The Student with The Student with

DiabetesDiabetes

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AgendaAgenda

Types of diabetes

Management

Hypoglycemia

Hyperglycemia

Responsibilities

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What is DiabetesWhat is Diabetes

Much of the food eaten becomes a sugar called glucose

The pancreas makes a hormone called insulin

Insulin allows the body to use the glucose for energy

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Types of DiabetesTypes of Diabetes

Type 1 Auto-immune illness

• Pancreas not producing enough insulin

• Requires insulin injections

• Must test blood glucose (BG) at school

Usually diagnosed at a younger age Chronic condition Cannot be prevented

Type 2 Most common type of diabetes Can often control with diet, exercise or pills May also take insulin Usually diagnosed at an older age – infrequent in school age child May not need to test BG sugars at school

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Each Student with Diabetes is an Each Student with Diabetes is an

Individual – Individual Plan of Individual – Individual Plan of

CareCare

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General Diabetes Management General Diabetes Management

GoalsGoals Keep student safe from extreme lows and

highs

Balance of food choices, exercise, & insulin

Aim for majority of blood glucose levels in

target – this is challenging

Normal school routines for student

Optimal learning at school

Promote normal growth & development

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Target Blood Glucose (BG) RangeTarget Blood Glucose (BG) Range

< 5 years: 6-12 range 5-10 years old: 4-10 range

>10 years: 4-7 range

Hypoglycemia < 4 (must treat)

Hyperglycemia > 15 (additional information needed)

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Blood Glucose (BG) TestingBlood Glucose (BG) Testing

Tool to assess BG (meter)

Done routinely before meals and if a low is suspected

Must treat immediately if < 4

Avoid placing “judgment value” i.e. good or bad on high or low blood glucose readings

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Insulin Delivery SystemsInsulin Delivery Systems

Most children get insulin before breakfast, supper and bedtime

Some children get insulin at lunch Syringe Insulin pen Pump

Insulin Pump provides an almost continuous flow of insulin

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Insulin Action – Insulin Action – around the clock around the clock

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Some Children Wear Insulin Some Children Wear Insulin

PumpsPumps

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School Nurse ConsiderationsSchool Nurse Considerations

Assess the level of assistance the student requires

Support with the development of independence

School Nurse Role Assist with BG testing if needed Assist with insulin administration via pen or syringe Assist with entering BG and carb amount into pump for pump bolus

Ideal is to bolus/give insulin pre food Hypoglycemia: identify and treat Prompt contact with care givers if concerns

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Age Appropriate ExpectationsAge Appropriate Expectations

Pre-Schooler washes hands before testing offers finger to be picked

School Age chose injection site identifies food groups tests independently - caregiver supervises younger child may need more direction

Teen independent with insulin, food choices, testing BUT - caregiver still involved to monitor and support

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Nutrition BasicsNutrition Basics Main nutrient that increases BG is carbohydrate

• grains, fruits, milk, sugars

Protein & Fat do not increase BG

Nutritious choices are encouraged, not always made!

No Forbidden Foods

Normalize with same eating times /routines/ food choices as other students

Allow child to eat all food as provided by caregivers

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Special Occasions at SchoolSpecial Occasions at School

Children with diabetes can and should participate in all school activities

With advanced planning, diabetes can be managed around all special events and treats

If uncertain how to proceed, contact caregiver for management advice or send the treat home

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ExerciseExercise

Children with diabetes can be involved in all school activities with some additional precautions

Exercise can lower BG• Consider checking BG levels before, during and after activity• May need additional glucose or carbohydrate

Important for school staff to be aware of impact of exercise on diabetes

Medical Alert Bracelet

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HypoglycemiaHypoglycemia Low Blood GlucoseLow Blood Glucose

Treat every BG less than 4 Causes

• Too much insulin• Too little Food

Delayed, inadequate or skipped meal or snack

Extra exercise without extra food or a decrease in insulin

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Hypoglycemia SymptomsHypoglycemia Symptoms

