Diabetes Care Tasks at School:

What Key Personnel Need to KnowDIABETES BASICS

Overall Goal: Optimal Student Health and Learning

ExerciseLegalRights

GlucagonAdministration

Health

&LearningNutritionInsulinRegimenKetones

MonitoringBlood Glucose

Hypoglycemia & Hyperglycemia

Learning ObjectivesParticipants will learn:What is diabetes?Why care at school is requiredBasic components of diabetes care at schoolShort and long term consequences of diabetes

What is Diabetes?Body does not make or properly use insulin:no insulin productioninsufficient insulin productionresistance to insulins effects

No insulin to move glucose from blood into cells: high blood glucose means:fuel loss. cells starveshort and long-term complications

Type 1 Diabetes auto immune disorderinsulin-producing cells destroyed

age of onset: usually childhood, young adulthooddaily insulin replacement necessarymost prevalent type of diabetes in children and adolescents

SYMPTOMS:

increased urinationtirednessweight loss

Type 1 DiabetesCAUSE:uncertain, likely both genetic and environmental factorsincreased thirsthungerblurred visionONSET:relatively quick

Type 2 DiabetesInsulin resistance first step Age at onset:

Most common in adultsIncreasingly common in childrenoverweightinactivity

Type 2 Diabetessome children show no symptoms at diagnosisSYMPTOMS:

ONSET:in childrenvariable timeframetired, thirsty, hunger, increased urination

Diabetes is Managed,But it Does Not Go Away.GOAL:To maintain target blood glucose

Diabetes Management 24/7Constant Juggling: Insulin/medication

with:

Exercise

Food intakeBGBGBG&

Diabetes ManagementProactive

a response is indicatedcorrective actions for highs or lowemergency intervention keep juggling the balls Reactive

Assistance in Diabetes ManagementRoutine Care:Many students will be able to handle all or almost all routine diabetes care by themselves Some students, because of age, developmental level, or inexperience, will need help from school staff.

Urgent Care:Any student with diabetes may need help with emergency medical care.

Care in the Schools: School Nurses and OthersNurse most appropriate to: Supervise diabetes careProvide direct care (when available)However, a nurse is not always available.

Non-medical school staff can be trained to assist studentsFor both routine and emergency care Including insulin and glucagon injections

Diabetes Medical Management PlanA Diabetes Medical Management Plan (DMMP) should be implemented for every student with diabetes.

DMMP is developed by the students personal health care team and family and signed by a member of students personal health care team

implemented collaboratively by the school diabetes team, including:

school nursethe student parents/guardians other school personnel

Elements of a DMMPDate of diagnosis

Emergency contact information

Students ability to perform self-management tasks at school

List of diabetes equipment and supplies

Specific medical orders for blood glucose monitoring, insulin, glucagon, and other medications to be given at school

Meal and snack planExercise requirementsActions to be taken in response to hypoglycemia and hyperglycemia

Quick Reference PlanDevelopment based on information from students DMMP

Summarizes how to recognize and treat hypoglycemia and hyperglycemia

Distribute to all personnel who have responsibility for students with diabetes

Where to Get More InformationAmerican Diabetes Association 1-800- DIABETESwww.diabetes.org

National Diabetes Education Program/NIHwww.ndep.nih.gov

This training is based on and should be used in conjunction with Helping the Student with Diabetes Succeed: A Guide for School Personnel, a guide developed by the National Diabetes Education Program (NDEP), which is a federally sponsored partnership of the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention and over 200 partner organizations. Training participants should read the NDEP guide prior to this training in order to gain a full understanding of the requirements of appropriate school diabetes care. Participants should have a copy of the guide during this training and for future reference.Some Key points about the overall training:Overall objective: The overall goal is to optimize both health and learning for students with diabetes by providing diabetes care training to school nurses and to other school personnel about how and when to perform routine and emergency diabetes care tasks for students. Completion of training will help prepare school personnel to perform diabetes care tasks.Rationale: The school nurse, when available, is the most appropriate person in the school setting to provide care for a student with diabetes. However, many schools do not have full-time nurses. Even for schools that do, the nurse may not always be available during the school day, during extracurricular activities, or field trips, etc., to assist with routine care and emergency care, so trained non-medical school staff members must be available to provide coverage.

This training component is one of eight components created specifically for school nurses and non-medical school personnel who perform diabetes care tasks at school.

These components are:

Diabetes BasicsHypoglycemia and HyperglycemiaBlood-Glucose MonitoringInsulin AdministrationGlucagon AdministrationKetone TestingNutrition and ExerciseLegal Considerations

This unit is Diabetes Basics.

Our objectives are to learn the following:What is diabetes?Why care at school is required. Basic components of diabetes care at schoolShort and long term consequences of diabetes

Diabetes is a chronic disease in which the body does not make or properly use insulin, a hormone that is needed to convert sugar, starches, and other food into energy by moving glucose from blood into the cells.

People with diabetes have increased blood glucose (sugar) levels for one or more of the following three reasons: EitherNo insulin is being produced,Insulin production is insufficient, and/orThe body is resistant to the effects of insulin.

As a result, high levels of glucose build up in the blood, and spill into the urine and out of the body. The body loses its main source of fuel and cells are deprived of glucose, a needed source of energy. High blood glucose levels may result in short and long term complications over time.

Type 1 DiabetesType 1 diabetes is a disease of the immune system, which is the bodys system for fighting infection.

In people with type 1 diabetes, the immune system attacks the beta cells, the insulin-producing cells of the pancreas, and destroys them. The pancreas can no longer produce insulin, so people with type 1 diabetes need to take insulin daily to live.

