Diabetic Care Managers Training
Nash-Rocky Mount Schools
Care of School Children with Diabetes
Updated: June 2013
Thank you for being a participant in the DCM Program!!
Your participation demonstrates your interest in all students
being successful in school.
You may already have an interest in diabetes and this program
will help you learn more.
Not only are we seeing an increase in Type 1 diabetes but there
is an alarming increase of Type 2 diabetes in our young
population.
We are very proud that the state of North Carolina is among
the eleven states who have legislation to assure these young
people a positive and supportive school experience.
When a student with diabetes is part of the school system,
the school staff automatically becomes a part of the
student’s health care team.
A student with diabetes can have special challenges for which
teachers and staff must be prepared.
This program is designed to train school personnel who are
available every day at school in basic and emergency
diabetes care.
Other personnel need to know some basic diabetes care to
allow the student to have a successful day at school.
DATA Program
(Diabetes Awareness, Training and Action)
Master Training
By: State partners and Certified Diabetes Educators
Target of Training: Two from Each LEA; One from each Charter School
From LEA: 504 Coordinator responsible for assuring implementation of general training plan
And One RN or other Health Professional responsible for intensive training
General Training for 504 Contacts
By: 504 Coordinator Master Trainer
Target: 504 Contact Person or Other Person from each school in the LEA
who becomes the trainer responsible for providing general training to all staff in his/her school
Intensive Training
By: RN Master Trainer or Certified Diabetes Educator
Target: Diabetes Care Manager (DCM) providing care management in each school in the LEA
Two per school
General Training of All School Staff
By: 504 Contact or Other Person
Target: All school personnel within the specific school
Part 1: Overview of SB 911: Care of School
Children with Diabetes
 Federal & State Support and History of the Law
Diabetes is considered a disability and is
covered under the following Federal Acts:
 Section 504 of the Rehabilitation Act of 1973
 Individuals with Disabilities Education Act of 1991
 Americans with Disabilities Act
 State Board of Education Policy # 04A107
Special Health Care Services (1995)
 Shall make available a registered nurse for assessment, care
planning, and on-going evaluation of students with special
health care service needs in the school setting…
 Senate Bill 911 passed unanimously in the House and
Senate in August, 2002!!
 On September 5, 2002 the bill was signed into law by
Governor Easley, only 3 months after its
introduction!!
 NRMPS held the first DCM class in July of 2003
 Implications for NC Schools
 Guidelines adopted in every school in the state must meet or exceed
American Diabetes Association recommendations.
Section 1 of SB 911
– Procedures for the development of a diabetes care plan
if requested by parent
– Procedures for the regular review
– Included should be:
– Responsibilities and staff development for teachers and
other school personnel
– Development of an emergency care plan
– Identification of allowable actions to be taken
– Extent of student’s participation in diabetes care
Section 2 of SB 911
– Local Boards of Education must ensure that
guidelines are implemented in schools in which
students are enrolled.
– Local Boards of Education will make available
necessary information and staff development
in order to support care plan requirements for
students with diabetes.
Section 3 of SB 911
• The NC State Board of Education delivered a progress
report in September, 2003.
Section 4 of SB 911
• The guidelines were implemented by the beginning of
the 2003-2004 school year.
• Guidelines were updated August, 2005.
-Children should have immediate access to diabetes
supplies and diabetes treatments as defined in the
IHP.
– Roles and responsibilities of the parents/guardians
and the schools are defined.
– DCM roles are also defined.
G.S. 115C-375.3
April 28, 2005
House Bill 496 states that local boards of education shall
ensure that guidelines for the development and
implementation of individual diabetes care plans are
followed.
Local boards are to make available necessary
information and staff development in order to support
and assist students with diabetes in accordance with
their individual diabetes care plans.
 A copy of the ADA Standards is available in the
Diabetes Care Manual online.
 An individual Health Plan (IHP) should be
developed by the parent/guardian, the student’s
diabetes care team, and the school nurse.
 At least 2 school personnel in each school should
be trained in diabetes care and emergencies
(Diabetes Care Managers / DCM).
Forms to Facilitate Implementation of the Law
 Diabetes Care Plan Request
Diabetes Care Plan
if doctor’s office does not have own version of plan
Responsibilities of Parent
completed every school year
Responsibilities of School
completed every school year
Quick Reference Plan
School Nurse Responsibilities
• Communicate with student, parent, school staff and
health care providers
• Educate staff on SB-911 Diabetes School Act
• Provide forms needed to parents and staff
• Provide training for all staff and DCM’s
• Act as a resource for student, staff and parents
• Provide and participate in continuing education for
diabetes management
DCM Responsibilities
• Communicate with nurse, student and parent (if
possible)before school year begins. Meeting to be
arranged by nurse.
• Ask questions about self care abilities of student
• Get to know the student
Student Responsibilities
• Demonstrate to nurse the ability to perform procedures
independently.
• Equipment kept at school- older students should carry
their equipment
• Diabetes care recommendations may change during
the school year
• Whom to tell about having diabetes. Some students
may not want anyone to know.
• Diet issues:
• Meals
• Snacks- parent to provide
• Emergency snacks- parent to provide and where are they kept
Parent Responsibilities
 Phone numbers
 Home, work, cell, pager









