Diabetes Training for School
Employees
Albemarle County Public Schools
Purpose of this Presentation
The purpose of this presentation is to
provide information for use in the training
of school personnel in the management of
diabetes including the administration of
insulin and glucagon as required by the
Code of Virginia.
Diabetes in Schools: Legislation
Virginia Senate Bill 889 requires
public schools with at least one
student diagnosed with diabetes to
ensure that at least two employees
have been trained in the
administration of insulin and
glucagon. http://leg1.state.va.us/cgibin/legp504.exe?000+cod+22.1-274
Section 504 of the Rehabilitation
Act of 1973 Requires all public
schools to afford children with
disabilities (including diabetes) an
equal opportunity to participate in all
academic as well as nonacademic and
extracurricular services and activities
regardless of disability.
Diabetes Medical Management Plan
A medical management plan must be
provided for each student with diabetes
(Individualized Health Care Plan – IHCP)
completed by the students’ medical
management team and signed by both the
health care provider and the student’s
parent.
Components of the Plan
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Contact Information – parent and provider
Blood glucose monitoring: when, where, and
how independent the student is
Insulin: when, type, amount, how (pen,
syringe, pump), by whom (student, nurse)
Diet: Meals and snacks: time, amount
Treatment/management of low blood
sugar.
Treatment/management of high blood
sugar.
BASICS of DIABETES MANAGMENT
Blood glucose testing
Insulin administration
Diet – carb counting
Exercise
Recognizing and treating high blood
sugar and low blood sugar
Emergency treatment of severe low
blood sugar
Blood Glucose Monitoring

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Different kinds of meters
Must be calibrated to match test strips
Examples of Glucometers

Freestyle
One Touch
Ascenia
When to Check Blood Glucose
Students may check their blood glucose:
 Before eating snacks or meals
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Before physical activity
When they have symptoms of low or high
blood glucose
Other times per plan
Blood Glucose Monitoring Skills
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Wash & dry hands.
Insert test strip in glucose meter
Select appropriate site on the fingertip (top
or sides).
Puncture fingertip accurately and obtain
optimal amount of blood to perform
accurate measurement.
Place drop of blood on test strip.
Obtain accurate reading.
Record blood glucose results.
INSULIN
All people with Type 1 Diabetes manage
their diabetes with insulin.
Old method: Long-acting (basal) insulin and
2 doses of intermediate acting insulin.
New method: Long acting (Lantus, Levemir,
Ultralente) and 3 shorter acting doses
(Humalog/Novalog) at mealtimes based
on amount of carbohydrates in meal.
Carbohydrate Counting
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Used in conjunction with a combination of long acting (eg.
Lantus) once a day with short acting (Humalog or Novalog)
with each meal.
Easier to learn than Exchanges or the Point System.
Food and insulin match better.
Increased variety of food choices.
More flexibility in meal/snack times.
Better blood sugar control.
Carbohydrate information on food labels makes meal
planning easier.
Focus is on carbohydrates, but protein and fat are still
important.
Count total carbohydrates.
Food Label
Nutrition Facts
Serving Size: 1 cup (253 g) Servings per container: 2
Amount per serving
260 calories
Total fat 8 g
Sat. fat 3 g
13%
17%
Cholesterol 130 mg
Sodium 1010mg
Total Carbohydrate 22 g
44%
42%
7%
Dietary Fiber 9 g
Sugars 4 g
Protein 25 g
% Daily Values
36 %
Tools for Carbohydrate Counting
Albemarle County Child Nutrition Services:
http://schoolcenter.k12albemarle.org/education/sc
temp/a93ebbb902ffa8b10a8102e55bd84ddf/11948
88543/carb_cts_.xls
USDA:
http://www.nal.usda.gov/fnic/foodcomp/search/
Fast food:
http://www.bddiabetes.com/resource.aspx?IDX=4253
Types of Insulin, Dosages & Times
Sample Plan
Pre-Breakfast
Pre-Lunch
Insulin
Humalog
Lantus: 10 units
before breakfast
Daily
Adjust for
blood
glucose
reading
Humalog
Pre-Dinner
Humalog
Carb Ratio: _1__ Carb Ratio: _1__ Carb Ratio: 1
units for every15_ units for every 15 units for every 15
grams carbs eaten grams carbs eaten grams carbs eaten
Correction Factor: Correction Factor: Correction Factor:
Add 1 unit for every
50 mg/dl above 150
Subtract: 1 units for
every 20 mg/dl below
100 mg/dl
Add 1 unit for every
50 mg/dl above 150
Subtract: 1 units for
every 20 mg/dl below
100 mg/dl
Add 1 unit for every
50 mg/dl above 150
Subtract: 1 units for
every 20 mg/dl below
100 mg/dl
If dose is half unit,
round up. For Carb
count round down
If dose is half unit,
round up. For Carb
count round down
If dose is half unit,
round up. For Carb
count round down
Calculating Insulin Dose:
Pens and Pumps
Determine amount based on plan:
 Step 1: Calculate number of carbs in meal
then determine the prescribed ratio (eg. 1
unit for each 15 grams carbs).
