Download - Type 1 Diabetes: What You Need to Know Angie Frey BSN, RN, CDE Fulton County Health Center
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Type 1 Diabetes:What You Need to KnowAngie Frey BSN, RN, CDE
Fulton County Health Center
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• There are 29.1 million people with diabetes in the United States
• 8.1 million people are undiagnosed
• Approximately 208,000 people younger than 20 years old have been diagnosed with
diabetes (Type 1 and Type 2)
• During 2008 – 2009, approximately 18,436 people younger than 20 years old were
newly diagnosed with Type 1 Diabetes while 5,089 people less than 20 years old were
newly diagnosed with Type 2 Diabetes
• The highest rate of new Type 1 Diabetes cases was amongst the non-Hispanic white
children and adolescents in 2008-2009.
• One in three American children born in 2000
and after will develop diabetes
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Type 1 Diabetes – Body makes little to no insulin resulting in one needing to take insulin injections
Approximately 5% of those diagnosed with Diabetes
Type 2 Diabetes – Body unable to correctly use one’s insulin (Insulin Resistance) OR unable to produce enough insulin (Insulin Deficiency)
Approximately 90-95% of those diagnosed with Diabetes
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Management of Diabetes
The 5 M’s of Diabetes Treatment:
1. Meals (Plate Method)
2. Medications Insulin (by injection or pump – Type 1 & possibly Type 2)
Oral Diabetes Medications (possibly Type 2)
3. Monitoring Blood Sugar
4. Motion (Exercise)
5. Managing
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Considerations When Managing Type 1 Diabetes at School
• Current Diabetes Medical Management Plan
• A 504 Plan
• A “low box” for the classroom and the nurse’s office
• Diabetes Supplies needed
• Communication Plan to School Personnel
• Classroom Buddy
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Diabetes Medical Management PlanDMMP
• Personal care plan for each student with diabetes
• Health Care Provider/Parent create this written and signed plan
• Provides specific instructions for the school personnel in how to assist a child with diabetes at school
504 Plan
• Takes information on DMMP and explains the school’s specific responsibilities
• Protect‘s child’s rights under federal laws
• Addressses who shall be trained to provide diabetes care tasks
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(Start these plans during 3 month visit during late Spring / early Summer)
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School Goal
• Provide nurturing environment that gives students the ability to safely care for their diabetes with minimal disruption of class time
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Meals : Plate Method
Each meal (9 inch plate) consists of:
• 1 serving of protein
• 3 servings of carbohydrates (1 starch, 1 fruit, and 1
milk)
• ½ plate of non-starchy vegetables ( lunch & supper)
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More Nutritious Eating
• Since carbohydrates quickly raise blood glucose the most… you may need to reduce or spread out your daily carb intake.
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Which foods contain carbohydrates?
Skim milkRiceDiet colaBaked chickenSugar-free puddingTurkey sandwichCottage cheeseWatermelonSpaghettiMayonnaiseCookiesIce cream
Scrambled eggsPeasFat-free yogurtPeanutsBananaBaked potatoesCornTortilla chipsTuna fishPizzaJelly beansPork chops
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Which foods contain carbohydrates?
Skim milkRiceDiet colaBaked chickenSugar-free puddingTurkey sandwichCottage cheeseWatermelonSpaghettiMayonnaiseCookiesIce cream
Scrambled eggsPeasFat-free yogurtPeanutsBananaBaked potatoesCornTortilla chipsTuna fishPizzaJelly beansPork chops
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Consider Timing of Meals and Snacks
• Amount of carbs in meals/snacks are timed to work with the action of insulin and physical activity
• If meals/snacks are skipped or delayed, the student may experience low blood glucose (hypoglycemia)
• Refer to student’s diabetes care plan for meal and snack schedule
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Tips Regarding Meals and Snacks
• Take notice if child is eating meal or snacks – (may clue you in to abnormal symptoms later in the day)
• Notify parents of field trips or events so plans can be made
• Advance planning for class parties
• Send a letter to other parents encouraging nutritious treats or other party ideas
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Medication : Insulin• People with Type 1 DM have to take insulin injections to live.
• Allows glucose in the bloodstream to enter each cell in the body to provide fuel for energy
• Type 1 diabetes = insulin = energy
= high blood glucose (> 250)
• Correct insulin dose = energy
= target blood glucose level
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Types of Insulin Injections
• Pens
• Vial/syringe
• Insulin Pump
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Insulin SpecificsRapid Acting Apidra (insulin glulisine),
Humalog (insulin lispro),
Novolog (insulin aspart)
Give just
prior to
eating
Short Acting Humulin R (insulin regular)
Novolin R (regular human insulin)
Give about 30 min. prior to eating
Intermediate Acting/
Combination
Humulin N, Novolin N (NPH)
Humalog 75/25, Humalog 50/50
Novolog 70/30, Humulin 70/30
Novolin 70/30
Typically takes twice a day with breakfast & supper
Long Acting Lantus (insulin glargine)
Levemir (insulin detemir)
Typically taken once a day at about same time
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Monitoring Blood Sugar
• Allows for adjustment of insulin, food, or activity to maintain target blood glucose level
• Students with Type 1 Diabetes – Typically should be checking their blood sugar before each meal (and possibly before snack time) along with when they feel their blood sugar is high or low.
