Diabetes in SchoolDiabetes in School

Diane SpokusDiane SpokusDoctoral CandidateDoctoral Candidate

Health EducatorHealth EducatorSouthcentral PA Area Health Education Center Southcentral PA Area Health Education Center

(AHEC)(AHEC)

AHEC MISSIONAHEC MISSION

The mission of The mission of the Pennsylvania the Pennsylvania AHEC Program AHEC Program is to help is to help communities communities meet their meet their primary health primary health care needscare needs

by creating a by creating a statewide statewide infrastructure infrastructure bridging bridging community community

and and

academic academic resources to:resources to:

NEEDS LOCAL NEEDS LOCAL SOLUTIONSSOLUTIONS

Each underserved Each underserved community & individual community & individual has a different set of has a different set of

needs that needs that

must be must be

identified and addressed.identified and addressed.

Recruit and Recruit and retain retain primary care primary care providers in providers in underserved underserved communities.communities.

AHEC Housed in 45 StatesAHEC Housed in 45 States

Southcentral PA AHEC RegionSouthcentral PA AHEC Region

OverviewOverview

Current statistics on childhood overweightCurrent statistics on childhood overweight

Contributing factors and behaviors Contributing factors and behaviors

Health ImpactHealth Impact

Prevention strategiesPrevention strategies

ResourcesResources

Thought Provoking QuoteThought Provoking Quote

““Today’s children’s lives may be shorter Today’s children’s lives may be shorter than their parents.”than their parents.”

(Food Fight, Brownell and Horgen, 2003)(Food Fight, Brownell and Horgen, 2003)

BackgroundBackground

OverweightOverweight

Chronic condition that develops when Chronic condition that develops when energy intake exceeds energy energy intake exceeds energy expenditure, resulting in excessive body expenditure, resulting in excessive body weightweight

EpidemicEpidemic

An estimated 9 million young people are An estimated 9 million young people are overweightoverweight

The percentage of children/adolescents The percentage of children/adolescents that are overweight has that are overweight has doubleddoubled since the since the 1970’s1970’s

Obesity is now the most prevalent Obesity is now the most prevalent nutritional diseasenutritional disease of children and of children and adolescents in the United Statesadolescents in the United States

EpidemicEpidemic

1 in 3 children born in the year 2000 will 1 in 3 children born in the year 2000 will develop Type II Diabetes (based on develop Type II Diabetes (based on current trends)current trends)

27% of children age 5-10 have 1 or more 27% of children age 5-10 have 1 or more heart disease risk factorsheart disease risk factors

Why Worry About Pediatric Why Worry About Pediatric Overweight?Overweight?

Probability of overweight children being Probability of overweight children being obese as an adults.obese as an adults.– 20% at 4 years of age20% at 4 years of age

– 50% at 6 years of age50% at 6 years of age

– 80% as an adolescent80% as an adolescent

Pediatric overweight impacts on adult healthPediatric overweight impacts on adult health– 2 fold increase in mortality as an adult in obese 2 fold increase in mortality as an adult in obese

vs. non-obese adolescentsvs. non-obese adolescents

Percentage of US Children and Percentage of US Children and Adolescents Who Were Adolescents Who Were

OverweightOverweight

Percentage of Overweight Percentage of Overweight Children & Youth Who Become Children & Youth Who Become

Obese AdultsObese AdultsP ercentage of O verw eight C hild ren &

Y outh W ho Becom e O bese A du lts

0

1 0

2 0

3 0

4 0

5 0

6 0

7 0

8 0

P e rc e n ta g e

P re s c h o o l

S c h o o l-a g e

A d o le s c e n t

N a tio n a l In s titu te fo r H e a lth C a re M a n a g e m e n t, N o v 2 0 0 3

Contributing FactorsContributing Factors

Physical ActivityPhysical ActivityDietDietGeneticsGeneticsEnvironmental (time, convenience, Environmental (time, convenience, technology & community design)technology & community design)SocioeconomicSocioeconomicBehavioralBehavioral

Complex interacting forces Complex interacting forces OBESITYOBESITY

Contributing Factors- Contributing Factors- Physical Activity Physical Activity

Children spend approximately 75% of their Children spend approximately 75% of their waking hours being inactivewaking hours being inactive

31% do not achieve recommended levels 31% do not achieve recommended levels of physical activityof physical activity