Type 1 diabetes can occur at any age, but the disease develops most often in children and young adults.

Type 1 diabetes accounts for about 5 to 10 percent of diagnosed diabetes in the United States.

Symptoms. The symptoms of type 1 diabetes usually develop over a short period of time. They include increased thirst and urination, constant hunger, weight loss, and blurred vision. Children may also feel very tired all the time. If not diagnosed and treated with insulin, the person with type 1 diabetes will eventually lapse into a life-threatening condition known as diabetic ketoacidosis (KEY-toe-asi-DOE-sis) or DKA.

Risk factors. Though scientists have made much progress in predicting who is at risk for developing type 1 diabetes, they do not know exactly what triggers the immune systems attack on beta cells. They believe that type 1 diabetes is due to a combination of genetic and environmental factors. Type 2 DiabetesThe first step in the development of type 2 diabetes is often a problem with the bodys response to insulin, called insulin resistance. This means that the body needs increasing amounts of insulin to control blood glucose. The pancreas tries to make more insulin, but after several years, insulin production may drop off.

Type 2 diabetes used to be found mainly in adults who were overweight and over age 40. Now, as more children and adolescents in the United States become overweight and inactive, type 2 diabetes occurs more often in young people. Many people with type 2 diabetes are overweight.

Onset in children: variable timeframe. Some children develop type 2 diabetes rather quickly, other more slowly.Some symptoms similar to type 1:Tired, thirsty, hunger, increased urination

Some children show no symptoms at diagnosis.Whether we consider type 1 or type 2 diabetes, the goal of effective diabetes management is to control blood glucose levels by keeping them within a target range that is individually determined for each child. Optimal blood glucose control helps to promote normal growth and development and allows for optimal learning. It is also needed to prevent the immediate dangers of blood glucose levels that are either too high or too low. Research has shown that maintaining blood glucose levels within the target range can prevent or delay the long-term complications of diabetes such as heart attack, stroke, blindness, kidney failure, nerve disease, and amputations of the foot or leg.

When insulin is no longer made, it must be obtained from another source--insulin shots or an insulin pump. All people with type 1 diabetes must take insulin. People with type 2 diabetes use diet and exercise, and oral medications, and/or insulin to manage their disease. Neither insulin nor other medications, however, are cures for diabetes: they only help control the disease.

Maintaining good blood glucose control is a constant juggling act, 24 hours a day, 7 days a week.

The key to optimal diabetes control is a careful balance or juggling of food, exercise, and insulin and/or oral medication. As a general rule, insulin/oral medication and exercise/activity makes blood glucose levels go down. Food makes blood glucose levels go up. Several other factors, such as stress, illness or injury, also can affect blood glucose levels.

The juggling act of managing the BIG 3 insulin and/or medication, food, and activity level is the proactive part of diabetes management. Keeping those balls in the air by following the diabetes regimen prescribed by the students health care team will go a long way in preventing health problems that might disrupt learning and participation in school.

Knowing how to react when the juggling isnt going very well is also an important part of the diabetes management plan.

If blood glucose levels are too low (hypoglycemia) or too high (hyperglycemia), immediate corrective action must be taken such as administering insulin, eating, or modifying activity level.

The need for assistance with diabetes care tasks will vary from student to student.Routine Care:Many students will be able to handle all or almost all of their routine diabetes care by themselves. Some students, because of age, developmental level, or inexperience, will need help from school staff. Urgent Care:Any student with diabetes may need help with emergency medical care.

The school nurse is the most appropriate person in the school setting to provide care for a student with diabetes.

Many schools in this country, however, do not have a full-time nurse and sometimes a single nurse must cover a large number of schools. Moreover, even when a nurse is assigned to a school full time, he or she will not always be available during the school day, during extracurricular activities, or on field trips. Yet, because diabetes management is needed 24 hours, 7 days a week -- and diabetes emergencies can happen at any time -- a student will always need access to diabetes care at school and at all school-related activities.

Because school nurses are not always available to provide direct care, non- medical school staff can and should be trained to assist students in both routine and emergency care, including insulin and glucagon injections.

A Diabetes Medical Management Plan (DMMP) should be implemented for every student with diabetes. A DMMP is written with the specific needs of an individual student in mind and should detail all the elements of care and assistance for that student. This type of plan could go by a different name in some school districts.

The DMMP is developed and signed by the students personal health care team and family and implemented collaboratively by the school diabetes team, which includes the school nurse, student, parents, and other school personnel.

In addition to a DMMP, a Section 504 Plan, Individualized Education Program (IEP) or other education plan is usually developed to specify how the students medical and academic needs will be implemented at school, and school nurses also often develop an individual nursing care plan.Turn to page 49 of Helping the Student with Diabetes Succeed: A Guide for School Personnel for a sample DMMP.A good school diabetes medical management plan includes the following elements:

Date of diagnosisEmergency contact informationStudents willingness and ability to perform self-management tasks at schoolList of diabetes equipment and suppliesSpecific medical orders for blood glucose monitoring, insulin, glucagon, and other medications to be given at schoolMeal and snack planExercise requirementsActions to be taken in response to hypoglycemia and hyperglycemia

Turn to page 53 of Helping the Students with Diabetes Succeed: A Guide for School Personnel for a sample quick reference plan. Development based on information from students DMMP Summarizes how to recognize and treat hypoglycemia and hyperglycemia. Distribute to all personnel who have responsibility for a student with diabetes.