Type 1 Diabetes:
What You Need to Know
Angie Frey BSN, RN, CDE
Fulton County Health Center
• There are 29.1 million people with diabetes in the United States
• 8.1 million people are undiagnosed
• Approximately 208,000 people younger than 20 years old have been diagnosed with
diabetes (Type 1 and Type 2)
• During 2008 – 2009, approximately 18,436 people younger than 20 years old were
newly diagnosed with Type 1 Diabetes while 5,089 people less than 20 years old were
newly diagnosed with Type 2 Diabetes
•
The highest rate of new Type 1 Diabetes cases was amongst the non-Hispanic white
children and adolescents in 2008-2009.
• One in three American children born in 2000
and after will develop diabetes
Type 1 Diabetes – Body makes little
to no insulin resulting in one needing to
take insulin injections
Approximately 5% of those diagnosed with
Diabetes
Type 2 Diabetes – Body unable to
correctly use one’s insulin (Insulin
Resistance) OR unable to produce
enough insulin (Insulin Deficiency)
Approximately 90-95% of those diagnosed with
Diabetes
Management of Diabetes
The 5 M’s of Diabetes Treatment:
1.
Meals (Plate Method)
2.
Medications
Insulin (by injection or pump – Type 1 & possibly
Type 2)
Oral Diabetes Medications (possibly Type 2)
3.
Monitoring Blood Sugar
4.
Motion (Exercise)
5.
Managing
Considerations When Managing
Type 1 Diabetes at School
• Current Diabetes Medical Management Plan
• A 504 Plan
• A “low box” for the classroom and the nurse’s office
• Diabetes Supplies needed
• Communication Plan to School Personnel
• Classroom Buddy
Diabetes Medical Management Plan
DMMP
• Personal care plan for each student
with diabetes
• Health Care Provider/Parent create this
written and signed plan
• Provides specific instructions for the
school personnel in how to assist a
child with diabetes at school
504 Plan
• Takes information on DMMP and
explains the school’s specific
responsibilities
• Protect‘s child’s rights under
federal laws
• Addressses who shall be
trained to provide diabetes
care tasks
(Start these plans during 3 month visit during late Spring / early Summer)
6
School Goal
• Provide nurturing environment that gives students the ability to safely care for their
diabetes with minimal disruption of class time
Meals : Plate Method
Each meal (9 inch plate) consists of:
• 1 serving of protein
• 3 servings of carbohydrates
(1 starch, 1 fruit, and 1 milk)
• ½ plate of non-starchy vegetables
( lunch & supper)
More Nutritious Eating
• Since carbohydrates quickly raise blood glucose the most…
you may need to reduce
or spread out your daily carb intake.
Which foods contain carbohydrates?
Skim milk
Rice
Diet cola
Baked chicken
Sugar-free pudding
Turkey sandwich
Cottage cheese
Watermelon
Spaghetti
Mayonnaise
Cookies
Ice cream
Scrambled eggs
Peas
Fat-free yogurt
Peanuts
Banana
Baked potatoes
Corn
Tortilla chips
Tuna fish
Pizza
Jelly beans
Pork chops
Which foods contain carbohydrates?
Skim milk
Rice
Diet cola
Baked chicken
Sugar-free pudding
Turkey sandwich
Cottage cheese
Watermelon
Spaghetti
Mayonnaise
Cookies
Ice cream
Scrambled eggs
Peas
Fat-free yogurt
Peanuts
Banana
Baked potatoes
Corn
Tortilla chips
Tuna fish
Pizza
Jelly beans
Pork chops
Consider Timing of Meals and Snacks
• Amount of carbs in meals/snacks are timed to work with the
action of insulin and physical activity
• If meals/snacks are skipped or delayed, the student may
experience low blood glucose (hypoglycemia)
•
Refer to student’s diabetes care plan for meal and snack schedule
12
Tips Regarding Meals and Snacks
• Take notice if child is eating meal or snacks – (may clue
you in to abnormal symptoms later in the day)
• Notify parents of field trips or events so
plans can be made
• Advance planning for class parties
• Send a letter to other parents encouraging nutritious
treats or other party ideas
13
Medication : Insulin
• People with Type 1 DM have to take insulin injections to live.
• Allows glucose in the bloodstream to enter each cell in the body to
provide fuel for energy
• Type 1 diabetes =
insulin
=
energy
= high blood glucose (> 250)
• Correct insulin dose = energy
= target blood glucose level
Types of Insulin Injections
• Pens
• Vial/syringe
• Insulin Pump
Insulin Specifics
Rapid Acting
Apidra (insulin glulisine),
Humalog (insulin lispro),
Novolog (insulin aspart)
Give just
prior to
eating
Short Acting
Humulin R (insulin regular)
Novolin R (regular human insulin)
Give about 30 min. prior
to eating
Intermediate
Acting/
Combination
Humulin N, Novolin N (NPH)
Humalog 75/25, Humalog 50/50
Novolog 70/30, Humulin 70/30
Novolin 70/30
Typically takes twice a
day with breakfast &
supper
Long Acting
Lantus (insulin glargine)
Levemir (insulin detemir)
Typically taken once a
day at about same time
Monitoring Blood Sugar
• Allows for adjustment of insulin, food, or activity to maintain
target blood glucose level
• Students with Type 1 Diabetes – Typically should be checking
their blood sugar before each meal (and possibly before snack
time) along with when they feel their blood sugar is high or low.