Girls are less likely than boys to engage in Girls are less likely than boys to engage in vigorous activityvigorous activity

YRBS 2001, CDCYRBS 2001, CDC

Contributing Factors- DietContributing Factors- Diet

2% of children (2 to 19 2% of children (2 to 19 years) meet the five main years) meet the five main recommendations for a recommendations for a healthy diet-healthy diet- Food GuideFood Guide PyramidPyramid

75% if children consume 75% if children consume more more saturated fatsaturated fat than than is recommended-is recommended- Dietary Dietary Guidelines for AmericansGuidelines for Americans

National Alliance for Nutrition and Activity, 2003National Alliance for Nutrition and Activity, 2003

45 % of children eat no 45 % of children eat no fruit.fruit.

20% eat less than one 20% eat less than one serving of vegetables. serving of vegetables. (7 servings a day are (7 servings a day are recommended for this age recommended for this age group)group)

Contributing Factors- DietContributing Factors- Diet

Children’s calorie intake increased by approximately 80 Children’s calorie intake increased by approximately 80 to 230 extra calories per day ( between 1989 and 1996, to 230 extra calories per day ( between 1989 and 1996, depending on the child’s age and activity level)depending on the child’s age and activity level)

The number of calories children consume from snacks The number of calories children consume from snacks increased by 30% between 1977 and 1996increased by 30% between 1977 and 1996

A child’s chance of becoming overweight increased by A child’s chance of becoming overweight increased by 60% with each additional can of soda or juice drink60% with each additional can of soda or juice drink

National Alliance for Nutrition and Activity, 2003National Alliance for Nutrition and Activity, 2003

Number of People with DiabetesNumber of People with Diabetes

United StatesUnited States 13 Million13 Million

PennsylvaniaPennsylvania 660,000 660,000

People with diabetes that do not know it:People with diabetes that do not know it:

United StatesUnited States 5.2 Million 5.2 Million

Learning ObjectivesLearning Objectives

Diabetes BasicsDiabetes Basics

Develop a Plan of TreatmentDevelop a Plan of Treatment

Effective Diabetes ManagementEffective Diabetes Management

HypoglycemiaHypoglycemia

HyperglycemiaHyperglycemia

Blood Glucose MonitoringBlood Glucose Monitoring

Emergency Action PlanEmergency Action Plan

The Child with Diabetes is a The Child with Diabetes is a Shared Responsibility in SchoolShared Responsibility in School

Schools/Teachers Schools/Teachers Responsibility and LiabilityResponsibility and Liability““A school district must provide a child with A school district must provide a child with a handicapping condition, including a handicapping condition, including children with diabetes, all services children with diabetes, all services necessary to assist the student to benefit necessary to assist the student to benefit from his/her school program.”from his/her school program.”

(Act 15, Section 504, Rehabilitation Act of 1973)(Act 15, Section 504, Rehabilitation Act of 1973)

Individual Education Plan (IEP)Individual Education Plan (IEP)or or

Individual Health Plan (IHP)Individual Health Plan (IHP)Written plan of the child’s specific health Written plan of the child’s specific health needsneeds

Every child with diabetes should have oneEvery child with diabetes should have one

Implemented collaboratively with the school Implemented collaboratively with the school nurse, student, parents, and school nurse, student, parents, and school personnelpersonnel

Emergency treatment and contact Emergency treatment and contact informationinformation

What is Diabetes?What is Diabetes?

It is a serious, chronic disease in which you It is a serious, chronic disease in which you have a have a highhigh blood sugar levelblood sugar level due to a lack due to a lack of insulinof insulinInsulin Insulin is needed to take the glucose(sugar) is needed to take the glucose(sugar) out of the bloodstream and move it into the out of the bloodstream and move it into the body’s cells to use for energybody’s cells to use for energy

Diabetes BasicsDiabetes Basics

Diabetes is a metabolic disorder that impairs Diabetes is a metabolic disorder that impairs the body’s ability to use food properlythe body’s ability to use food properly

When we eat food it breaks down into sugarWhen we eat food it breaks down into sugar

Sugar is needed for energySugar is needed for energy

Sugar gets into the body’s cells with the help of Sugar gets into the body’s cells with the help of insulininsulin

Insulin is a hormone released by the pancreasInsulin is a hormone released by the pancreas

When sugar can’t get into the cells it builds up in the When sugar can’t get into the cells it builds up in the bloodstream causing a high blood sugar level bloodstream causing a high blood sugar level

This is DiabetesThis is Diabetes

Blood Glucose LevelsBlood Glucose Levels

The amount of glucose in the blood. The The amount of glucose in the blood. The recommended blood glucose levels for recommended blood glucose levels for most people with diabetes are from about most people with diabetes are from about 80 to 120 before a meal, 180 or less after 80 to 120 before a meal, 180 or less after a meal, and between 100 and 140 at a meal, and between 100 and 140 at bedtime.bedtime.