Supplies
Snacks
School absences
Care Plan request
Care Plan
Medication forms
Diet form
Student photo
Medic alert ID
Parent Request for Care Plan
• No MD signature required
• Must request for Care Plan to be implemented
• Consent for release of information
• Trained staff in place
• Request for Care Plan completed annually
Parents Need to Know...
 Student, parent or 911 will have to assume
responsibility for diabetes care until Care Plan signed
and returned.
 A new Care Plan is required annually.
 Communicate on regular basis with school staff and
bus driver either verbally or written.
Role of the Diabetes Care Managers in Each School
• Participate in the Intensive training session.
• Obtain certificates of course completion and maintain
documentation as proof of completion.
• Participate in care planning conferences.
• Have ready access to the student’s care plan/quick
reference.
• Be readily reached in case of a diabetes emergency.
• Communicate with school nurse any issues or concerns
regarding the daily care of the student.
The nurse will communicate these issues with parents, health
care providers and other staff.
• Make staff aware of your role as DCM- this includes
substitute teachers.
• Assist the student with diabetes care as indicated in the
care plan.
• Be available to go with the student on field trips or to
school-sponsored extracurricular activities as
indicated.
• Attend continuing education sessions as needed.
 Questions ??
Diabetes Defined
“Diabetes Mellitus is a group of metabolic diseases
characterized by hyperglycemia (high blood sugar)
resulting from defects in insulin secretion, insulin
action, or both.” (Diabetes Care, Supplement 1, 26:1,
January, 2003, p. S5)
Movie Clip
What is Diabetes ?
 Diabetes is a chronic disease that
impairs the body’s ability to use food
properly.
 Insulin helps convert food into
energy, in people with diabetes
either the body doesn’t make
insulin or it can’t use it properly.
 Without insulin, glucose (sugar)-
the body’s main energy sourcebuilds up in the blood.
 Insulin is a hormone produced
in the beta or islet cells in the pancreas.
 It is necessary to move the
sugar or glucose from the
blood stream to the cells.
 Glucose is necessary to keep the cells in the
body healthy.
Type 1:
*Also known as Juvenile-Onset
or Insulin Dependent
Diabetes
*Results from the body’s
destruction of the part of the
pancreas which produces the
hormone, insulin
*Insulin is required for glucose
metabolism (using blood
sugar for fuel in the cells)
*A person cannot live without
insulin
Type 2:
• Also known as Adult-Onset or
Non-insulin-Dependent
Diabetes
* Characterized by insulin
resistance; insulin is
produced but not used
correctly by the body- thus
the blood sugar rises
*Central abdominal obesity is
directly related to insulin
resistance
*Fast growing epidemic in our
young population
*Related to family history of
diabetes, weight gain, and
sedentary lifestyle
Type 1 (immune-mediated) Diabetes
 Usually not obese; often recent weight loss
 Short duration of symptoms (thirst and frequent urination)
 Presence of ketones at diagnosis with about 35% presenting with ketoacidosis.
 Often a honeymoon period after blood sugars are in control during which the
need for insulin diminishes significantly (and sometimes is not needed to
control blood sugars) for a while.
 Ultimate complete destruction of the insulin-producing cells needing
exogenous insulin for survival
 Ongoing risk of ketoacidosis
 Only about 5% with a family history (in first or second degree relatives) of
diabetes
Type 2 Diabetes in Children
 Overweight at diagnosis; little or no weight loss (obesity is the hallmark of
type 2 diabetes)
 Usually have sugar in the urine but no ketones
 As many as 30% will have some ketones in the urine at diagnosis
 About 5% will have ketoacidosis at diagnosis
 Little or no thirst and no increased urination
 Strong family history of diabetes
 45 - 80% have at least one parent with diabetes
 Diabetes may span many generations of family members
 74 - 100% have a first or second degree relative with diabetes
 Typically from African, Hispanic, Asian, or American Indian origin
 Disorders likely to cause insulin resistance are common
 About 90% of children with type 2 have dark shiny patches on the skin
(acanthosis nigricans), which are most often found between the fingers and
between the toes and on the back of the neck ("dirty neck") and in axillary
creases.
 Polycystic ovary syndrome (PCOS)
 Reasons for Controlling diabetes:
 Diabetes
 is the 7th leading cause of death in the
United States
 is the major cause of blindness, non-traumatic
amputations, kidney failure leading to dialysis and the
need for a kidney transplant
 is a major cause of heart attacks and strokes
 can stunt normal growth and development if not
controlled prior to puberty
 Currently, most Type 1 diabetic students are taking insulin by
syringe, pen device, or insulin pump.
 The amount of insulin taken has to be balanced with food
intake (specifically carbohydrates) and physical activity.
 The outcome of all this is
measured by self-monitoring of
blood sugar and keeping a
written log or computer program.
 Ketone testing may also be necessary when the blood sugar is
very high or if the child complains of a stomach ache. (Only
for students with Type 1 diabetes and only if ordered by doctor)
Movie Clip
 Normal blood sugar 70-140 without diabetes
 Target Blood Sugar for diabetics
 <6 years: 100-160 pre-meal and bedtime
 6-12 years: 80-160 pre-meal and bedtime
 >12 years: 80-140 pre-meal; < 160 2 hours after
eating
Hyperglycemia:
 High blood glucose (hyperglycemia) occurs when the body
gets too little insulin, too much food, or too little exercise.
 Hyperglycemia may also occur when a child has an illness
such as a cold.
 Hyperglycemia may occur when a child is under extreme
stress.
Frequent Causes:




