Lorain County General Health District
Inservice on Diabetes for Unlicensed School Personnel
Purpose:
To enable school personnel to effectively take care of children with diabetes, specifically Type 1 (insulin dependent)
while the child is attending school
Objectives:
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After the in-service, school personnel should be able to meet the following objectives:
Have a basic understanding of the disease
Perform effective diabetes management, including understanding the student’s needs, blood sugar readings and the role of
carbohydrates in the diet
Identify medical emergencies
Understand actions to take during an emergency
What Is Diabetes?
Diabetes is a chronic disease in which the body does not make or properly use insulin, a hormone needed to convert sugar, starches
and other food into energy.
There are two types of diabetes, Type 1 and Type 2.
Type 1 diabetes (previously known as insulin-dependent diabetes)
 Most common among elementary age children
 Auto-immune disease where the body's immune system destroys the insulin-producing cells in the pancreas
 Children with this type of diabetes need to take insulin daily to live
Type 2 diabetes (previously known as non-insulin dependent diabetes)
 Used to found only in adults; now seen in overweight children
 Characterized by insulin resistance and relative insulin deficiency
Effective Diabetes Management
1. All children with diabetes will come to school with a Diabetes Medical Management Plan. This plan will have all of the
information needed to care for the diabetic child while at school. It must be signed by the child’s parent and healthcare
provider.
2. A Quick Reference Emergency Plan for the student with diabetes will be kept in designated area(s).
3. An Individual Health Plan will be compiled and updated by the nurse, as needed, in the school.
4. The key to good blood glucose control is to carefully balance food, exercise and insulin. As a general rule, food makes blood
glucose levels go up, and exercise and insulin makes blood glucose levels go down.
Hypoglycemia (Low Blood Sugar)
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Greatest immediate danger to students with diabetes
Can be treated easily and effectively
If not treated, it can lead to unconsciousness and seizures and become life threatening
Prompt recognition and treatment with food can prevent any medical emergency
Why does hypoglycemia occur?
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Student hasn’t had enough to eat, missed a snack or delayed mealtime
Too much insulin
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Student was exercising (gym class, recess, etc.)
Unscheduled exercise session
Symptoms of Hypoglycemia
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Hunger
Shakiness
Paleness
Changes in behavior or mood
Sweatiness on upper lip
Sleepiness, laying head down on desk
Treatment of Hypoglycemia – Rule of 15 (Give 15 gm carb snack and recheck in 15 minutes)
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Provide a quick sugar source such as the following:
o 3-4 glucose tablets
o One juice box or equal amount of juice in a cup
o ½ can or regular, not sugar-free, soda
o ½ tube of glucose gel
If child is very sleepy, shake them or stimulate until you can squirt glucose gel into the cheek or place a glucose tab
inside the cheek. The inner cheek area provides good absorption.
Wait 15 minutes, recheck blood sugar or do an initial check if there was no time to check before treatment started.
Continue with more food if blood sugar level is still low (below 80).
Child should follow with a more substantial snack such as cheese, peanut butter crackers or sandwich.
Severe Hypoglycemia
If low blood sugar is not recognized and treated quickly and correctly, the diabetic may suffer from severe hypoglycemia,
resulting in loss of consciousness and possibly seizures. This is a life threatening situation.
An unconscious diabetic is unable to eat or drink anything to help raise their blood sugar; therefore, alternate methods to raise
blood sugar are needed.
An unconscious diabetic needs an injection of glucagon.
 Glucagon is a hormone produced in the pancreas
 Stimulates the liver to release stored glucose
 Used to raise very low blood sugar
 Injected into the muscle of an unconscious diabetic
If the diabetic student is unconscious and does not have glucagon at the school, follow this procedure.
 Lay student on his/her side and squirt a tube of glucose gel between the cheek and gums
 Call 911
 Once student begins to arouse have him/her eat or drink a carbohydrate snack
Hyperglycemia (High Blood Sugar)
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Caused by the body not producing insulin
Initial reason a person is diagnosed with diabetes
How can hyperglycemia occur if the person takes insulin?
Hyperglycemia is a phenomenon that can occur throughout the diabetic’s lifetime and can be caused by the following:
 Not enough insulin was taken
 Illness (big factor in school age children)
 Stress or emotional upset (seen more in teenagers)
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Eating food that has not been counted and covered by the appropriate amount of insulin (ex. sneaking a cookie)
Decreased amount of exercise or activity
Symptoms of Hyperglycemia
Symptoms of high blood sugar (hyperglycemia) come on slower than symptoms of low blood sugar (hyperglycemia). It will
become life threatening if left untreated, but the sudden urgency to treat is not the same as with low blood sugar.
 Increased thirst (major sign)
 Increased urination (major sign)
 Stomach ache
 Blurred vision
 Fruity breath odor, vomiting and increased sleepiness are late signs
Treatment of Hyperglycemia
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Treatment is with additional insulin.
If the child does not take insulin at school, the parent should be notified. The parent may come in and administer
the additional insulin or take the child home.
In the meantime, give the child plenty of water or sugar free liquids and allow flexible bathroom privileges.
Blood Sugar Numbers – What do they mean?
Because of the advances in medical technology, the blood sugar monitor has been a very helpful tool in caring for diabetic children
at school. There are several brands of monitors on the market, and they are all very easy to use.
The Numbers
The numbers that follow are suggestions. Some doctors have their own scale, but this will help as a guideline for what is
considered high, low and normal.
Blood Sugar Level
Under 50
Suggestions
Very low and considered dangerous – give 3-4 glucose tablets or 15-18 gm
carbs immediately! Recheck blood sugar level in 15 minutes and repeat if
needed.
50-70
Low – give 2-4 glucose tablets
70-90
Generally nothing to eat if 80 or above unless symptoms of sweating,
paleness, sleepiness, etc. are present.
90-180
Normal level
180-250
High but okay
250-300
High – notify parent, no food, additional water if needed
300-400
Very high – needs additional insulin, call parent and nurse