 Step 2: Correction factor for blood glucose
reading (add insulin for higher blood sugar
reading and subtract for lower reading).
Example from Sample Plan
Student’s lunch contains 60 grams of carbs
and his blood sugar reading is 160mg/dl.
Step 1: 1 unit for each 15 grams = 4 units
Step 2: Correction factor: add 1 unit for
blood sugar reading of 160mg.
Insulin dose = 5units
More Examples from Sample Plan
Calculating Insulin Dose
Grams of
carbs
Blood Sugar Amount of
Insulin (Dose)
80 g (5.3 units
round down)
80 mg/dl
(minus 1
unit)
360 (plus 5
units)
4 units
90 (no
correction)
175 (plus 1
unit)
4 units
75 g (5 units)
65 g (4 units
round down)
100 g (6 units
round down)
10 units
7 units
Insulin Chart
Insulin Chart
For physician ordered sliding scale of 1 unit for every 15 grams of carbs consumed
Correction factor for blood sugar readings: Add 1 unit for every 50 above 150
Subtract 1 unit for every 20 below 80
Follow all orders regarding parameters to call parent for high or low blood sugar or when unsure.
C
A
R
B
S
15 - 29
30 - 44
45 - 59
60 - 74
75 - 89
90 - 104
105-119
120-134
135-149
60-79
0
0
1
2
3
4
5
6
7
80 - 99
0
1
2
3
4
5
6
7
8
100-149
2
3
4
5
6
7
8
9
10
Blood Sugar Readings
150-199 200-249 250-299
3
4
5
4
5
6
5
6
7
6
7
8
7
8
9
8
9
10
9
10
11
10
11
12
11
12
13
300-349
6
7
8
9
10
11
12
13
14
350-399
7
8
9
10
11
12
13
14
15
400-499
8
9
10
11
12
13
14
15
16
>450
9
10
11
12
13
14
15
16
17
Types of Insulin Injections
Types of Insulin Injections:
1.
Vials and syringes
2.
Insulin pens
3.
Insulin pumps
Insulin Vials and Syringes
Insulin Vial and Syringes
Insulin Pens
Insulin Pumps
For All Types of Insulin Skills
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Determine appropriate storage & security
of insulin, syringes, & medical supplies.
State where plan is located.
State “5 rights” of medication
administration: student, medication, dose,
time and route.
Determine insulin dose per plan.
Document amount of insulin and time of
administration.
Insulin Types
NAME
LETTER
ONSET OF
PEAK
DURATION
ACTION
ACTION
Regular
R
30 min.
2-4hrs
3-6hrs.
Humalog/Novolog*
10 - 20 min.
1-3 hrs.
3-5 hrs
Semilente
S
1-2 hours
2-8 hours
10-16 hours
NPH
N
2-4hrs.
4-10 hrs.
1O-l8 hrs.
Lente
L
2-4hrs.
4-l2hrs.
12-2O hrs.
UltraLente
U
6-l2hrs
No Peak
18-3O hrs.
Lantus (glargine)
G
1 hr
No Peak
18-26 hrs
Detemir/Levemir
1-3 hrs
8-10 hrs.
18 -24 hrs.
70/30
70/30 It is pre mixed and works like 70% NPH and 30%
Regular
50/50
50/50 II is pre mixed and works like 50% NPH and 50%
Regular
*Humalog/Novolog
Works so quickly it should be taken no sooner than 15
minutes before a meal.
Just a word of caution, hypoglycemia may be a factor when
using Humalog.
