe disposal of sharps, lancets and test strips. 2.

4 FAST ACTING SUGAR: Student will consume fast acting sugar to prevent or treat low blood sugar (e.g. when meter registers below 4.0 or where otherwise specified by parent). Some samples of fast acting sugar the student may take are: 175 mls (6oz) juice or pop (not diet); or 5-6 lifesavers; or 3 glucose tablets or as directed by parent. Students parents are responsible to provide the fast acting sugar. School Support: Provide safe, secure and accessible location(s) for storage of the fast acting sugar. *** If the storage location for the fast acting sugar is locked after school hours provide a process for students to access fast acting sugar for after school and evening activities (e.g. carry their own). Have a process in place to communicate to parents when new supplies of fast acting sugar are required. Support the student in being able to take the fast acting sugar anywhere and at all times on school property and during all school sanctioned activities. KEYTONE MONITORING: School staff have no responsibilities in the actual procedure of checking of ketone levels. Student may carry out the checking for ketone levels which involves the use of a device that draws blood in the school setting. The procedure is to check for rising levels of ketones which if untreated can spiral into the potentially dangerous condition known as diabetic ketoacidosis (DKA). School Support: Provide safe and appropriate location for testing to be done. Where appropriate have the testing location disinfected by custodial staff using appropriate cleaners. INSULIN INJECTIONS: Students with type 1 diabetes lose the ability to internally regulate their blood sugar levels because the pancreas no longer makes sufficient insulin. The student must try to control their blood sugar levels using injected insulin. Most injections are administered outside of school hours (before breakfast, and supper and at bed time). Some students require an injection at school before lunch. The student and family are responsible for administering the insulin injection at school. Recent advances in medical devices allow students with diabetes to choose the way they administer their insulin: INSULIN SYRINGE Insulin syringes are specially made syringes for self injection of insulin. INSULIN PEN Insulin pens look like a pen and allow the student to dial in the desired dose. 3.

5 INSULIN PUMP The student who wears an insulin pump receives insulin continuously via a small catheter placed under the skin (stomach). The student must press buttons on the pump to receive the correct dosage of insulin. The pump must be worn 24 hours a day and can only be taken off for short periods of time such as gym. School Support: Provide a safe and appropriate location for insulin injection. If the insulin pump beeps during class it is important to allow the student to call their parents to problem solve issues related to the pump. School staff do NOT provide insulin injections or push the button on the insulin pump. EATING MEAL TIME/SNACK TIME: Food is like medicine to the student with diabetes. It is important that the student eat all the food (meals and snacks) provided by parents because eating inadequately, delaying a meal or skipping a snack can easily cause low blood sugar. PHYSICAL ACTIVITY (PHYSICAL EDUCATION CLASSES, SPORT TEAMS): Activity can cause low blood sugar during, immediately after and up to 24 hours after participation by a student with type 1 diabetes. The low blood sugar can often be prevented by student eating an extra food or drinking a juice box prior to the activity. Student is to have their blood sugar testing kit and fast acting sugar readily accessible whenever they are participating in activity. Review with teachers and school staff what they are NOT responsible for on school site and on field trips: Administer Insulin syringe injections Administer glucagon syringe injections Determine procedure for low blood glucose count Push the release button on the insulin pump Provide the supply of fast acting sugar LOW BLOOD SUGAR MANAGING A POTENTIAL EMERGENCY SITUATION APPENDIX A: (A low blood sugar means that the level of sugar present in the blood is inadequate for the brain to function properly.) For how to identify signs and symptoms and manage incidents of low blood sugar (hypoglycaemia) refer staff to Appendix A in their Responsibility Checklist. For severe low blood sugar (student is unresponsive, unconscious or having a seizure) school staff is to call 911 and inform EMS student has type 1 diabetes. School Staff are NOT to provide glucagon injections. Hypoglycaemia Action Flowchart Provide staff and/or locate the form in suitable locations throughout the school 4.

6 HIGH BLOOD SUGAR - MANAGING A CONDITION WHICH IS NOT AN EMERGENCY BUT MAY REQUIRE ACCOMMODATIONS APPENDIX B: For how to identify signs and symptoms and manage incidents of high blood sugar (hyperglycaemia) refer staff to Appendix B in their Responsibility Checklist. There may be times when the child has high blood sugar and will require to have access to fluids (e.g. water at the desk) and the washroom at all times. SITUATIONS OF WHEN TO CALL PARENTS: A low blood sugar that requires assistance If the student needs assistance to manage a low blood sugar or if it takes them longer than 15 minutes to recover from a low blood sugar. Illness - vomits: If the student is unwell at school or when the student vomits phone parents immediately. If you cannot reach parents within 30 minutes, call 911. If the insulin pump is beeping Allow the student to call their parents to problem solve any issues related to the pump with out delay INFORMING ON CALLS AND OCCASIONAL TEACHERS: School administration is to develop a process and communicate the process to classroom teachers whereby the identity of students with type 1 diabetes is communicated to on call teachers and Occasional teachers. Sample processes to consider for informing Occasional teachers: Teacher identifies students, they teach with type 1 diabetes, on Smart Find message system when they call in their absence. Where appropriate school has a list of students with medical conditions (e.g. type 1 diabetes) and their class. This list is given to the occasional teacher when they pick up the keys and lesson plan at the office. Occasional teacher then compares the list to the class lists to identify students they may be teaching with medical concerns. OR Teachers write the name of the students in their class with type 1 diabetes on their lesson plan. Each classroom teacher has a folder where lesson plans for Occasional Teachers are located. Folder to contain: The names of students they teach, with medical conditions, (e.g. type 1 diabetes) The student s Hypoglycaemia Emergency Action Plan. FIELD TRIPS/ACTIVITIES OFF SCHOOL SITE: Provide the following information to teachers taking students with diagnosed type 1 diabetes off school site on field trips etc. This information is located in Classroom Teacher and Staff Member Responsibility Checklists: When taking student off school site it is important that there is communication with the parent/guardian to develop a careful and clear plan of expectations to meet the needs of the student with type 1 diabetes. Inform parents that school staff do not do syringe injections for insulin or glucagon or bolos the insulin pump.