Types of DiabetesTypes of Diabetes

Type 1Type 1 Type 2Type 2– NoNo Insulin Insulin Not enoughNot enough insulin produced insulin produced

producedproduced Body Body unable to useunable to use insulin insulin

producedproduced

Risk FactorsRisk Factors

Type 1Type 1

Causes:Causes:

HeredityHeredityAutoimmune disorderAutoimmune disorderEnvironmentalEnvironmental

Population:Population:People under age 30People under age 3010% population10% population

Type 2Type 2

Causes:Causes:Heredity (Family)Heredity (Family)ObesityObesityPhysically inactivePhysically inactiveDietary IntakeDietary IntakeAdvancing AgeAdvancing AgeEthnicity (Race)Ethnicity (Race)

Population:Population:AdultsAdultsChildrenChildren90% population90% population

Risk FactorsRisk Factors

Certain racial or ethnic groups, such as Certain racial or ethnic groups, such as African Americans, Hispanic/Latino African Americans, Hispanic/Latino Americans, American Indians, and some Americans, American Indians, and some Asian Americans and Pacific Islander Asian Americans and Pacific Islander Americans.Americans.

Contributing Factors-Contributing Factors-SocioeconomicSocioeconomic

National Growth and Health StudyNational Growth and Health Study– Concluded parental socioeconomic status is Concluded parental socioeconomic status is

associated inversely with childhood associated inversely with childhood overweight in white children but not African overweight in white children but not African American and HispanicAmerican and Hispanic

Contributing Factors-Contributing Factors-BehavioralBehavioral

Family meal patterns and food choicesFamily meal patterns and food choices

Food availabilityFood availability

Portion sizesPortion sizes

School food service and vendingSchool food service and vending

Health ImpactHealth Impact

CardiovascularCardiovascular

Endocrine systemEndocrine system

PulmonaryPulmonary

OrthopedicOrthopedic

Gastrointestinal/HepaticGastrointestinal/Hepatic

Mental HealthMental Health

Health ImpactHealth Impact

CardiovascularCardiovascular– High blood pressureHigh blood pressure– Elevated cholesterol Elevated cholesterol

levelslevels– Elevated triglyceride Elevated triglyceride

levellevel

EndocrineEndocrine– Type 2 diabetesType 2 diabetes– Menstrual irregularityMenstrual irregularity– Early onset of Early onset of

menstruationmenstruation– Insulin problemsInsulin problems

Signs and Symptoms of Signs and Symptoms of DiabetesDiabetes

Type 1Type 1– Frequent urinationFrequent urination– Very thirsty/hungerVery thirsty/hunger– Feeling very tiredFeeling very tired– Blurred visionBlurred vision– Unexplained weight Unexplained weight

loss loss

Type 2Type 2– Frequent urinationFrequent urination– Very hungry/thirstyVery hungry/thirsty– Feeling very tiredFeeling very tired– Blurred visionBlurred vision– Slow healing cutsSlow healing cuts– Frequent infectionsFrequent infections– No symptoms at allNo symptoms at all

DiabetesDiabetes

Type 1Type 1Absolute insulin deficiencyAbsolute insulin deficiency

TreatmentTreatmentInsulin ShotsInsulin Shots

Meal Planning/Health DietMeal Planning/Health DietMonitoring GlucoseMonitoring Glucose

Exercise Exercise

Type 2Type 2Produce insulinProduce insulin

Insulin ResistanceInsulin Resistance

TreatmentTreatmentMeal Planning/Health DietMeal Planning/Health Diet

ExerciseExercise

Weight LossWeight Loss

Monitoring GlucoseMonitoring Glucose

Medication (pills, insulin, or Medication (pills, insulin, or both, if necessary)both, if necessary)

