Diabetes Education Information for Teachers and School staff

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1 Diabetes Education Information for Teachers and School staff The information below is intended to educate school staff on the basics of diabetes care. If you have a student in your classroom or you will be providing care for a diabetic student you will receive 1:1 training by the school nurse. Please see your school nurse if you have questions regarding this information. What is type 1 diabetes? Type 1 diabetes, previously called juvenile diabetes or insulin-dependent diabetes, is an autoimmune disease in which the body destroys insulin-producing beta cells in the pancreas. Insulin is required by the body to use glucose, the simple sugar into which foods are broken down by our digestive system. Without insulin, the body starves to death. It's important to note that everyone is insulin-dependent. People without diabetes make insulin in their pancreas. People with type 1 diabetes must inject insulin. What is type 2 diabetes? Type 2 diabetes typically develops after age 40, but can appear earlier, and has recently begun to appear with more frequency in children. In this form of

2 diabetes, the pancreas still produces insulin, but the body does not produce enough or is not able to use it effectively. Treatment includes diet control, exercise, self-monitoring of blood glucose and, in some cases, oral drugs or insulin. Diabetes can be managed with insulin injections, blood sugar monitoring, proper diet and exercise. Schools are responsible for following a students diabetes care plan while at school. There should be staff trained at the school site to assist the student as requested by the parent according to the Physicians directions. High and Low Blood Sugars Children with diabetes face two problems that teachers need to understand: hypoglycemia and hyperglycemia. You should learn the symptoms and how to treat each. * Hypoglycemia, or low blood sugar, occurs when the blood sugar level is too low, due to too much insulin, too little food, or too much exercise. Children with low blood sugar sometimes behave

3 erratically or act sleepy, and are often very hungry and shaky. Low blood sugar must be treated immediately by giving the child foods with simple sugars, such as glucose tablets, fruit juice or regular (NOT diet) soda. If you suspect that a child has low blood sugar, do not leave the child unattended because the child can lose consciousness. Never send a child who you suspect has a low blood sugar to the nurse or clinic alone. A low blood sugar must be treated immediately by giving fruit juice, regular soda or another simple sugar. * Hyperglycemia, or high blood sugar, occurs when the blood sugar level is too high, due to too little insulin or too much food. Children with high blood sugar sometimes act lethargic and sleepy, and are often very thirsty and need to go to the bathroom a lot. High blood sugar is treated by giving additional insulin and sugar-free drinks, such as water or diet (NOT regular) soda. Children with diabetes must be given free access to water and the bathroom whenever they feel the need. Prolonged hyperglycemia due to insufficient insulin can lead to a very serious condition called diabetic ketoacidosis, which can lead to coma and death.

4 It is assumed that kids with diabetes sometimes pretend to feel low or high to get out of the classroom, or to get out of an activity that they do not like. This is very unlikely. Most kids with diabetes don't want to be different, and they don't want their diabetes to cause them to be treated differently. If you think this is a problem, speak with the School Nurse or the child's parents, but do not deny the child's request for water or a blood sugar test. How is Type 1 Diabetes Treated? Children with type 1 diabetes are treated with insulin taken via injections or using an insulin pump, blood sugar monitoring, a carefully managed diet and exercise. Frequent blood glucose tests help determine the correct amount of insulin to take and help identify low and high blood sugars. Children must be allowed to test their blood sugar at school. Children should be permitted to check their blood sugar whenever and wherever they want. Insulin Injections Most children with type 1 diabetes take insulin several times a day. Very few kids take two shots, one before breakfast and one before dinner. They use two different kinds of insulin: one short acting and one long acting. Most kids who use injections take three or more injections per day, with one shot of short acting

5 insulin taken before each meal, and long acting taken with the pre-breakfast and pre-dinner shots. Many kids with diabetes use an insulin pump instead of taking injections. An insulin pump is about the size of a pager. Kids can wear it on their belt or carry it in their pocket. A thin tube connects the pump to a small canula (thin tube) inserted under the skin that delivers insulin continuously. Kids who use an insulin pump give extra insulin to cover each meal that they eat. Insulin pens/injections make it easy for kids to do their own injections, either in the classroom or in the designated care area. Kids who inject insulin before lunch might need time before lunch to accommodate their injection. Kids who use an insulin pump will take extra insulin as needed to cover food. Blood Sugar Monitoring Children with diabetes check their blood sugar many times per day. A blood sugar check involves pricking a finger with a lancet and placing a drop of blood on a special test strip. A blood sugar meter analyzes the

6 test strip and reports the blood sugar level, usually in less than one minute. This process is called blood sugar testing, blood sugar checking or blood sugar monitoring. They all mean the same thing. Some children with diabetes are required to do blood sugar checks during the school day. Many do a check before lunch. Doing a blood sugar check is simple enough that most grade school children can be taught how to do it themselves. Younger kids might need some adult supervision. Lancing devices and blood glucose meters should not be shared, even among kids with diabetes. Children with diabetes must be allowed to check their blood sugar at school. The Americans with Disabilities Act and the Individuals with Disabilities Education Act establish the legal basis for blood sugar monitoring at school. When a child with diabetes has low blood sugar (hypoglycemia), he or she must be given access to emergency glucose to treat the low blood sugar. When a child with diabetes has high blood sugar (hyperglycemia), he or she must be allowed free access to water and the restroom.

7 Meal Planning Children with diabetes usually follow a meal plan. Meal plans come in many varieties, and is usually tailored specifically to the needs of each child. Parents should provide schools with a physician signed diabetes care plan, for complete care instructions while at school. Parents should also provide morning and afternoon snacks for those children with diabetes who require them. These snacks usually consist of protein and carbohydrates, such as crackers with peanut butter. Children with diabetes who require snacks, but who are not allowed to eat them when required, are at very high risk for hypoglycemia. For these kids, snacks are part of the essential medical care and are not optional. All children with diabetes must be allowed to have ready access to emergency glucose to counter the effects of hypoglycemia. Left untreated, hypoglycemia can lead to loss of consciousness, convulsions and coma. Also, teachers must allow kids with diabetes to eat snacks when prescribed by their doctor.

8 Exercise Exercise is important for all kids, and kids with diabetes are no exception. Diabetes does not prevent a child from participating in any exercise or outdoor activity. Gym class (physical education) and recess can, however, be a challenging time for kids with diabetes since exercise, like insulin, works to lower blood sugar. Teachers should know if a child has diabetes so they can provide help if needed. Children with diabetes often eat an additional snack before participating in strenuous exercise. A good rule of thumb is 15 grams of carbohydrates for each 30 minutes of exercise. The diabetes medical management plan will provide instructions for snacks prior to exercise. Kids with diabetes should be allowed to carry emergency glucose to treat hypoglycemia, especially if they will be outside, far away from the designated care area or classroom. Activity and exercise Diabetic students cannot be denied access to recess/pe or exercise (unless documented otherwise by a physician on their diabetes medical management plan.

9 Teachers supervising recess, Physical education teachers and athletic coaches/trainers should consider keeping a supply of emergency glucose on hand to treat hypoglycemia. Parents can provide glucose tablets, which work best and will not be confused with candy. Adapted from: ADA Children with Diabetes: Information for School and Child Care Providers. Contact person(s) for diabetic emergencies: Wendy Marchinko RN Pamela Deal Pauletta Harrington Lauren Basinger

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