The Student with Diabetes

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Types of diabetes
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Management
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Hypoglycemia
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Hyperglycemia
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Responsibilities
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 Much of the food eaten becomes a sugar called glucose
 The pancreas makes a hormone called insulin
 Insulin allows the body to use the glucose for energy
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 Auto-immune illness
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Pancreas not producing enough insulin
Requires insulin injections
Must test blood glucose
(BG) at school
 Usually diagnosed at a younger age
 Chronic condition
 Cannot be prevented
 Most common type of diabetes
 Can often control with diet, exercise or pills
 May also take insulin
 Usually diagnosed at an older age – infrequent in school age child
 May not need to test BG sugars at school
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 Keep student safe from extreme lows and highs
 Balance of food choices, exercise, & insulin
 Aim for majority of blood glucose levels in target – this is challenging
 Normal school routines for student
 Optimal learning at school
 Promote normal growth & development
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< 5 years: 6-12 range
5-10 years old: 4-10 range
>10 years: 4-7 range
Hypoglycemia < 4 (must treat)
Hyperglycemia > 15 (additional information needed)
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 Tool to assess BG (meter)
 Done routinely before meals and if a low is suspected
 Must treat immediately if < 4
 Avoid placing “judgment value” i.e. good or bad on high or low blood glucose readings
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 Most children get insulin before breakfast, supper and bedtime
 Some children get insulin at lunch
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Syringe
Insulin pen
Pump
 Insulin Pump provides an almost continuous flow of insulin
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around the clock coverage
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 Assess the level of assistance the student requires
 Support with the development of independence
 School Nurse Role
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Assist with BG testing if needed
Assist with insulin administration via pen or syringe
Assist with entering BG and carb amount into pump for pump bolus
Ideal is to bolus/give insulin pre food
Hypoglycemia: identify and treat
Prompt contact with care givers if concerns
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 washes hands before testing
 offers finger to be picked
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 chose injection site identifies food groups
 tests independently - caregiver supervises
 younger child may need more direction
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 independent with insulin, food choices, testing
BUT - caregiver still involved to monitor and support
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 Main nutrient that increases BG is carbohydrate
• grains, fruits, milk, sugars
 Protein & Fat do not increase BG
 Nutritious choices are encouraged, not always made!
 No Forbidden Foods
 Normalize with same eating times /routines/ food choices as other students
 Allow child to eat all food as provided by caregivers
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 Children with diabetes can and should participate in all school activities
 With advanced planning, diabetes can be managed around all special events and treats
 If uncertain how to proceed, contact caregiver for management advice or send the treat home
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 Children with diabetes can be involved in all school activities with some additional precautions
 Exercise can lower BG
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Consider checking BG levels before, during and after activity
May need additional glucose or carbohydrate
 Important for school staff to be aware of impact of exercise on diabetes
 Medical Alert Bracelet
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Low Blood Glucose
 Treat every BG less than 4
 Causes
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Too much insulin
Too little Food
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Delayed, inadequate or skipped meal or snack
Extra exercise without extra food or a decrease in insulin
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
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Shaking
Headache
Stomach ache
 Pale skin
 Hunger
 Fatigue
 Irritability
 Blurred vision
 Slurred speech
 Decreased level of consciousness
• Important to understand students individual symptoms
• If unsure if student is low, do a BG test.
• If unable to test, always treat.
• Occurrence of a severe low is rare in the school setting
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Treatment for Mild or Moderate Hypoglycemia
 Junior juice (125 ml)
 3-4 dex glucose tablets
 2 rolls of rockets
 2 tsp. honey
 3 tsp. sugar
 1/3 cup regular soda
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High Blood Glucose
Above 15 is considered warning of hyperglycemia
 Causes
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Too much food
Too little insulin
Inaccurate BG test result
Decreased activity
Illness/infection
Stress
If BG is > 15mmol/L and child is feeling unwell (flu like symptoms) notify caregivers.
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Mild - Moderate
 Symptoms
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Increased urination
Increased thirst
Blurry vision
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Increased hunger
 Recommendations
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Fluids and washroom access
Inform parent
Contact parent if unwell
Severe
 Symptoms
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Fruity breath
Vomiting
Stomach cramps or pain
Extreme weakness
Sleepiness
Difficulty breathing
Coma
Medical emergency
Contact parent and/or 911
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 If the BG > 15mmol and the child feels unwell with flu like symptoms, contact the caregivers immediately
 If the BG is > 15mmol and the child is well (able to eat, drink, and be involved in school routines)
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 contact the caregivers if part of plan of care continue with the usual school activities of meals and snacks as provided by caregivers continue with usual activity plan (no additional activity required) encourage water intake if child is agreeable expect increased use of the washroom document BG and any concerns in agenda or planner
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If at any time a student experiences a decreased level of consciousness, call 911
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 Challenging regimen with limitations & restrictions
 How you can help
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• treat diabetes matter-of-factly
BG variability is common – diabetes is hard to control appreciate no one makes ideal food choices at all times provide encouragement & understanding accommodate diabetes management within classroom routines as much as possible
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 Learn about diabetes
 Ensure all meals and snacks, as provided by parents, are completed on time
 Know symptoms and management of hypo/ hyperglycemia
 Communicate regularly with parents
 Provide space for testing and storage of diabetes supplies in the classroom
 Know when to contact parents/guardians
 Educate other students
 Consider best location for diabetes care – may prefer privacy
 Update annually using Trillium website: http://www.trilliumhealthcentre.org/programs_services/womens_chil drens_services/childrensHealth/familyCareCentre/paediatricDiabetes
Clinic.html
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 Notify teacher when feeling unwell
 Accurately document BG in planner/agenda
 Take sharps home for safe disposal
 Eat all food provided by parents in a timely manner
 Educate other students
 Participate in all school activities
 Tell adults - parents, teacher – when supplies are low
 Wear medic alert
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 Establish positive relationship with school
 Take sharps home for safe disposal
 Provide nutritious lunch and snack choices
 Ensure extra supplies are stored at school
 Communicate as needed with school and educate as required
 Advocate for child’s best care
 Update school staff each year: http://www.trilliumhealthcentre.org/programs_services/wo mens_childrens_services/childrensHealth/familyCareCentre/ paediatricDiabetesClinic.html
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For additional information on Type 1 diabetes:
Canadian Diabetes Association www.diabetes.ca
Juvenile Diabetes Research Foundation www.jdrf.ca
Trillium Health Centre
//www.trilliumhealthcentre.org/programs_services
/womens_childrens_services/childrensHealth/fa milyCareCentre/paediatricDiabetesClinic.html
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