- For monitoring frequency, check DMMP
• Target blood sugar range is individual; but generally the goal
before meals is between 80 – 150.
Motion (Exercise)
Children with diabetes need to
participate like all other children
Blood glucose sugar is affected by
physical activity
Common school activities:
Gym class
Recess/field days
After school sports
Planning Safe Exercise
Have easily accessible:
Student’s DMMP
Water/fluids
Snacks (carbs)
Insulin/pump supplies
Blood glucose monitor
Glucagon kit for emergency
Emergency phone numbers
Managing
• This is the combination of the first 4 Ms of treatment (Meals, Medication,
Monitoring, Motion) that works for each person with Diabetes to keep their
blood sugar within the recommended target ranges
• Different for each person –
Determined by “trial & error”
Emergency Situations
• High blood glucose (hyperglycemia &
diabetic ketoacidosis—DKA)
• Blood glucose over 250 and ketones in urine
• Low blood glucose (hypoglycemia)
• Blood glucose 70 or less
Hyperglycemia
Signs & Symptoms
Causes
• Extreme thirst
• Not enough insulin or missed
injections
• Frequent urination
• Dry, Flushed Skin
• Eating too many carbs
• Headache / Stomach ache
• Illness or infection
• Blurred Vision
• Feeling Tired or Not Well
• Emotional/physical stress
• Lack of exercise or activity
Effects of Hyperglycemia
Decreased ability to focus
+
Decreased energy level
+
Frequent trips out of the classroom
=
Decreased school performance
23
Diabetic Ketoacidosis (DKA)
• Most serious consequence of very high blood glucose levels
-- cells not being nourished
• Causes rapid breakdown of fat for energy; leads to ketones in
the urine
• Ketones increase blood acidity; negative impact on all body
organs
• Goal is prevention by regular blood glucose testing & extra
insulin if needed
24
When to Check for Urine Ketones
• Usually when glucose greater than 250
• Check student care plan
• Ketostix are usually foil-wrapped strips (the more glucose in urine
the darker the color)
• Most students can do this themselves
• Assistance may be needed for smaller children
• Use disposable gloves if assisting child
• If moderate to large ketones parent usually contacted.
25
Hypoglycemia
(Low Blood Sugar)
• Occurs when the blood glucose is too low
• Happens quickly
• Needs immediate attention
• Give child fast acting sugar as directed in diabetes care plan
Causes of Hypoglycemia
(Low blood glucose sugar)
• Too much insulin
• Meals or snacks are late or missed
• Extra or extreme exercise
• Excitement in young children (start and finish of school year,
holidays, etc.)
• Alcohol experimentation (older children)
27
Hypoglycemia
(Low Blood Sugar)
Signs & Symptoms
Treatment
• Shaking
• Check Blood Sugar
• Pale skin
(If blood sugar less than 70)
• Sweating
• Treat with: (See DMMP)
• Confusion
• Hunger / Irritable
• Impaired Vision
• Weakness/Fatigue
• Headache / Stomach ache
• Behavior / Personality Change
½ cup juice , ½ cup regular pop,
4 glucose tabs, or
3 rolls smarties
(fat free candy)
• Recheck blood sugar in 15
minutes
• Follow with next meal or
snack with protein
Prolonged low blood sugar can lead to:
Unresponsiveness > Seizures > Unconsciousness
Glucagon
• Naturally occurring hormone made in the pancreas.
• A life-saving, injectable hormone that raises blood glucose level
by stimulating the liver to release stored glucose sugar
• Can save a life. Cannot harm a student – cannot overdose
When to Give Glucagon
If authorized by the DMMP and if student exhibits:
• Unconsciousness, unresponsiveness
• Seizures
• Inability to safely eat or drink
(Monitor expiration date)
30
Tips for Preparing in Event of an Emergency or Lockdown
1. Consider Supplies
Having access to glucometer (meter), food, insulin, water, and the restroom
2. Hypoglycemia
A quick–acting carbohydrate (glucose tabs, juice box) in classroom or kept
with student
3. Insulin
School’s plan for accessing medication in event of a rare lockdown or
evacuation
4. Written Plans & School Protocals
Include lockdown / emergency provision in DMMP and/or 504 plan
Summary of Diabetes Care Activities in
School
• Checking blood glucose (sugar) levels
• Timely eating of meals/snacks
• Taking insulin when needed
• Participating in physical activity
• Extra bathroom/water fountain breaks if needed
• Strong school personnel/family/student communication
• Emergency care
Diabetes Management at School Can Help:
• Provide a supportive learning environment
• Reduce absences
• Reduce classroom disruption
• Provide support in the event of an emergency
• Achieve full participation in activities
• Foster self-esteem through independence
33
Resources
•American Diabetes Association
http://www.diabetes.org/living-withdiabetes/parents-and-kids/diabetes-care-atschool/
•National Diabetes Education Program
http://ndep.nih.gov
•Diabetes Youth Services
Bonnie Heatwole BSN, RN
Telephone 419-291-1234
http://dys4kids.org
•Juvenile Diabetes Research Foundation
http://nwohio.jdrf.org/life-with-t1d/