 Pre-Mixed Insulins: 50/50 or 70/30 Combined Regular and NPH or Lente insulins.
 50/50 is 50% NPH and 50% Regular
 70/30 is 70% NPH and 30% Regular
Preparing for Insulin Injection: Steps 1
through 4
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Step 1: Remove cap
Step 2: Wipe the top with
alcohol swab
Step 3: Draw air into the
syringe equal to the dose
Step 4: Put the needle
through the rubber top of
the vial and push the
plunger to inject air into
the vial

Preparing for Insulin Injection:
Steps 5 through 7
Step 5: Draw up dose Leave
syringe in the vial and turn both upside
down. Hold the syringe and fial firmly in
one hand. Make sure the tip of
theneedle is in the insulin
Step 6:
Check for bubbles Before
you take the needle out of the vial,
check the syringe for bubbles
Step 7:
Tap to release If bubbles
are in the medicine, hold the syringe
straight up and tap the side of the
syringe until the bubbles float to the
top. Push the bubbles out with the
plunger and draw the insulin back in
until you have the correct dose.
Injection Instructions
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Gather together the insulin-loaded
syringe or pen, an alcohol swab and a
dry cotton swab or tissue.
Select the injection site (illustration).
Swab the site with an alcohol swab.
Gently pinch up the skin and fat with the
thumb and forefinger.
Hold the syringe like a pencil, close to
the needle for better control.
Push the needle in quickly and all the
way, at a 90-degree angle to the
pinched-up skin.
Push the plunger in to inject the insulin.
Slowly let go of the pinched-up skin and
then remove the needle.
Using a dry swab, apply gentle pressure
to the injection site to prevent bruising.
Discard the needle and syringe in the
sharps container. To avoid possible injury,
never leave used needles lying around.
Insulin Pen Injection Skills
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Determine amount of insulin to be administered
based on plan.
Prepare pen by applying needle appropriately.
Prime the pen with 2 units – dial 2 and push
plunger to dispense the two into trashcan.
Dial the correct dose to be administered.
Demonstrate accurate injection technique.
Dispose of used needle correctly.
Document amount of insulin and time
administered.
Insulin Vials and Syringes Skills
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Assemble supplies: vials, syringes, alcohol
pads.
Accurately measure insulin dose with
syringe.
Locate appropriate sites for injection.
Demonstrate accurate injection technique.
Dispose of syringes in sharps container.
Record amount of insulin and time
administered.
Insulin Pumps
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Pumps vary by manufacturer.
Calculate amount of bolus at meal time per
plan.
Enter the amount on pump per instructions.
Record the amount of bolus.
Hyperglycemia (High Blood Sugar)
Causes of Hyperglycemia:
- Too much food
- Too little insulin
- Decreased activity
- Illness
- Infection
- Stress
Symptoms of Hyperglycemia
Mild
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Thirst
Fatigue/sleepiness
Increased hunger
Blurred vision
Weight loss
Stomach pains
Flushing of skin
Lack of concentration
Sweet fruity breath
Moderate
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•
•
•
Any of the mild symptoms
Dry mouth
Nausea
Stomach cramps
Vomiting
Severe
•
•
•
•
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Any of the mild or moderate
symptoms plus:
Labored breathing
Very weak
Confused
Unconscious
Symptoms of Hyperglycemia
Symptoms of
Hyperglycemia
Mild
Thirst
Frequent urination
Fatigue
Increased hunger
Blurred vision
Stomach pains
Flushing skin
Inability to concentrate
Sweet, fruity breath
Moderate
Mild symptoms plus
Dry mouth
Nausea
Stomach cramps
Vomiting
Severe
Mild and moderate symptoms plus
Labored breathing
Very weak
Confused
Unconscious
Treatment for Hyperglycemia: High Blood
Sugar
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Allow free use of the bathroom.
Encourage student to drink water.
Check urine for ketones per plan.
Follow instructions in plan.
Students who test positive for ketones should not
participate in p.e. or sports until ketones are no
longer present.
Call parent for high blood sugar per plan.
Some students’ plan will state that the student
needs to go home for blood sugar above a certain
number (300 or higher depending on the plan).