Not enough insulin *
Expired insulin
Food not covered by insulin * (too much food)
Decreased physical activity * (not enough activity)

Illness, injury
Stress
Other hormones




Menstrual periods
Any combination of the above
* most common causes
Signs of hyperglycemia
 Frequent Urination *
 Extreme Hunger
 Extreme Fatigue
 Unusual Thirst *
 Irritability
 Blurred Vision
* most common
Complication of prolonged hyperglycemia
 Ketones(acids) can build up and result in
Movie Clip
diabetic ketoacidosis (DKA).
What is DKA?
 Acids that build up in body and cause student to
feel ill
 Emergency state, can lead to coma, death.
 Common symptoms include fruity odor to
breath, nausea, vomiting, drowsiness
 Number one reason for hospitalizing children
with diabetes
 Early detection and treatment of ketones
prevents hospitalizations
“Hypoglycemia”
Movie Clip
Hypoglycemia
 Sometimes called an insulin reaction
 Occurs when blood sugar is below the target range
(under 70-80)
 Can be caused by too much insulin, increased activity,
eating too few carbohydrates
 Happens when the body does not have enough sugar
in the blood
Lows happen when insulin and blood sugar
are out of balance.
 People without diabetes do not usually
get hypoglycemia.
 Their body can tell when it has enough
insulin and stops releasing it automatically.
 But people with diabetes have to figure
out how much insulin their body will need.
Recognizing Low Blood Sugar
 It is important to recognize a low blood
sugar as soon as possible so that it does
not progress to a severe reaction.
 Early signs are caused by the release of
a hormone named epinephrine.
 People make this hormone when they
are excited.
Frequent Causes of Low Blood Sugar
 Meals that are late or missed
 Extra exercise or activity
 An insulin dose which is too high
 Unplanned changes in schedule
 Lock down, assembly, field trip
Signs and Symptoms of
Low Blood Sugar (early signs)









