Helping
Belton ISD
Students Stay Safe & Healthy
What Every BISD Staff Needs to Know About:
Diabetes Basics
Belton ISD
Health Services
Diabetes
What Every BISD Staff Needs to Know
About Diabetes
• What is diabetes?
• How to recognize and respond to the signs &
symptoms of low blood glucose (hypoglycemia)
& high blood glucose (hyperglycemia)
• Who to contact immediately in case of an
emergency
What is Diabetes?
Diabetes is a serious, chronic disease that impairs the body’s
ability to use food.
Body does not make or properly use insulin:
•
•
•
no insulin production
insufficient insulin production
resistance to insulin’s effects
What Happens When We Eat?
Insulin’s job is
to get glucose into cells
GLUCOSE
INSULIN
Diabetes occurs when there is not enough
insulin for what the body needs. Without insulin,
the body’s main energy source, glucose, cannot
be used as fuel and builds up in the blood.
Before this diabetic child
received insulin he was
starving because he was not
receiving glucose for energy
Insulin Saved His Life
Two Main Types of Diabetes
Type 1 Diabetes
• People with Type 1 Diabetes must receive
insulin through either injections or an insulin
pump. Insulin taken in this manner does not
cure diabetes and may cause their blood
glucose to become dangerously low.
• They must carefully balance food, medications,
and activity to keep blood glucose levels as
close to normal as possible.
Glucose CANNOT enter cell without…..insulin
Type 2 Diabetes: The Obesity Cycle
• Type 2 Diabetes is the most common form
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•
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•
•
typically afflicting obese adults and youth.
The larger you are, the more insulin your body has
to make.
High insulin levels cause an increase in appetite
Increase food intake cause the body to make more
insulin.
Insulin does not work well in fatty tissue.
Type 2 diabetics can control their disease through
diet and exercise alone or may require oral
medications or insulin injections.
Diabetes is Managed,
But it Does Not Go Away
GOAL:
To maintain
target blood
glucose
Diabetes Management 24/7
Constant Juggling:
Insulin/medication
with:
Exercise
BG
&
BG
Food intake
BG
Know How to Recognize and Respond to the
Signs & Symptoms of High Blood Glucose
• Allow student to check their blood
glucose
• Stop testing/ class work/exercise.
The student’s diabetic plan
specifies when they may resume
these activities
• Do not send a symptomatic
student to the clinic unescorted.
Send with a responsible
buddy/adult.
• Provide/encourage access to
water and bathroom
• Seek help from the student’s
unlicensed diabetic care assistant
(UDCA) or school nurse
• Maintain confidentiality
Know How to Recognize and Respond to the
Signs & Symptoms of Low Blood Glucose
• Allow student to check their blood
glucose and eat a snack
• Stop testing/ class work/exercise.
The student’s diabetic plan
specifies when they may resume
these activities
• Do not send a symptomatic
student to the clinic unescorted.
Send with a responsible
buddy/adult.
• Seek help from the student’s
unlicensed diabetic care assistant
(UDCA) or school nurse
• Maintain confidentiality
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.
Care in the Schools:
School Nurses and Others
Nurse will:
• Coordinate diabetes care
• 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 checking blood glucose, administering insulin
and glucagon injections
Every Diabetic Should Have a
Diabetes Care
Plan that gives
Instructions on :
•Daily schedule/Routine Care
•Student’s Participation in their
Care
•Location of Equipment &
Supplies
•Emergency Contact Info
•Physician Contact Info
•Names and contact info of
Trained Staff (nurse & UDCAs)
The Diabetes Plan should include
a Quick Reference Plan or
an Emergency Care Plan
Summarizes how to
recognize and treat
hypoglycemia and
hyperglycemia
• Distribute to all
personnel who have
responsibility for
students with
diabetes
•
Helping the Diabetic Student Succeed
• All BISD staff need to have a basic understanding of
diabetes and to recognize and respond to the signs &
symptoms of low and high blood glucose
• Some may need to learn the knowledge and skills to
assist the student in an emergency situation
• Others may be assigned to be an unlicensed diabetic
assistant(UDCA). They will be taught the knowledge and
be allowed to practice and demonstrate the skills so that
they can be responsible for all aspects of the diabetic
care.  Legal Considerations
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Nutrition & Physical Activity Considerations
How to Check Blood Sugar
How to Give Glucagon
How to Intervene when Blood Sugar is Low
How to Intervene When Blood Sugar is High
How to Check Ketones
How TO Give Insulin (Syringe, pen, or pump)
Helping the
Diabetic Student
Succeed
Legal Considerations
III
Laws protect diabetic students
• Eliminate Discrimination
• Provide equal access to educational and school related
opportunities.
• Provide a medically safe environment
Law: Chapter 168
Passed in 2005
Law Requires a Plan that Addresses:
• Level of ability of student to participate in care
• Location/timing of blood glucose monitoring
• Identity of trained diabetes personnel
• Location of diabetes supplies
• Free access to water & restroom
• Ensure meals and snacks allowed at necessary times
• Full participation in all school-sponsored activities
• Alternative times for academic exams if student is
experiencing hypo- or hyperglycemia
• Absences without penalty for diabetes-related
appointments/illness
• Confidentiality & student’s right to privacy
Unlicensed Diabetes Care Assistant
UDCA
• Parent/guardian must authorize & state that they
understand that an unlicensed diabetes care
assistant is not liable for civil damages as provided
by Section 168.009
• UDCAs will have access to the student’s plan and to
a person with expertise in diabetes (physician, RN,
CDE, dietician)
• Principal must have access to MD if RN is not
available
UDCA has Immunity from Disciplinary
Action or Liability
• Not considered
practicing
Unlicensed
diabetes
carenursing
assistant…
• Exempt from applicable laws restricting
activities
• Exercise reasonable judgment in emergencies
Section 22.0512(b), Education Code
• School nurse not responsible for actions of
unlicensed diabetes care assistant (UDCA)
Helping the
Diabetic Student
Succeed
Nutrition & Exercise
III
School Nutrition Management