What Happens When You EatWhat Happens When You Eat

Cells in your body need sugars and starches for Cells in your body need sugars and starches for energy to do their jobenergy to do their jobFood you eat is turned into sugar and starches Food you eat is turned into sugar and starches by the stomachby the stomachSugars and starches are carried in the Sugars and starches are carried in the bloodstream to the cellsbloodstream to the cellsThe pancreas makes more insulin – the key- that The pancreas makes more insulin – the key- that opens the doors of the cells so the sugar goes opens the doors of the cells so the sugar goes into the cellinto the cell

What Happens When You EatWhat Happens When You Eat

= Sugar

= Insulin

Not Having DiabetesNot Having Diabetes

If you have Insulin, you have the KeyIf you have Insulin, you have the Key

= Sugar

= Insulin

Having DiabetesHaving Diabetes

Not having Insulin - you lack the Key to open the door to Not having Insulin - you lack the Key to open the door to cell wallcell wall

Complications of DiabetesComplications of Diabetes

Eye DamageEye Damage– blindnessblindness

Increased risk for heart attack and strokesIncreased risk for heart attack and strokes

Kidney damageKidney damage

Nerve damageNerve damage

Foot ulcers/impaired wound healingFoot ulcers/impaired wound healing– amputationsamputations

Lifestyle ChangesLifestyle Changes

Healthy DietHealthy Diet

Physical ActivityPhysical Activity

Stop SmokingStop Smoking

Reduce StressReduce Stress

Type 1Type 1Effective Diabetes ManagementEffective Diabetes Management

InsulinInsulin (1-4 injections daily)(1-4 injections daily)

Blood glucose monitoring (3-4 times daily)Blood glucose monitoring (3-4 times daily)

Meal Planning (carbohydrate counting)Meal Planning (carbohydrate counting)

ExerciseExercise

Ketone Testing (BS>240 or illness)Ketone Testing (BS>240 or illness)

Lab work- keep within target rangeLab work- keep within target range

Type 2 Type 2 Effective Diabetes ManagementEffective Diabetes Management

Meal Planning (decrease fat/cholesterol)Meal Planning (decrease fat/cholesterol)

Increase activity (physical exercise)Increase activity (physical exercise)

Glucose monitoringGlucose monitoring

Medication (oral or insulin)Medication (oral or insulin)

Lab work- keep within target rangeLab work- keep within target range

HypoglycemiaHypoglycemia(Low Blood Sugar)(Low Blood Sugar)

Teachers Must KnowTeachers Must Know– Know the symptoms common to your studentKnow the symptoms common to your student– Times most likely to occurTimes most likely to occur

(before lunch, during and after exercise)(before lunch, during and after exercise)

– How to treatHow to treat– Response time after treatmentResponse time after treatment

(15 minutes)(15 minutes)

– When do parents wish to be notified?When do parents wish to be notified?

Causes of HypoglycemiaCauses of Hypoglycemia (Low Blood Sugar level)(Low Blood Sugar level)

Causes:Causes:

Skipped meals/snacksSkipped meals/snacks

Extra Exercise (burns more sugar)Extra Exercise (burns more sugar)

Incorrect dose of insulinIncorrect dose of insulin

HypoglycemiaHypoglycemia(Low Blood Sugar)(Low Blood Sugar)

SymptomsSymptoms– ShakinessShakiness SweatingSweating– AnxiousAnxious Irritable/cryingIrritable/crying– HeadacheHeadache Fast HeartbeatFast Heartbeat– HungerHunger DizzinessDizziness– Impaired vision (Blurry)Impaired vision (Blurry)– Decreased concentrationDecreased concentration– Difficulty following directionsDifficulty following directions– Weak and tiredWeak and tired

Treatment of HypoglycemiaTreatment of Hypoglycemia

Follow your facility’s protocolsFollow your facility’s protocols15 grams Carbohydrate= 1 serving15 grams Carbohydrate= 1 serving

(Fruit, milk, starches)(Fruit, milk, starches)4 Glucose tablets4 Glucose tablets

4 ounces of Juice (1/2 cup)4 ounces of Juice (1/2 cup)4-5 ounces regular soda 4-5 ounces regular soda 1 cup milk1 cup milk4-6 lifesavers/hard candy4-6 lifesavers/hard candy2 Tablespoons raisins2 Tablespoons raisins

(Use parent preference when (Use parent preference when possible)possible)