Hunger
Shakiness
Dizziness
Sweatiness
Fast heartbeat
Drowsiness
Feeling irritable, sad or angry
Nervousness
Pallor
More Signs and Symptoms of
Low Blood Sugars (later signs)
 Feeling sleepy
 Being stubborn
 Lack of coordination
 Tingling or numbness of the tongue
 Personality change
 Passing out
 Seizure
What To Do When Hypoglycemia Occurs
 If possible always do a blood sugar
check first.
 If meter is unavailable and child feels
sick, go ahead and treat.
 Eat or drink about 15 grams of fast-acting
carbohydrate.
 Wait 15 minutes and test blood sugar.
 If blood sugar remains lower than 70 or
below target for individual child, treat again.
Hypoglycemia Busters
 2-4 glucose tablets
 3-4 teaspoons of
 4 ounces of apple or
sugar or syrup
 1 cup of low fat milk
 1 tube of cake gel
orange juice
 4-6 ounces of regular
soda
 4-8 Lifesavers
 2 tablespoons of
raisins
Catch Low Blood Sugar Early
 Be alert for any symptoms and times when
a low blood sugar is likely to occur.
 Test blood sugar if there is any doubt.
 Fast acting carbohydrate or sugar should always
be available.
 Treat low blood sugar promptly or it can
turn into severe hypoglycemia.
Severe Hypoglycemia
When severe hypoglycemia occurs, this indicates that
not enough sugar is getting to the brain.
The student may lose consciousness and/or have
convulsions (seizures).
At this time the student will need the assistance of
someone else.
What Happens when the Child is Unconscious?
 Glucagon injection may then be necessary.
 Drinking soda or eating glucose tablets
is not possible and would be dangerous when the child is
unconscious.
 Glucagon is a substance or hormone that makes the liver
release sugar into the blood stream.
What is Glucagon?
 Glucagon is a naturally occurring hormone made in
the pancreas
 Raises blood sugar by releasing glycogen (a carbohydrate)
from the liver
 Can save a life (severe hypoglycemia can cause brain damage or death)
 Cannot harm a student
Glucagon Kit
Movie clip




Location of kit should be designated in care plan.
Store at room temperature
Monitor expiration date: parent to replace
After mixing, dispose of any unused portion.
Emergency Kit Contents:
1 mg of freeze-dried glucagon (Vial)
1 ml of water for reconstitution (Syringe)
Combine immediately before use
When to Give Glucagon
If authorized by the student’s care plan and if
student exhibits:
 Unconsciousness, unresponsiveness
 Convulsions or seizures
 Inability to safely eat or drink
Procedure: Act Immediately
 Position student safely on side for
comfort and protection from
injury
 Call 911
 Call school nurse and parents as
per care plan
Treatment tools for Diabetes Management
 Blood sugar testing
 Carbohydrate counting
 Insulin administration
Blood sugar monitoring
 Self-Monitoring of Blood Sugar:
 Is important for anyone with diabetes
 Currently is done by placing a very small drop of blood
on a test strip in a blood glucose meter
Movie clip
 Takes from 5-45 seconds, depending
on the meter
 Should be recorded in the child’s log book
*A blood glucose sensing device that does not require blood is
available. It does not replace blood sugar monitoring.
Glucometer Demonstration
Movie clip
Lancing Devices
Lancets
Pen-type Lancing Devices
Know the Meter
250

Features vary:
–
–
–
–
–

53
Ease of use
Sample size needed
Wait time
Alternate-site testing capacity
Ability to reapply, if insufficient sample
Become familiar with the operation of each
student’s meter
What does the number mean?
Reference student’s target range
 Individualized for student
 May vary throughout day
 Take action per care plan
Communicate sensitively
School Nutrition Management

Student’s family and health care team determine an
individualized meal plan

Meals & snacks need to be carefully timed to balance
exercise and insulin/medications

Encourage healthy eating for all students
Movie clip
Meal Plans for diabetes
Key:


Balance insulin/medications
with carbohydrate intake
Most students have flexibility in WHAT to eat.
3 most common meal plans:
 Exchange System
 Basic Carbohydrate Counting
 Advanced Carbohydrate Counting

Many students have flexibility in WHEN to eat.
 More precise insulin delivery (pumps, pens)
 New types of insulin
Exchange System Meal Plan
Meal plan comprised of a given number of
servings from each of major food groups:

carbohydrates (fruit, starch, milk)

meat/meat substitutes

vegetables

fat
 Itemizes number of exchanges from each
category for each meal/snack
 Exchange List

Basic Carbohydrate Counting

Calories from:

carbohydrate

protein

fat

Each nutrient type affects blood sugar differently.

Carbohydrate has the biggest effect on blood sugar.

