Diabetes Care Tasks at School:
What Key Personnel
Need to Know
DIABETES BASICS
Gregory E. Peterson, DO, FACP
Gregory E Peterson, DO, FACP
Medical Director, Diabetes Center
American Diabetes Association Recognition Program since 1993
Adjunct Professor Internal Medicine
Des Moines University
Health Policy Fellow and Advisor
Governor’s Council on Fitness and Nutrtion
Chairman
DIABETES BASICS
Diabetes Care in the School
● Description: Diabetes care in the school setting is necessary for the child’s
immediate safety, long-term well being, and optimal academic
performance. The DCCT (The Diabetes Control and Complications
Trial), proved that normalization of blood glucose (glycemic) control
would reduce the complications of diabetes.
● DCCT/EDIC (The Epidmiology of Diabetes Interventions and
Complications) the 17 year follow up demonstrated dramatic differences
● In order to achieve the most optimal glycemic control, a child must
monitor blood glucose frequently, follow a meal plan, and take
medications., like insulin, which is usually taken in multiple daily
injections or through an infusion pump.
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Objectives
● Blood glucose monitoring, including the frequency and
circumstances requiring blood glucose checks.
● Insulin administration (if necessary), including
doses/injection times prescribed for specific blood
glucose values and the storage of insulin.
● Meals and snacks, including food content, amounts,
and timing.
● Symptoms and treatment of hypoglycemia (low blood
glucose), including the administration of glucagon if
recommended by the student’s treating physician.
● Symptoms and treatment of hyperglycemia (high blood
glucose).
● Checking for ketones and appropriate actions to take
for abnormal ketone levels, if requested by the
student’s health care provider.
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Overall Goal:
Optimal Student Health and Learning
Monitoring
Blood
Glucose
Ketones
Glucagon
Health
Administration
&
Learning
Insulin
Regimen
Hypoglycemia
&
Hyperglycemia
Legal
Rights
Exercise
Nutrition
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Learning Objectives
Participants will learn:

What is diabetes?

Why care at school is required

Basic components of diabetes care at school

Short and long term consequences of diabetes
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What is Diabetes?
Body does not make or properly use insulin:



no insulin production
insufficient insulin production
resistance to insulin’s effects
No insulin to move glucose from blood into cells:

high blood glucose means:
fuel loss. cells starve
short and long-term complications
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Type 1 Diabetes
 auto immune disorder
 insulin-producing cells destroyed
 daily insulin replacement necessary
 age of onset: usually childhood, young adulthood
 most prevalent type of diabetes in children
and adolescents
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Type 1 Diabetes
ONSET:
SYMPTOMS:
CAUSE:
relatively quick
increased urination
tiredness
weight loss
increased thirst
hunger
blurred vision
uncertain, likely both genetic and
environmental factors
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Type 2 Diabetes
 Insulin resistance – first step
 Age at onset:


Most common in adults
Increasingly common in children


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overweight
inactivity
Type 2 Diabetes
ONSET:
SYMPTOMS:
in children
variable timeframe
tired, thirsty, hunger,
increased urination
some children show no
symptoms at diagnosis
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Diabetes is Managed,
But it Does Not Go Away.
GOAL:
To maintain target
blood glucose
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Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
Food intake
BG
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BG
Diabetes Management
Proactive
Reactive




keep juggling the balls
a response is indicated
corrective actions for
highs or low
emergency intervention
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Assistance in
Diabetes Management
Routine Care:
 Many students will be able to handle all or almost all
routine diabetes care by themselves
 Some students, because of age, developmental level,
or inexperience, will need help from school staff.
Urgent Care:
 Any student with diabetes may need help with
emergency medical care.
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Care in the Schools:
School Nurses and Others
Nurse most appropriate to:
 Supervise diabetes care
 Provide direct care (when available)
However, a nurse is not always available.
Non-medical school staff can be trained to assist students
 For both routine and emergency care
 Including insulin and glucagon injections
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Diabetes Medical Management Plan

A Diabetes Medical Management Plan (DMMP) should be
implemented for every student with diabetes.

DMMP is


developed by the student’s personal health care team and family and
signed by a member of student’s personal health care team
implemented collaboratively by the school diabetes team, including:
school nurse
the student
parents/guardians
other school personnel

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Elements of a DMMP
 Date of diagnosis
 Emergency contact information
 Student’s ability to perform self-management tasks at school
 List of diabetes equipment and supplies
 Specific medical orders for blood glucose monitoring, insulin,
glucagon, and other medications to be given at school
 Meal and snack plan
 Exercise requirements
 Actions to be taken in response to hypoglycemia and
hyperglycemia
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Quick Reference Plan

Development based on information from
students DMMP

Summarizes how to recognize and treat
hypoglycemia and hyperglycemia

Distribute to all personnel who have
responsibility for students with diabetes
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Where to Get More Information
American Diabetes Association
1-800- DIABETES
www.diabetes.org
National Diabetes Education Program/NIH
www.ndep.nih.gov
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