Treatment of HypoglycemiaTreatment of Hypoglycemia

Once symptoms go away give light snack Once symptoms go away give light snack or meal in the next 30 minutes.or meal in the next 30 minutes.– Example:Example:

½ peanut butter or meat sandwich½ peanut butter or meat sandwich

andand

½ glass milk½ glass milk

Treatment of HypoglycemiaTreatment of HypoglycemiaWhat to DoWhat to Do

Intervene promptly. Follow IHPIntervene promptly. Follow IHP

Check blood sugarCheck blood sugar

Treat with 1 carbohydrate= 15 gramsTreat with 1 carbohydrate= 15 grams

Wait 15 minutesWait 15 minutes

Recheck blood sugarRecheck blood sugar

Retreat if blood sugar is Retreat if blood sugar is << 60 or as specified in 60 or as specified in IHPIHP

Follow with substantial snack or lunch if neededFollow with substantial snack or lunch if needed

Points to RememberPoints to Remember

Never leave student unattendedNever leave student unattended

Have a sugar source availableHave a sugar source available

Buddy system can be helpfulBuddy system can be helpful

School attendance may be affectedSchool attendance may be affected

What is Hyperglycemia?What is Hyperglycemia?

High blood sugar High blood sugar levellevel

CausesCauses– Too little medicineToo little medicine– Too much foodToo much food– Too little exerciseToo little exercise– Illness,infection, stressIllness,infection, stress

HyperglycemiaHyperglycemia(High Blood Sugar)(High Blood Sugar)

SymptomsSymptoms– Extreme ThirstExtreme Thirst– Frequent UrinationFrequent Urination– Dry SkinDry Skin– Increased HungerIncreased Hunger– DrowsinessDrowsiness– Visual Disturbances /Blurred VisionVisual Disturbances /Blurred Vision– Weight LossWeight Loss– Slow healing cutsSlow healing cuts– Classroom performance may dropClassroom performance may drop

Causes of HyperglycemiaCauses of Hyperglycemia (High Blood Sugar)(High Blood Sugar)

Missed insulin injectionMissed insulin injection

Not enough insulinNot enough insulin

Eating too much foodEating too much food

Impending or acute illnessImpending or acute illness

InfectionInfection

Too little exerciseToo little exercise

Emotional or physical stressEmotional or physical stress

Treatment of HyperglycemiaTreatment of Hyperglycemia

Unless the child is sick they can stay in schoolUnless the child is sick they can stay in school– TREATMENT:TREATMENT:

Follow IHP and facility’s protocolFollow IHP and facility’s protocol

Increase fluids (water, without sugar)Increase fluids (water, without sugar)– Diet drinks, broth, ice chips, waterDiet drinks, broth, ice chips, water

Follow meal planFollow meal plan

Monitor blood sugar more frequentlyMonitor blood sugar more frequently

Take medication according to IHPTake medication according to IHP

Deal with stressDeal with stress

If blood sugar is >240 or as indicated in IHP, check for ketonesIf blood sugar is >240 or as indicated in IHP, check for ketones

Call parent/doctor when ketones present or as indicated in IHPCall parent/doctor when ketones present or as indicated in IHP

Foot CareFoot Care

Do’sDo’s– Look at feet dailyLook at feet daily– Wash feet dailyWash feet daily

Use lukewarm waterUse lukewarm waterKeep skin softKeep skin softDry feet wellDry feet well

– Check shoes before Check shoes before putting onputting on

– Always wear socksAlways wear socks– Keep feet warm and dryKeep feet warm and dry

Don’tsDon’ts– Walk barefootWalk barefoot

– Use heating pads/hot Use heating pads/hot water bottleswater bottles

– Wear tight socks or knee Wear tight socks or knee highshighs

– Wear socks with holes Wear socks with holes

– Wear torn or tight shoesWear torn or tight shoes

How To TreatHow To Treat High Blood SugarHigh Blood Sugar

Follow your facility’s protocolFollow your facility’s protocol

Follow directions provided by doctorFollow directions provided by doctor

Give fluids Give fluids without sugarwithout sugar if able to swallow if able to swallow– Such as:Such as:

Diet drinksDiet drinks

BrothBroth

Ice ChipsIce Chips

WaterWater

Blood Glucose MonitoringBlood Glucose Monitoring

Role of the SchoolRole of the School– Facilitate blood glucose monitoring per IHPFacilitate blood glucose monitoring per IHP