Meals & snacks may need to
be carefully timed to balance
exercise and
insulin/medications

Most students have flexibility
in WHAT to eat due to Basic
Carbohydrate Counting

Many students have flexibility
in WHEN to eat due to insulin
pumps and improved insulin.
Our Job: School Meals & Snacks


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Provide school menus and nutrition
information to student/family in
advance. Belton ISD website provides
this information
Provide sufficient time for eating
Only monitor actual food intake if its
part of their plan. May need to do for:
 young or newly diagnosed
 picky eaters
Respect, encourage independence
Beyond the Routine: School Parties
Provide parent/guardian with advance notice of
parties and special events.
Some students will prefer to bring their own foods.
Beyond the Routine: Field Trips

Train and send at least 2 UDCAs if nurse is not going

Send appropriate lunch & plenty of snacks to treat
hypoglycemia

Send diabetes equipment and supplies

Send plan including list of emergency contacts

Consult with parent/guardian about food and/ or insulin
adjustments for extra activity level.
Sugar is NOT the Enemy
There is no justification for complete restriction of sugar:
• Sometimes sugar can be a life-saving friend!
• Timing does matter! and sometimes sugar (or any
carbohydrate) is not a good choice.
Exercise & Diabetes
Everyone benefits from exercise and physical activity.
Students with diabetes should fully participate.
Exercise & Diabetes
Since exercise can lower blood sugar levels….
•May need to make adjustments to insulin/ medications
and food intake.
•A quick-acting source of glucose, glucose meter, and
water should always be available.
•PE teachers and coaches must be familiar with
symptoms of both high and low blood glucose.
Exercise & Blood Glucose Monitoring
• May need to check before, during, and
after exercise
• Especially when trying a new activity
or sport
• If blood sugar starts to fall, student
should stop and have a snack
• Students with pumps may disconnect
or adjust the basal rate downward, in
lieu of snack
Helping the
Diabetic Student
Succeed
Blood Glucose Monitoring
III
School Blood Glucose (sugar) Check
 Know the target blood glucose range in PLAN
 Check at times specified in PLAN
 Provide Immediate Action – Treatment to get back within
target
 Provide monitoring data to parent/guardian/Dr. when
requested
Any Time, Any Place Monitoring
should be available for students who are
more independent.
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better blood glucose control
safer for student
student gains independence
less stigma
less time out of class.
When to Check?
Regularly scheduled checks may be done:
 Before meals and snacks
 Before, during and/or after exercise
Extra checks may be necessary:
 Periods of stress or illness
 Hypoglycemia or hyperglycemia symptoms
 Change in diabetes management
• Insulin/medication doses
• Meal plan
• Activity
Supplies to Check Blood Glucose (Sugar)
 Blood Glucose Meter
 Blood Glucose Strips
 Lancets
 Lancing Device
250
53
Preparation
1.
Gather blood glucose monitoring
supplies:
- Lancets and lancing device
- Test strips and meter
2.
Wash hands
3.
Have student wash hands
4.
If assisting or performing for
student, put on disposable
gloves.
Readying the Lancet & the Meter
4. Insert a lancet into the device
5. Check the setting for the depth of the stick
6. Insert a strip into the meter
Lancing the Finger
7. Hold the lancet device to the side of the
finger and press the button to stick the
finger.
Applying Blood to Strip
8. Follow instructions included with the meter
when applying blood to strip
Results
9. Wait until blood glucose results
displayed.
10. Dispose of lancet
11. Record blood glucose results,
take action per PLAN
• If they are not in their target range,
assist the student to take the appropriate
action…Follow the PLAN
La Feria ISD
• Know the student’s target range
September 11, 2009
What does the number mean?
• Communicate sensitively
42
Helping the
Diabetic Student
Succeed
Managing Hypoglycemia:
Low Blood Sugar
III
Vocabulary
Glucose
a simple sugar found in the blood. the fuel that all body cells
need to function.
HYPOglycemia
a LOW level of glucose in the blood
Quick-acting glucose