Shaking Headache Stomach ache Pale skin Hunger

Fatigue Irritability Blurred vision Slurred speech Decreased level of consciousness

• Important to understand students individual symptoms• If unsure if student is low, do a BG test. • If unable to test, always treat.• Occurrence of a severe low is rare in the school setting

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HypoglycemiaHypoglycemia Treatment for Mild or Moderate Treatment for Mild or Moderate HypoglycemiaHypoglycemia

Junior juice (125 ml) 3-4 dex glucose tablets 2 rolls of rockets 2 tsp. honey 3 tsp. sugar 1/3 cup regular soda

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HyperglycemiaHyperglycemia High Blood GlucoseHigh Blood Glucose

Above 15 is considered warning of hyperglycemia

Causes• Too much food• Too little insulin• Inaccurate BG test result• Decreased activity• Illness/infection• Stress

If BG is > 15mmol/L and child is feeling unwell (flu like symptoms) notify caregivers.

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HyperglycemiaHyperglycemia

Mild - Moderate Symptoms

Increased urination Increased thirst Blurry vision Increased hunger

Recommendations• Fluids and washroom access• Inform parent• Contact parent if unwell

Severe Symptoms

Fruity breath Vomiting Stomach cramps or pain Extreme weakness Sleepiness Difficulty breathing Coma Medical emergency Contact parent and/or 911

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Hyperglycemia ManagementHyperglycemia Management

If the BG > 15mmol and the child feels unwell with flu like symptoms, contact the caregivers immediately

If the BG is > 15mmol and the child is well (able to eat, drink, and be involved in school routines) contact the caregivers if part of plan of care continue with the usual school activities of meals and snacks as provided by caregivers

continue with usual activity plan (no additional activity required)

encourage water intake if child is agreeable expect increased use of the washroom document BG and any concerns in agenda or planner

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Emergency SituationsEmergency Situations

If at any time a student experiences a decreased level of consciousness, call 911

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Psychosocial AspectsPsychosocial Aspects

Challenging regimen with limitations & restrictions

How you can help• treat diabetes matter-of-factly• BG variability is common – diabetes is hard to control• appreciate no one makes ideal food choices at all times• provide encouragement & understanding• accommodate diabetes management within classroom

routines as much as possible

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School’s ResponsibilitySchool’s Responsibility Learn about diabetes Ensure all meals and snacks, as provided by parents, are completed on time Know symptoms and management of hypo/ hyperglycemia Communicate regularly with parents Provide space for testing and storage of diabetes supplies in the classroom Know when to contact parents/guardians Educate other students Consider best location for diabetes care – may prefer privacy Update annually using Trillium website: http://www.trilliumhealthcentre.org/programs_services/womens_childrens_services/childrensHealth/familyCareCentre/paediatricDiabetesClinic.html

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Student’s ResponsibilityStudent’s Responsibility

Notify teacher when feeling unwell Accurately document BG in planner/agenda Take sharps home for safe disposal Eat all food provided by parents in a timely manner Educate other students Participate in all school activities Tell adults - parents, teacher – when supplies are low Wear medic alert

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Caregiver’s ResponsibilitiesCaregiver’s Responsibilities

Establish positive relationship with school Take sharps home for safe disposal Provide nutritious lunch and snack choices Ensure extra supplies are stored at school Communicate as needed with school and educate

as required Advocate for child’s best care Update school staff each year:http://www.trilliumhealthcentre.org/programs_services/

womens_childrens_services/childrensHealth/familyCareCentre/paediatricDiabetesClinic.html

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Diabetes WebsitesDiabetes Websites

For additional information on Type 1 diabetes:

Canadian Diabetes Association www.diabetes.ca

Juvenile Diabetes Research Foundation www.jdrf.ca

Trillium Health Centre//www.trilliumhealthcentre.org/

programs_services/womens_childrens_services/childrensHealth/familyCareCentre/paediatricDiabetesClinic.html