– Act on blood glucose test result per IHPAct on blood glucose test result per IHP

– Provide monitoring data to parentsProvide monitoring data to parents

Blood Glucose MonitoringBlood Glucose Monitoring

BenefitsBenefits– SafetySafety– Manage IllnessManage Illness– Improve Blood Sugar ControlImprove Blood Sugar Control– Adjust InsulinAdjust Insulin– Sense of ControlSense of Control– Know effects of foods, exercise, and stressKnow effects of foods, exercise, and stress

Factors That Change Blood Factors That Change Blood Sugar LevelsSugar Levels

DietDiet

ExerciseExercise

MedicationMedication

EmotionsEmotions

HormonesHormones

Rapid growthRapid growth

IllnessIllness

Menstrual periodsMenstrual periods

Blood Glucose Monitoring in SchoolBlood Glucose Monitoring in School

Who is responsible?Who is responsible?

Teacher/Nurse/ Student Teacher/Nurse/ Student When:When:

Before lunchBefore lunch

Before and after GYMBefore and after GYM

SymptomaticSymptomatic

Where:Where:

Designated areaDesignated area

Document Blood Sugar in log bookDocument Blood Sugar in log book

UNIVERSAL PRECAUTIONSUNIVERSAL PRECAUTIONS

Emergency ManagementEmergency Management

HypoglycemiaHypoglycemia

– <70 mg/dl<70 mg/dl

– Treat with carbohydrateTreat with carbohydrate

– If unresponsive call 911If unresponsive call 911

– Administer Glucagon- Administer Glucagon- (hormone that raises (hormone that raises blood glucose levels by blood glucose levels by causing the release of causing the release of stored carbohydrate stored carbohydrate from the liver))from the liver))

HyperglycemiaHyperglycemia

– Check for ketones- Check for ketones- call parent/MD or call parent/MD or as indicated in IHPas indicated in IHP

– Increase fluids Increase fluids (non-sugared)(non-sugared)

InsulinInsulin

Medication taken by injection through a Medication taken by injection through a syringe/pumpsyringe/pump

Types of InsulinTypes of InsulinRapid actingRapid actingShort actingShort actingIntermediateIntermediateLong Long Mixtures of fast/long actingMixtures of fast/long acting

Sliding scale may be utilizedSliding scale may be utilized

Meal planningMeal planning

SnacksSnacks

LunchesLunches

School partiesSchool parties

Field tripsField trips

After school activitiesAfter school activities

– Meals and snacks must be scheduledMeals and snacks must be scheduled

– Consistency is the keyConsistency is the key

ExerciseExercise

BenefitsBenefits– Better control of blood sugarBetter control of blood sugar– Feel goodFeel good– Maintain normal body weightMaintain normal body weight– Improved enduranceImproved endurance

– Precaution: Can cause HypoglycemiaPrecaution: Can cause Hypoglycemia

IllnessIllness

Frequent monitoringFrequent monitoring

Ketone testing:Ketone testing:– Urinate on a reagent strip then compare colorUrinate on a reagent strip then compare color– Positive for ketones- follow IHPPositive for ketones- follow IHP– Increase fluids- water- to prevent dehydrationIncrease fluids- water- to prevent dehydration

Psychological IssuesPsychological Issues

At each stage of development there will be different At each stage of development there will be different issues to deal with relating to food, insulin, blood glucose issues to deal with relating to food, insulin, blood glucose testing, diabetestesting, diabetes

Referral to psychologist/counselorReferral to psychologist/counselor

Becoming independent with their care can be a problemBecoming independent with their care can be a problemSelf esteem is important for each studentSelf esteem is important for each student

They do not wish to feel different than their peersThey do not wish to feel different than their peers

SummarySummary

Children with diabetes can do every thing other children Children with diabetes can do every thing other children can docan do

Remember they were a child before the diabetesRemember they were a child before the diabetes

Do not assume your student completely understands Do not assume your student completely understands his/her conditionhis/her condition

Developing an individual care plan will help them gain Developing an individual care plan will help them gain control with managing their diabetes and will help all control with managing their diabetes and will help all those involved with their carethose involved with their care

Key TermsKey Terms

Autoimmune diseaseAutoimmune disease – A disorder in – A disorder in which the immune system mistakenly which the immune system mistakenly attacks an destroys body tissue that it attacks an destroys body tissue that it believes to be foreign. In type 1 diabetes, believes to be foreign. In type 1 diabetes, an autoimmune disease, the immune an autoimmune disease, the immune system attacks and destroys the insulin-system attacks and destroys the insulin-producing beta cells.producing beta cells.