- For monitoring frequency, check DMMP
• Target blood sugar range is individual; but generally the goal before meals is between 80 – 150.
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Motion (Exercise)
Children with diabetes need to participate like all other children
Blood glucose sugar is affected by physical activity
Common school activities:Gym class
Recess/field days
After school sports
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Planning Safe Exercise
Have easily accessible:
Student’s DMMP
Water/fluids
Snacks (carbs)
Insulin/pump supplies
Blood glucose monitor
Glucagon kit for emergency
Emergency phone numbers
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Managing
• This is the combination of the first 4 Ms of treatment (Meals, Medication, Monitoring, Motion) that works for each person with Diabetes to keep their blood sugar within the recommended target ranges
• Different for each person –
Determined by “trial & error”
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Emergency Situations
• High blood glucose (hyperglycemia &
diabetic ketoacidosis—DKA)• Blood glucose over 250 and ketones in urine
• Low blood glucose (hypoglycemia)
• Blood glucose 70 or less
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Hyperglycemia
Signs & Symptoms
• Extreme thirst
• Frequent urination
• Dry, Flushed Skin
• Headache / Stomach ache
• Blurred Vision
• Feeling Tired or Not Well
Causes
• Not enough insulin or missed injections
• Eating too many carbs
• Illness or infection
• Emotional/physical stress
• Lack of exercise or activity
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Effects of Hyperglycemia
Decreased ability to focus +
Decreased energy level +
Frequent trips out of the classroom =
Decreased school performance
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Diabetic Ketoacidosis (DKA)
• Most serious consequence of very high blood glucose levels
-- cells not being nourished
• Causes rapid breakdown of fat for energy; leads to ketones in the urine
• Ketones increase blood acidity; negative impact on all body organs
• Goal is prevention by regular blood glucose testing & extra insulin if needed
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When to Check for Urine Ketones
• Usually when glucose greater than 250
• Check student care plan
• Ketostix are usually foil-wrapped strips (the more glucose in urine the darker the color)
• Most students can do this themselves
• Assistance may be needed for smaller children
• Use disposable gloves if assisting child
• If moderate to large ketones parent usually contacted.
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Hypoglycemia(Low Blood Sugar)
• Occurs when the blood glucose is too low
• Happens quickly
• Needs immediate attention
• Give child fast acting sugar as directed in diabetes care plan
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Causes of Hypoglycemia(Low blood glucose sugar)
• Too much insulin
• Meals or snacks are late or missed
• Extra or extreme exercise
• Excitement in young children (start and finish of school year, holidays, etc.)
• Alcohol experimentation (older children)
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Hypoglycemia(Low Blood Sugar)
Signs & Symptoms
• Shaking
• Pale skin
• Sweating
• Confusion
• Hunger / Irritable
• Impaired Vision
• Weakness/Fatigue
• Headache / Stomach ache
• Behavior / Personality Change
Treatment
• Check Blood Sugar
(If blood sugar less than 70)
• Treat with: (See DMMP)
½ cup juice , ½ cup regular pop, 4 glucose tabs, or3 rolls smarties (fat free candy)
• Recheck blood sugar in 15 minutes
• Follow with next meal or snack with protein
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Prolonged low blood sugar can lead to:Unresponsiveness > Seizures > Unconsciousness
Glucagon
• Naturally occurring hormone made in the pancreas.
• A life-saving, injectable hormone that raises blood glucose level by stimulating the liver to release stored glucose sugar
• Can save a life. Cannot harm a student – cannot overdose
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When to Give Glucagon
If authorized by the DMMP and if student exhibits:
• Unconsciousness, unresponsiveness
• Seizures
• Inability to safely eat or drink
(Monitor expiration date)
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Tips for Preparing in Event of an Emergency or Lockdown
1. Consider Supplies Having access to glucometer (meter), food, insulin, water, and the restroom
2. Hypoglycemia A quick–acting carbohydrate (glucose tabs, juice box) in classroom or kept with student
3. Insulin School’s plan for accessing medication in event of a rare lockdown or evacuation
4. Written Plans & School Protocals Include lockdown / emergency provision in DMMP and/or 504 plan
2.
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Summary of Diabetes Care Activities in School
• Checking blood glucose (sugar) levels
• Timely eating of meals/snacks
• Taking insulin when needed
• Participating in physical activity
• Extra bathroom/water fountain breaks if needed
• Strong school personnel/family/student communication
• Emergency care
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Diabetes Management at School Can Help:• Provide a supportive learning environment
• Reduce absences
• Reduce classroom disruption
• Provide support in the event of an emergency
• Achieve full participation in activities
• Foster self-esteem through independence
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Resources•American Diabetes Association
http://www.diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-at-school/
•National Diabetes Education Program http://ndep.nih.gov
•Diabetes Youth Services Bonnie Heatwole BSN, RN Telephone 419-291-1234
http://dys4kids.org
•Juvenile Diabetes Research Foundation http://nwohio.jdrf.org/life-with-t1d/