foods containing simple sugar that raises blood glucose levels
Glucose tablets or gel
special products that deliver a pre-measured amount of pure
glucose … a fast-acting form of glucose used to counteract
hypoglycemia
Hypoglycemia:
Possible Causes
• Too much insulin
• Too little food
• Extra physical activity
Hypoglycemia:
Possible Signs & Symptoms
Mild Symptoms
Hunger
Sleepiness
Shakiness
Changed behavior
Weakness
Sweating
Paleness
Anxiety
Blurry vision
Dilated pupils
Increased heart rate/palpitations
Moderate to Severe Symptoms
Yawning
Confusion
Irritability/frustration
Restlessness
Extreme
tiredness/fatigue
Dazed appearance
Inability to swallow
Unconsciousness/coma
Sudden crying
Seizures
Mild Hypoglycemia:
What to do
• Intervene promptly. Follow PLAN.
• Verify with blood glucose test when available.
• When in doubt, always treat. If no meter is available, treat
immediately.
Have student eat or drink fast acting carbs (15g)
– Test blood glucose 10-15 minutes after treatment
– Repeat treatment if blood glucose level remains low or if
symptoms persist
– If symptoms continue, call parents
Quick Acting Glucose for Hypoglycemia
Treatment for Lows: 15 g Carbohydrate
• 4 oz. fruit juice
• 15 gm glucose tablets (2-3 tablets)
• 1 tube of glucose gel
• 4-6 small hard candies
• 1-2 tablespoons of honey
• 6 oz. regular (not diet) soda (about half a can)
Hypoglycemia: Prevention
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•
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•
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Keep a quick-acting sugar source with the student. ALWAYS.
Treat at onset of symptoms
Eat, Insulin, Test, Exercise ON TIME.
Ensure reliable insulin dosing.
Ensure insulin dosing matches food eaten.
• Watch picky eaters
• Consult with parent/guardian when snack, meal or exercise times must be
changed.
• Monitor blood-glucose variations on gym days, an extra snack may be
required ½ hour before gym or during prolonged vigorous exercise
• A student should never be unattended when a low blood glucose is
suspected.
Severe Hypoglycemia:
What to do
Rare, but life threatening, if not treated promptly:
• Place student on his or her side
• Inject glucagon, per student’s IHP
• Never attempt to give food or put anything in the student’s
mouth
• Call 911, then parent/guardian
• Student should respond in 15 to 20 minutes
• Remain with the student until help arrives
Helping the
Diabetic Student
Succeed
Glucagon Administration
Glucagon
a hormone given by injection that raises the level of glucose
in the blood.
III
When to Give Glucagon
If authorized by the student’s PLAN and if student exhibits:
• Unconsciousness, unresponsiveness
• Convulsions or seizures
• Inability to safely eat or drink
Glucagon Kit Storage
• Place: As designated in PLAN
• Store at room temperature
• Expiration date: Monitor
• After mixing, dispose of any unused portion.
Preparation
1. Flip cap off glass vial containing dry
powder
2. Remove cap from syringe
Mixing Solution
3.
Inject entire fluid in syringe into the bottle
containing powder
4.
Shake gently or roll to mix until all powder is
dissolved and solution is clear.
Drawing out
5.
Inspect. Solution should be clear and
colorless.
6.
Draw prescribed amount of glucagon back
into syringe.
Dosing & Injecting
7. Clean site if possible
8. Inject at 90° into the tissue under cleansed area, using the same
technique as an insulin injection (however, needle is much larger
than insulin syringe needle)
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•
•
buttocks
thigh
arm
After Injecting
9.
May take 15-20 minutes for student to regain consciousness.
10. Check blood sugar.
11. Give sips of fruit juice or regular soda, once student is awake
and able to drink.
12.
Advance diet as tolerated.
13.
Document as per PLAN
Don’t be surprised if:
•Student does not remember being unconscious, incoherent or
has a headache
•Blood sugar becomes very high (over 200)
•Nausea or vomiting occurs
Helping the
Diabetic Student
Succeed
Managing Hyperglycemia:
High Blood Sugar
III
HYPERglycemia = HIGH Sugar
• Too much sugar in the blood, but cells are “starving”
• Hyperglycemia due to insufficient insulin may lead to
diabetic ketoacidosis (DKA) if not treated (the build up of