Key TermsKey Terms

Insulin ResistanceInsulin Resistance – A condition in which – A condition in which the body does not respond normally to the the body does not respond normally to the action of insulin. Many people with type 2 action of insulin. Many people with type 2 diabetes have insulin resistance.diabetes have insulin resistance.

Key TermsKey Terms

Ketones Ketones – Chemicals that the body – Chemicals that the body makes when there is not enough insulin in makes when there is not enough insulin in the blood and the body must break down the blood and the body must break down fat for its energy. Ketones can poison and fat for its energy. Ketones can poison and even kill body cells. When the body does even kill body cells. When the body does not have the help of insulin, ketones build not have the help of insulin, ketones build up in the blood and “spill” over into the up in the blood and “spill” over into the urine so that the body can get rid of them. urine so that the body can get rid of them. Ketones that build up in the body for a Ketones that build up in the body for a long time lead to serious illness and coma.long time lead to serious illness and coma.

ResourcesResources

American Diabetes Association (ADA)American Diabetes Association (ADA)– 1-800—DIABETES1-800—DIABETES– www.diabetes.orgwww.diabetes.org

American School Health AssociationAmerican School Health Association– 1-330-678-16011-330-678-1601– www.ashaweb.orgwww.ashaweb.org

Centers for Disease Control and Prevention (CDC)Centers for Disease Control and Prevention (CDC)– 1-800-311-34351-800-311-3435– www.cdc.govwww.cdc.gov

Juvenile Diabetes Research Foundation InternationalJuvenile Diabetes Research Foundation International– 1-800-533-CURE1-800-533-CURE– www.jdrf.orgwww.jdrf.org

Emergency KitEmergency Kit

Blood glucose meter, testing strips, lancets, and Blood glucose meter, testing strips, lancets, and batteries for the meterbatteries for the meterUrine ketone stripsUrine ketone stripsInsulin and suppliesInsulin and suppliesInsulin pump and supplies, including syringesInsulin pump and supplies, including syringesOther medicationsOther medicationsAntiseptic wipes or wet wipesAntiseptic wipes or wet wipesFast-acting source of glucoseFast-acting source of glucoseCarbohydrate-containing snacksCarbohydrate-containing snacksHypoglycemia food supplies (enough for 3 episodes): Hypoglycemia food supplies (enough for 3 episodes): quick-acting sugar and carbohydrate/protein snacksquick-acting sugar and carbohydrate/protein snacksGlucagon emergency kitGlucagon emergency kit

ResourcesResources

Food Guide Pyramid for ChildrenFood Guide Pyramid for Children– www.usda.gov/cnpp/KidsPyra/LittlePyr.pdfwww.usda.gov/cnpp/KidsPyra/LittlePyr.pdf– 5 a Day5 a Day– www.5aday.comwww.5aday.com

Dole-5-A-Day education materialsDole-5-A-Day education materials– Free to elementary teachersFree to elementary teachers– www.dole5aday.comwww.dole5aday.com

ResourcesResources

American Dietetic AssociationAmerican Dietetic AssociationAmerican Academy of American Academy of PediatricsPediatricsAmerican Academy of Family American Academy of Family PhysiciansPhysiciansAmerican Medical AssociationAmerican Medical AssociationCenters for Disease ControlCenters for Disease ControlActivateActivateWeight Control Information Weight Control Information CenterCenterDepartment of AgricultureDepartment of Agriculture– Team NutritionTeam Nutrition– Food & Nutrition Information Food & Nutrition Information

CenterCenter

www.eatright.orgwww.eatright.org

www.aap.orgwww.aap.org

www.aafp.orgwww.aafp.org

www.ama-assn.orgwww.ama-assn.org

www.cdc.govwww.cdc.gov

www.kidnetic.comwww.kidnetic.com

www.niddk.nih.gov/health/nutrit/wiwww.niddk.nih.gov/health/nutrit/win.htmn.htm

www.fns.usda.gov/tnwww.fns.usda.gov/tn

www.nal.usda.gov/fnicwww.nal.usda.gov/fnic