TOTAL carbohydrate matters more than the source
(sugar or starch.)
Advanced Carbohydrate Counting
USING THE INSULIN-TO-CARB RATIO
The insulin-to-carb ratio:
 Varies from student to student.
 Is determined by the student’s health care team
 Should be included in the care plan
School Meals & Snacks

Provide school menus and nutrition
information to student/family in
advance

Provide sufficient time for eating

Monitor actual food intake per care plan
 young, or newly diagnosed
 picky eaters

Respect, encourage independence
Practice Carb Counting
Tools you should have
Breakfast: took sliding scale insulin at home
Scrambled Eggs and Cheese w/Toast, white milk
Insulin= 1 unit/10 gm carb
Glucose
Insulin
Food
Carbs
Carbs
Insulin
180-250
2 units
0
10
1
251-325
3 units
Scrambled Egg and Cheese
(.90)
20
2
326-400
4 units
Toast (13.4)
15
30
3
>400
5 units
White milk (12)
10
40
4
Sliding Scale=
Carb coverage=
26.3 25
Carbs eaten=
Total insulin given=
Breakfast: BS 335 has not had sliding scale insulin yet
Reduced fat donut and juice
Insulin= 1 unit/15 gm carb
Glucose
Insulin
Food
Carbs
Carbs
Insulin
180-250
2 units
Reduced fat donut (43)
45
15
1
251-325
3 units
Juice- grape (18)
20
30
2
326-400
4 units
61 65
45
3
>400
5 units
60
4
75
5
90
6
Sliding Scale=
Carb coverage=
Carbs eaten=
Total insulin=
BS 168 before lunch
Chicken Nuggets, dinner roll, coleslaw, strawberries, chocolate milk
Insulin= 1 unit/15 gm carb
Glucose
Insulin
Food
Carb
Carbs
Insulin
180-250
2 units
Chicken nuggets (9.94)
10
15
1
251-325
3 units
Dinner roll (14.0)
15
30
2
326-400
4 units
Coleslaw(10.90)
10
45
3
>400
5 units
Strawberries- frozen (33.63) 35
60
4
Chocolate milk (24.0)
25
75
5
95
90
6
105
7
(92.47)
Sliding scale=
Carb coverage=
Carbs eaten=
Total insulin=
 Blood sugar before lunch was 65
 Turkey and gravy w/rice, cranberry sauce, roll, sweet potato souffle, peaches
and strawberry milk Special Instructions
If blood sugar is 60-70 before the meal subtract 15 gm from the total carbs eaten and cover
the remaining amount with insulin. If < 60 follow the “rule of 15” before sending to lunch.
Glucose
Insulin
180-250
2 units
Food
Carbs
Carbs
Insulin
251-325
3 units
Turkey and Gravy (7.76)
5
60
4
326-400
4 units
Rice (25.04)
25
75
5
>400
5 units
Cranberry sauce (26.18)
25
90
6
Dinner roll (14)
15
105
7
Sweet potato souffle (54.44)
55
120
8
Peaches (13.91)
15
135
9
Strawberry milk (32)
35
150
10
165
11
180
12
Sliding scale=
Carbs eaten=
Carb coverage=
Total insulin=
(173.33) 175
School Parties
 Provide parent/guardian with advance notice of
parties/special events.
 Follow the student’s care plan, 504 Plan or IEP
 Some students will prefer to bring their own foods.
 Provide nutritious party snacks to encourage healthy
eating habits for all.
 Classroom Party at 2pm- had lunch at 11:30 and insulin at 12:00
 1 frosted cupcake
 2 oreo cookies
 Chips- one handful
 Water
 Where can you find the carb amounts?
Google it!
 Do you need to know what the blood sugar was before the
party? How much insulin do you need to give and why?
Where are you looking for your information??
Special Instructions
1 unit/10 gms carbohydrate for breakfast and snacks
First 20 gms of snack are “free”
Carbs
Insulin
10
1
20
2
30
3
Food
Carbs
40
4
Frosted cupcake (29)
30
50
5
2 Oreo’s (9 each)
20
60
6
Chips (15 gm/oz)- about 20 chips in an ounce or single serving
10
70
7
Water (0)
0
Sliding scale=
Carbs eaten=
Carb coverage=
Total insulin=
Glucose
Insulin
180-250
2 units
251-325
3 units
326-400
4 units
>400
5 units
What every student with diabetes wants
you to remember:
Sugar is NOT the Enemy
There is no justification for complete restriction of sugar:
 Sometimes sugar can be a life-saving friend!
 However, timing matters a lot with diabetes, and sometimes
sugar (or any carbohydrate) is not a good choice at all.
Field Trips

Bring snacks to treat hypoglycemia- parent to
provide. Keep snacks and supplies with the
student.