ketones in the body that can lead to serious illness and coma)
• PLAN should specify signs and action steps that might
include: Ketone testing a procedure for measuring the level of ketones in
the urine or blood.
Ketones (ketone bodies) Chemicals that the body makes
when there is not enough insulin in the blood and the
body must break down fat for its energy.
Hyperglycemia:
Risks & Complications
• Hyperglycemia due to inadequate insulin can lead
to coma or death (mainly in type 1).
• Interferes with a student’s ability to learn and
participate.
• Serious complications (heart, healing, kidneys,
eyesight)develop when glucose levels remain above
target range over time or are recurring.
Hyperglycemia: Possible Causes
• Too little insulin
• Expired insulin
• Not enough food
• Decreased physical
activity
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Illness, injury
Stress
Other hormones
Menstrual periods
Any combination of
the above
Hyperglycemia:
Possible Signs & Symptoms
Severe Symptoms
Labored breathing
Very weak
Confused
Unconscious
Moderate Symptoms
Stomach cramps
Dry Mouth
Nausea
Vomiting
Mild Symptoms
Lack of concentration
Frequent urination
Flushing of skin
Sweet, fruity breath
Fatigue/sleepiness
Thirst
Blurred vision
Increased hunger
Weight loss
Stomach pains
Hyperglycemia: What to do
Goal: lower the blood glucose to a
target range.
Follow IHP
• Verify with blood glucose test.
• Check ketones .
• Allow free use of bathroom & access to water.
• Administer insulin if PLAN indicates (pen,
syringe, pump).
• Recheck blood glucose in 1-2 hours.
• Call parents .
Hyperglycemia: Prevention
• Stay on schedule for blood glucose checks, insulin
doses, meals, snacks, & exercise
• Ensure that food eaten matches insulin dosing:
Monitor food : count carbs of all food eaten if plan
indicates
• Consult with parent/guardian when snack, meal, or
exercise times must be changed.
• Take appropriate action if a missed dose is
suspected or if an insulin pump malfunctions.
• Avoid “over treating” low blood sugar reactions.
• Respect the students; realize their limits
Practical Implications for Educators
• Students with hyperglycemia often do not concentrate well.
• During academic testing:
– Check blood glucose before and during testing, per educational plan.
– Provide access to food/drink and restroom.
– If a serious high or low blood glucose episode occurs, students
should be excused with an opportunity for retake.
• Students should have adequate time for taking medication, checking
blood glucose, and eating.
• Eliminate barriers to:
• snacking
• blood glucose testing
• access to water and bathrooms
• Avoid making judgments based on individual blood glucose readings.
Helping the
Diabetic Student
Succeed
Ketone Testing
III
Why test for ketones?
• Ketones (acids) can build up and result in diabetic
ketoacidosis (DKA).
What is DKA?
• Acids that build up in body & cause student to feel ill
• Emergency state, can lead to coma, death.
• Common symptoms include fruity odor to breath,
nausea, vomiting, drowsiness
• Number one reason for hospitalizing children with
diabetes
• Early detection and treatment of ketones prevents
hospitalizations
How to test urine ketones
1.
Gather supplies
2.
Student urinates in clean cup
3.
Put on gloves, if performed by someone other
than student
4.
Dip the ketone test strip in the cup containing
urine.
5.
Wait 15 - 60 seconds
6.
Read results at designated time
7.
Record results, take action per PLAN
Test Results: Color code
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no ketones
trace
small
moderate
large ketones present
Treatment of Ketones
PLAN specific for an individual student
Generally:
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•
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•
•
free use of bathroom
sugar-free liquids
insulin as per DMMP
no physical activity
if vomiting or lethargic, call parents
Helping the
Diabetic Student
Succeed
Insulin Administration
III
Insulin in Schools Today
• Many students need to take insulin in school
• Insulin regimens vary
• Need for assistance will vary.
• GOAL:
Maintenance of blood glucose target range
Delivery Methods
 Insulin Syringe
 Insulin Pen
 Insulin Pump
When to Give Insulin
Administer as specified by Physician Orders:
Generally:
