CHILDREN WITH DIABETES AT SCHOOL

Diabetes Specialist NursesDiabetes Specialist Nurses

What is diabetes?What is diabetes?

Diabetes is a condition in which the level of glucose or sugar in the blood is higher than normal because the body is unable to use it properly.

This is because the body’s method of converting glucose into energy is not working as it should

InsulinInsulin

This is a hormone that is made in the Pancreas (which is a gland that lies behind the stomach)

Insulin helps the glucose or sugar that we eat to enter the cells where it is used by the body to give us energy

Children With DiabetesChildren With Diabetes

Most children will have type 1 diabetes • They can no longer produce insulin because the

cells of the pancreas that produce insulin are destroyed

– Without insulin the child’s body cannot use glucose and the blood glucose level rises.

Eats a meal

Blood sugar rises

Insulin is released

Blood sugar falls

Eats a meal

Blood sugar rises

No insulin/insufficient insulin is released

Blood sugar does not fall

Person without diabetes

Person with diabetes

Symptoms of diabetesSymptoms of diabetes

Increased thirst Going to the toilet frequently Extreme tiredness Weight loss Blurred vision

Teachers are often in a position to notice the signs that a child may have diabetes

Treating diabetesTreating diabetes

Most children are treated with a combination of insulin and a balanced diet

Insulin has to be injected – it is a protein that would be broken down in the stomach if it was swallowed like a medicine

Treating diabetesTreating diabetes Majority of children take 4 injections per day and will

need to inject insulin at school. This is not because their diabetes is “worse” or harder to control.

Taking more injections allows more flexibility in lifestyle, better concentration and better behaviour.

Some children may be on an insulin pump.

Administering insulin at schoolAdministering insulin at school

The children that are on four injections or an insulin pump will have to administer insulin at lunchtime. The treatment regimen will be documented in their individual care plan. The Diabetes Specialist Nurse and parents will visit individual schools to discuss diabetes care when

the child is newly diagnosed requires a change to their treatment moves to a new school problem with diabetes at school

Administering insulin at schoolAdministering insulin at school

The school will need to identify an appropriate area where administration of insulin and blood glucose monitoring can be carried out

In some circumstances the child may require assistance with the administration of insulin and/or blood glucose monitoring.

If a lunch time injection is required the parent will contact the school to identify appropriate staff to administer the insulin.

Once the school has identified the appropriate people, a training programme will be provided.

This will be discussed at the individual meeting and documented in the child’s care plan.

DietDiet The diet for children with diabetes is based on the

balanced varied diet which is recommended for every child – low in fat and sugar & high in fibre

The child and family will have seen a Dietitian, who will have advised on suitable food choices and discussed any particular needs to staff.

Eating TimesEating Times

Meals and snacks should be eaten at regular intervals – following a plan discussed by the family and their Dietitian

A missed or delayed meal could lead to “low blood sugar” Hypoglycaemia. The child should eat all of their lunch to prevent a hypo occuring.

Eating timesEating times

It may be necessary on occasions to allow the child to have a snack in class, but it is best eaten at break time to avoid any fuss.

If you feel the class should understand why the child is having a snack first ask the child how they feel about their diabetes being discussed with the class.

Snacks Snacks

The choice of food will depend on the individual child but should include

Sandwich Cereal bar Portion of fruit Two biscuits

Hypoglycaemia (Hypo)Hypoglycaemia (Hypo)

Hypoglycaemia is the most common short-term complication in diabetes – and occurs when the blood sugar is too low

The symptoms can be different for each child and are documented on their individual care plan

Most children recognise a “hypo” and will take appropriate action themselves

Possible causes of HypoglycaemiaPossible causes of Hypoglycaemia

Too little food for the insulin taken Not enough food to fuel an activity A missed or delayed snack

Signs and symptoms of hypoglycaemiaSigns and symptoms of hypoglycaemia

Sweating Trembling/shakiness Drowsiness Headache Lack of concentration

Hunger Pallor Glazed eyes Mood changes especially

angry or aggressive behaviour

Each child will have their particular signs and symptoms and these will be documented on the individual care plan

Treating a hypoTreating a hypo

It is VERY important that a hypo is treated quickly. If left untreated the blood glucose levels will

continue to fall and the child could become unconscious.

The child should not be left alone during a hypo nor sent of to get food to treat it. Recovery treatment must be brought to the child.

What To DoWhat To Do Immediately – give something sugary e.g.

Lucozade, Fresh Fruit Juice, Glucose Tablets, Non Diet Fizzy Drink

The exact amount may vary from person to person – parents or carer will advise and it will be documented in the care plan

Glucogel, honey or jam may be massaged into child’s cheek if they are too drowsy to take anything themselves

Follow WithFollow With

Starchy food to prevent blood sugar dropping again

snack eg sandwich, cereal bar, portion of fruit, 2 biscuits

or lunch time meal if due

If the child is unconscious do not give anything to eat or drink call an ambulance

Following treatmentFollowing treatment

Following treatment for hypo the child should continue with normal school activities.

Physical activityPhysical activity Diabetes should not stop children from

enjoying any kind of physical activity or being selected to represent their school providing they have made simple preparations

Preparations are needed because all forms of physical activity use up glucose

Physical activityPhysical activity

The more strenuous and prolonged the activity the more food will be needed, before, and possibly during and afterwards. It may also be beneficial to test during exercise.

BEFORE ACTIVITY The child may require an extra snack

Physical activityPhysical activity

DURING ACTIVITY There should be glucose tablets or sugary drink

nearby.

AFTER ACTIVITY The child may require some starchy food eg

packet of crisps – but this will depend on how strenuous the activity was.

Other ConsiderationsOther Considerations

Sickness– If child is unwell blood sugars may rise, it may

happen even with a simple cold.– The child may become thirsty and run to the

toilet frequently– This should be reported to parent/carer as

insulin adjustments may be necessary

Blood Glucose MonitoringBlood Glucose Monitoring Most children with diabetes will need to test their

blood glucose levels on a regular basis. They may need to do this at school.

Blood glucose testing involves pricking the finger, using a special finger-pricking device and a blood glucose meter.

If tests are required at school the parents can advise how often they should be done.

School TripsSchool Trips

Should not cause any real problem

Child should take their injection kit and blood glucose monitoring kit in case of delay

Extra snacks should be taken

Overnight StaysOvernight Stays

No problem as long as

Child is able to do own injection and blood glucose monitoring

A member of staff is willing to take the responsibility of helping with this in the younger/less able child

Going AbroadGoing Abroad

It is important that travel insurance will cover pre-existing conditions such as diabetes

Travel and diabetes – Individual advice provided by Diabetes Specialist Nurse. Diabetes UK publication gives advice on managing diabetes away from home

Points of Contact for Diabetes Specialist Nursing Service

Points of Contact for Diabetes Specialist Nursing Service

Armagh & Dungannon Locality– Olivia Creaney Tel No: (028) 87713526

Craigavon & Banbridge Locality– Pauline Ingram Tel No: (028)38398238

Newry & Mourne Locality– Janette Newell Tel No: (028) 30834365