7 Parents need to know the itinerary, times of expected stops, food breaks, and anticipated activity and return time. Field trip location (e.g. trip to rural setting, Camp in Algonquin Park, or trip to urban centre (Ottawa), or locations out of province, out of country: The school trip supervisor is to contact the commercial trip provider/site manager with information on the student with type 1 diabetes to check if the trip provider/site manager can guarantee they can accommodate the student s requirements for safe participation in the program and location. Distance to Hospital/EMS needs to be taken into consideration. Without an assurance that accommodations and management of the type one diabetes student can be made on the trip and at the activity site NO participation on the trip by the student. Arrangements for the accommodations and management of their child s type one diabetes, while on the trip, is to be communicated to parents in order to make an informed decision as to their child s participation on the trip. The student should bring extra supplies (e.g. glucose tablets, juice, a snack) in case of unexpected delays. Blood glucose testing and monitoring kit to be accessible, at all times, by the student. Teacher in charge of trip to inform other teachers, volunteers, bus driver of identity of diabetic student and review emergency plans. Child with type 1 diabetes assigned to group with parent or staff member trained in responding to a type one diabetes incident/emergency. PHYSICAL EDUCATION CLASSES AND SPORT TEAMS: Provide the following information to teachers providing students with physical activities. This information is located in Classroom Teacher and Staff Member Responsibility Checklists: Activity/exercise can cause low blood sugar during an activity, immediately after an activity and up to 24 hours after an activity. This can often be prevented by eating an extra food or drinking a juice box before activity (check the Students Management Plan). Physical Education teachers and coaches are to be familiar with the symptoms, treatment and prevention of low blood sugar. Inform parents/students of upcoming activities (practices, games) so they can plan accommodations for the activity/exercise. Sports or other activities that take place during mealtime require additional planning by the student. Timing of meals and snacks may be varied and the insulin dose adjusted so that students with diabetes can safely participate. Check the student has testing kit and supplies readily accessible whenever they are participating in activity/sports (both on or off school site). Check that the student has available a supply of fast acting sugar such as glucose tablets or juice boxes on outings or sport events. Allow the student to check their blood sugar level whenever they feel unwell and take a fast acting sugar if the reading is below 4.0 (or otherwise specified by parent). Emergency Drill: Simulate a hypoglycaemia emergency similar to a fire drill to ensure that all elements of the emergency treatment plan is in place and that everyone knows their role and what to do. 6.

8 Appendix A LOW BLOOD SUGAR - HYPOGLYCEMIA When supporting a student with type 1 diabetes the emergency situation you are most likely to encounter is Low Blood Sugar also known as hypoglycemic reaction or insulin shock. A low blood sugar means that the level of sugar present in the blood is inadequate for the brain to function properly. Every student will have their own unique signs and symptoms of feeling low (refer to student s Hypoglycemia Emergency Action Plan). The key to keeping a student safe is managing a low blood sugar as soon as it is detected. When in doubt, TREAT! Causes Symptoms Treatment Low blood glucose usually develops as a result of one or more of the following: insufficient food due to delayed or missed meal more exercise or activity than usual without a corresponding increase in food; and/or too much insulin The student may say he/she feels low, may look unwell or act in a strange manner. Signs of a low blood sugar include:. cold, clammy, sweaty skin. paleness, quietness. fatigue, dizziness. shakiness. hunger, irritability. tearfulness Signs of a VERY low blood sugar include:. loss of co ordination. hostility. confusion. staggering gait. appearing intoxicated At the first sign of a low blood sugar allow the student to check their blood sugar level using their meter. If the reading is below 4.0 (or otherwise specified by parent) ensure the student takes their fast acting sugar immediately. If it is not possible to check blood sugar OR if in doubt TREAT! (give sugar immediately) If the parents have not provided you with more specific instructions which can be readily complied with, give: 175 mls (6oz) juice or pop (not diet ); or 5-6 lifesavers; or 3 glucose tablets or as directed by parent 2 tspns/10ml/ or 2 packets of sugar; or 2 tspns/10ml of honey Follow up as per Diabetes Plan Signs of a SEVERE low blood sugar include:.unconscious,.unresponsive.cannot swallow properly.seizure. NEVER give food or drink. Place student on their side..call 911.Inform EMS student has type 1 diabetes.call emergency contact.

9 HIGH BLOOD SUGAR HYPERGLYCEMIA Appendix B Children with diabetes sometimes experience high blood sugar. High Blood Sugar (Hyperglycemia) is NOT an emergency situation, unless student is vomiting, and it may require the following accommodations in the classroom. High Blood Sugar Causes May develop as a result of one or more of the following: too much food; less than the usual amount of activity (indoor recess); growth spurts stress not enough insulin; and/or illness. Symptoms The earliest and most obvious symptoms are increased thirst and urination. Other: dry mouth, blurred vision, drowsiness. Treatment: Allow the student to check their blood sugar since symptoms of high blood sugar can be confused with symptoms of low blood sugar. A blood sugar of above 14 is usually considered too high but refer to students individual plan for individual parameters.. Allow the student to drink water at their desk. Allow the student to have open bathroom privileges. Do not use exercise to lower blood sugars as this can potentially make the blood sugar go higher. EMERGENCY situation if student is VOMITING:.phone parents immediately. if parents are not available CALL 911. inform EMS the student has type 1 diabetes 8.