Bring lunch as appropriate. If taking a school bag
lunch, get carb counts before leaving.

Consult with parent/guardian about food and/or
insulin adjustments for extra activity level.

Bring diabetes equipment and supplies and insulin
administration information.

Bring list of emergency contacts
Exercise & Diabetes
Everyone benefits from exercise and physical activity.
Students with diabetes should fully participate.
In general, exercise lowers blood sugar levels.
 May need to make adjustments to insulin/medications
and food intake.
 A quick-acting source of glucose, glucose meter, and
water should always be available.
 PE teachers and coaches must be familiar with
symptoms of both high and low blood glucose.
Exercise & Blood Glucose Monitoring
Check before, during, and after exercise per care plan.
 Especially important to check before trying a new activity or
sport
 If blood sugar starts to fall, student should stop and have a
snack
 Students with pumps may disconnect or adjust the basal rate
downward, in lieu of snacking (per care plan)
Questions
Insulin
 Most students take at least two injections of insulin a
day.
 Long-acting and rapid acting insulin most common.
 Some students are on intensive insulin therapy or wear
the insulin pump.
 A combination of different insulin is most often used.
 It is important to remember that insulin types have
different “peak” times. These are times when insulin is
working hardest to lower blood sugar.
Insulin Action
 Insulin types are categorized as rapid- acting,
fast-acting, intermediate- acting, long-acting or
basal.
 Each type has a different onset, peak and
duration.
When to Give Insulin
Administer as specified by care plan:
Generally:
 Before meals
 For blood glucose levels significantly above
target range
 For increased ketones
Dosage Specifications
Care plan should specify conditions clearly.
 Dosage based upon insulin to carbohydrate
ratios for meals and snacks
 Correction dosage to treat hyperglycemia
Delivery Methods
Insulin Syringe
Insulin Pen
Insulin Pump
Jet Injector
Insulin
Syringes
 Sizes – 30, 50, 100
units
 Use only once
 Dispose of in
sharps container
Movie clip
Insulin Pen Devices
Movie clip
Sampling of Pumps
Web link
Minimed
One-Touch Ping
tSlim
AccuCheck Spirit
OmniPod
What is an Insulin Pump?
 Battery operated device about the size of a pager
 Reservoir filled with insulin
 Computer chip with user control of insulin delivery
 Worn 24 hours per day
 Delivers one type of insulin
Insulin Pump Therapy
 Based on what body does naturally

Small amounts of insulin all the time
(basal insulin)

Extra doses to cover each meal or snack
(bolus insulin)
 Rapid or Short-Acting Insulin
 Precision, micro-drop insulin delivery
 Flexibility
Movie clip
Pump Supplies at School
 Infusion set
 Reservoir
 Insulin
 Skin prep items
 Alcohol wipes
 Syringe (in case of malfunction)
 Pump batteries
 Inserter (if used)
 Manufacturers manual, alarm card
Administering Insulin: Concerns and Issues
 A vial or pen of insulin is good for 30 days after
opening.

Date the vial or pen when opened
 Check expirations date on insulin to make sure it
is in date.
 Triple check yourself when drawing up a dose of
insulin.
 Double check the student’s dose if he/she is
drawing up the insulin.
What if…
You give too much insulin?
 Notify the school nurse.
She will let you know what to do and will contact parent and
healthcare provider as needed.
 Nurse will let the parent know what actions are being taken to
keep the child safe.
 Eat enough carbs to cover the extra insulin given- if gave 2 units
extra and 1u/15gm then have eat 30 gm

 Test blood sugar at least every hour for the rest of the school day.
 Make sure the child has extra food/juice readily available.
 Alert the teacher(s) that student may run low and to contact you if
needed.
What if…
You gave too little insulin OR if insulin leaks from the site:

If you give too little insulin, an additional shot can be given to make
up the missed amount. Document your actions.

If the child refuses the extra shot, document the occurrence and
notify the school nurse- she will notify parent.

Generally there is not much you can do if insulin leaks at the site.
Blood sugars may run a little higher that day.