 Before meals
 For blood glucose levels
significantly above target range
 For increased ketones
Dosing
For many students, insulin dose varies,
depending upon:
–
–
–
–
Blood glucose readings
Food availability/preference
Physical activity level
Age/body weight
Follow prescribed guideline by PLAN.
Insulin Injection with Syringe
• Get supplies and explain procedure to student
• Wash hands and place gloves
• Inspect insulin. Check expiration date. Roll bottle to mix if
bottle instructions indicate
• Pull syringe down to ____units
• Push needle into bottle and push plunger up
• Pull plunger down to ___units
• Locate injection site and wipe with alcohol swab
• Pinch up skin and push needle into skin and push plunger in
• Pull needle out
• Dispose of needle properly
• Document
Insulin Injection with Pen
• Get supplies and explain procedure to student
• Wash hands and place gloves
• Inspect insulin pen. Check expiration date and amount of
insulin
• Attach needle using sterile technique
• Dial pen to correct amount: ____units
• Locate injection site and wipe with alcohol swab
• Pinch up skin and push needle into skin and push pen
plunger in
• Pull needle out
• Dispose of needle properly
• Document
Insulin with an Insulin Pump
 Battery operated device about the size of a pager
that delivers insulin into the body via a thin plastic
tube: an infusion set (reservoir filled with insulin)
 Computer chip helps control insulin delivery by
punching a keypad.
Components
• Pump
• Insulin
• Reservoir
• Tubing/Need
le/catheter
Worn 24 hours a Day
Site changes every 2-3 days
Insulin Pump Therapy
• Based on what body does naturally
• Gives small amounts of insulin all
the time . That is called the basal
rate (basal insulin)
•
Gives extra doses to cover each
meal or snack (bolus insulin)
Basal Rate
Basal rate is set. It is the amount of
insulin that is being continually given
automatically.
Meal Bolus
Meal Bolus changes. The amount of insulin
given depends upon how many
carbohyrdrates are going to be eaten.
Buttons on the pump must be pushed.
Determine # of Carbs
12 grams
15 grams
30 grams
15 grams
TOTAL= 72 grams
How to Give an
Insulin Bolus
1. Press B.
2. ENTER BG screen: Use arrow to enter blood glucose value and then
press ACT. If blood glucose is high, screen will read “check for occlusion.”
Press ACT. Screen will read “BG to update sensor”, No will be
highlighted. Press ACT.
3. ENTER FOOD screen: Use arrows to enter # of carbs being consumed.
Press ACT.
4. ESTIMATE DETAILS screen: Confirm bolus (insulin amount__.___) and
press ACT
5. SET BOLUS screen: Confirm bolus (insulin amount__.___) and press ACT
6. BOLUS DELIVERY screen: Insulin bolus starts counting up & beeps when
completed
Correction Bolus
Here is an example of when you might need to give insulin with a
pump because the student’s blood glucose is high. This is called
giving a correction bolus of insulin.
•Student has a headache and checks her blood sugar. Blood
sugar is 323.
•You want the blood sugar to return to the target range. Follow
the directions for high blood sugar. (Check ketones, drink
water)
•Enter the blood sugar into the pump and follow the directions it
gives for the units of insulin to give as a bolus.
How to Suspend and Remove the Insulin Pump
Suspend and remove
pump if student’s
becomes
unconscious and a
severe blood blood
sugar is suspected.
Do this after
glucagon is given
and 911 is called.
Pump Management at School
Supplies
 Where is the PLAN?
 What is the student’s schedule? When
will they have PE?
 Wil they have a snack?
 When do they eat? Where is the list of
carbs for the school menu?(school
website)
 Where is the meter, quick acting sugar,
glucagon, ketone strips, and extra pump
supplies?
Example of Pump Management at School: Routine Schedule
Responsibility
Time
Location of
student
Person
responsible
Taking off pump before PE
10:30
10:00
210
Teacher &
UDCA
Assist student to replace
pump, check blood sugar, &
document in log.
11:10
Gym or
playground
UDCA
On some days (WED) student will have PE early and return to class to
replace pump with teacher
Accompany student to
cafeteria, count carbs, enter
blood sugar, carbs, & insulin
bolus in pump. Document.
11:20
cafeteria
UDCA
Enter carbs of snack & insulin
bolus in pump. Document.
3:00
311
UDCA