Hypoglycemia: Low Blood Sugar
Causes of low blood sugar
 Too much insulin
 Missed food
 Delayed food
 Too much or too intense exercise
Symptoms of Hypoglycemia
Mild
Hunger
Shakiness
Weakness
Paleness
Anxiety
Dizziness
Sweating
Drowsiness
Personality change
Inability to concentrate
Moderate
Headache
Behavior change
Poor coordination
Blurry vision
Weakness
Slurred speech
Confusion
Severe
Loss of consciousness
Seizure
Inability to swallow
IMPORTANT!!!!
A student who complains of feeling low or
who you suspect may be low should never
be sent to check blood glucose, to go the
nurse’s office or anywhere else alone. The
student could lose consciousness or become
disoriented.
Treatment of Mild Hypoglycemia
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Follow plan for parameters for treatment.
Provide quick acting source of
carbohydrates such as juice or glucose
tablets per plan.
Wait 10 to 15 minutes and recheck blood
glucose.
Student may self treat if permitted by plan.
Treatment of Moderate Hypoglycemia
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Student will need assistance/supervision.
Give quick acting carbohydrate per plan.
Wait 10 to 15 minutes and check again.
Follow parameters of plan for how much
carbohydrate to give and when to repeat if
needed.
May administer glucose gel or icing if
student is low but conscious and able to
swallow.
Hypoglycemia – Mild to Moderate (Skills)
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State signs of hypoglycemia.
State treatment of mild to moderate
hypoglycemia.
Describe use of glucose gel or icing for
treatment of hypoglycemia.
What is GLUCAGON?
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A hormone that is made naturally in the pancreas.
It releases stores of glucose from the liver causing
blood glucose levels to rise. Because it is produced
naturally it is a safe drug -- it cannot be overdosed
and it has no major side effects.
Glucagon injection is used for severe hypoglycemia
when the diabetic is unable to swallow.
When injected it causes blood sugar to rise and the
person to regain consciousness.
Glucagon is to be injected into the muscle of the
legs, arms or buttocks.
Treatment of Severe
Hypoglycemia: GLUCAGON
Glucagon Kit: Lilly
For video on glucagon administration see
http://web.diabetes.org/video/glucagon.wmv
Glucagon Instructions Steps 1 - 3
1.
Remove the flip off seal from the
bottle of glucagon. Wipe rubber
stopper on bottle with alcohol
swab.
2.
Remove the needle protector from
the syringe and inject the entire
contents of the syringe into the
bottle of powdered glucagon. Do
not remove the plastic clip from
the.
3.
Swirl bottle gently until the
glucagon dissolves completely. Do
not shake – shaking may cause
bubbles to form. Glucagon
should not be used unless the
solution is clear and of a waterlike consistency.
Glucagon Instructions Steps 4 through 8
4. Using the same syringe, hold
bottle upside down and making
sure the needle tip remains in
the solution, gently withdraw
all of the solution from the
bottle. The plastic clip on the
syringe will prevent the rubber
stopper from being pulled out
of the syringe.
5. Clean the injection site on
buttock, arm, or thigh with
alcohol.
6. Insert the needle into the loose
tissue and inject the amount
(half or all per plan). Apply
light pressure at the injection
site and withdraw the needle.
7. Turn person on side.
8. As soon as patient is able to
swallow give fast acting sugar
such as juice or soft drink
followed by a long acting
source of sugar such as
crackers and cheese or a meat
or peanut butter sandwich.
Sprite or ginger ale work well
if stomach is upset.
Severe Hypoglycemia: Glucagon
Skills
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Accurately state when Glucagon should be administered.
Describe how to mix and withdraw Glucagon from vial.
Determine dose based on plan (0.5mg or 1.0mg).
Locate appropriate injection sites and injection technique
(intramuscular).
Precautions: turn child on side, call 9-1-1 & state it is a
diabetic emergency, call parents.
Give quick acting carbohydrate such as soft drink (NOT
DIET) when student is awake and can swallow.
Document time and amount of Glucagon administered.
Sample Log
Student Name: __________________________
BLOOD GLUCOSE LOG
Date
Time
Blood
Sugar
Food/Carbs
Insulin
Comments
Conclusion
As school personnel we want
to ensure that all of our
students learn and prosper in
school. By understanding the
basics of diabetes and knowing
how to care for a student with
diabetes, you will be able to
help your student take
advantage of all of the learning
and growing opportunities
your school has to offer.
Thank you for interest and
willingness to help your
student with diabetes succeed
and thrive in school.