If insulin leaks are a common problem, take a little more time with
the injection and count 10 seconds before withdrawing the needle.
After Giving Insulin By Any Route
 Check site for leakage
 Correction doses (SSI for high sugar only):
 Retest per care plan
 Meal/snack doses:
 Timeliness- give ASAP after eating
 Supervision of food amount per care plan
Management of Type 2 Diabetes
 The preferred method of treating Type 2 diabetes in
young people is exercise and weight management.
 Often, Type 2 diabetes requires the child to eat a
certain amount of carbohydrate at each meal.
 Oral medications would be an option if Type 2
diabetes is not controlled with the measures
mentioned above.
 Some Type 2 diabetics will require insulin.
Oral Meds
 The most frequently used medication for increasing
insulin sensitivity in Type 2 diabetes in kids is
metformin or Glucophage™.
 Metformin works by preventing the liver from
releasing glucose into the system and does not cause
low blood sugars or promote weight gain.
School implications
 Students with hyperglycemia or hypoglycemia often do not
concentrate well.
 During academic testing:
 Check blood glucose before and during testing, per
educational plan.
 Access to food/drink and restroom.
 If a serious high or low blood glucose episode occurs,
students should be excused with an opportunity for retake.
 Students should have adequate time for taking
medication, checking blood glucose, and eating.
School Implications
 “Make the right choice the easy choice” by
eliminating barriers to:
– snacking
– blood glucose testing
– access to water and bathrooms
 Avoid making judgments based on individual
blood glucose readings.
Liability Concerns and Issues for DCMs
 How do I prevent liability situations from occurring?
 Be very familiar with the student’s care plan and refer to
it often.
 If the student needs assistance with administering
insulin, make sure the most recent dosage schedule is
available for your use.
 When in doubt- call your nurse!! You have time to stop
and think and make an informed decision. You are not
alone!
Liability Concerns and Issues
 How do I prevent liability situations from occurring?
 Be very familiar with the student’s care plan and refer to
it often.
 If the student needs assistance with administering
insulin, make sure the most recent dosage schedule is
available for your use.
 When in doubt- call your nurse!! You have time to stop
and think and make an informed decision. You are not
alone!
– Insulin (pen or vial) kept at room temperature is
discarded 30 days after opening. Date pen or vial when
opened.
– Check expirations dates on insulin and glucagon to
make sure they are in date.
– Triple check yourself when drawing up a dose of
insulin. Double check the student’s dose if he/she is
drawing up the insulin.
What about sharps, blood, and carrying medication
around the school?
 Self-monitoring of blood sugar should be supported.
 The lancet should not be removed from the lancing device.




The parent or student should change the lancet.
The testing strips can be discarded in the trash
Used needles and syringes should be disposed of in a
sharps container
Insulin pumps cannot be removed except to quick release
in certain instances.
Students injecting insulin with pens or syringes should be
provided a safe place for injecting.
 Glucose Tabs are not medication.
 Some students with diabetes should be monitored at
all times for safety of all involved.
 Other discipline problems should not interfere with
the self-management rights of the student with
diabetes.
What if I make a mistake?
 Most incidents occur when we are in a rush to do
something. So, slow down and think carefully.
Remember to use logic. If it doesn’t make sense,
question it! Call your nurse!
 If an incorrect dosage is given, document the
procedure you take to keep the child safe.
Protection from litigation
The State of NC now has SB911 in place with
directives for adoption by all public schools in
the state.
Many State Agencies have organized this training
program.
You are now going through the training and will
receive a certificate of completion once the
training has satisfactorily been completed.
You will maintain up to date knowledge through
continuing education.
You will have resources to call upon if questions
or problems arise.
 Do I have any other protections?
 NC General Statute 90-21.14 adopted in 1975:

Provides immunity for rescuers

Provides immunity for acquirers and enablers

Encourages/requires CPR & AED training
This is the “Good Samaritan Law”
What’s next?
 You as DCM, should be known by administration
and staff throughout the school – Communication!!
 You and the nurse should make sure an emergency
communication protocol is set up and is followed.
 You should have easy access to the child’s care plan
and be included in any care plan conferences or
revisions.
 You should be notified when special events or
conferences occur for the child in order to include
this in your schedule.
Congratulations!
 What’s next?
 Skills Sheets with your nurse as students
with diabetes enroll and require care
 Keep certificate as proof of training
 Diabetic Care Manual
Credits
 Diabetes Awareness, Training, and Action (DATA)
Program- Master Trainer Manual
 Training Curriculum developed for the NC Public
School System in response to NC Session Law 2002103, Senate Bill 911, Care of School Children with
Diabetes