Helping you help students manage their diabetes. Canadian Diabetes Association s website at diabetes.ca. More information

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1 Kids with diabetes in your care management Helping you help students manage their diabetes This resource kit provides basic information to people who provide care to students with diabetes, including parents/guardians, school staff, childcare workers and coaches. Its purpose is to help ensure the safety and wellbeing of students with diabetes. Table of Contents 2 Standards of Care for Students with Type 1 Diabetes in School 7 About Diabetes 10 Hypoglycemia (Low Blood Glucose) Guidelines and Procedures 11 Signs, Symptoms and Treatment of Hypoglycemia (Low Blood Glucose) 13 Kids with Diabetes Information Card 15 Communication and Education Checklist 17 Glossary Appendices 18 Frequently Asked Questions 22 Test Your Diabetes Knowledge 26 School Employee as Good Samaritan: Assisting Students with Diabetes 27 Letter of Agreement Tool Managing diabetes is a full-time job for the family and student with diabetes. It is important that people who care for children with diabetes understand their unique needs. The information in this resource kit supports ongoing communication among the student with diabetes, parents/guardians, school staff, childcare workers and coaches. You are encouraged to copy and keep handy the pages of this booklet that are appropriate to you; e.g. if you are a teacher, you will want to keep the Kids with Diabetes information card with you in the classroom. We also recommend that you keep the Signs, Symptoms and Treatment of Hypoglycemia (Low Blood Glucose) pull-out card nearby. A letter of agreement between the parents/guardians and school may be useful to some families and school administrators. A sample letter of agreement can be found on page 27, and is also available on the We value your feedback Canadian Diabetes Association s website at diabetes.ca. More information The Canadian Diabetes Association offers many resources to help you understand the management of diabetes. Contact your local Canadian Diabetes Association office at BANTING ( ), or visit diabetes.ca. We encourage you to let us know how you use the Kids with Diabetes in Your Care Resource Kit and how we could improve it. Please send your comments to or call BANTING ( ).

2 Standards of care for students with type 1 diabetes in school The purpose of setting these standards is to acknowledge and clarify the essential partnerships among parents/guardians, students and school personnel caring for children with type 1 diabetes in the school system. The goals are as follows: to enhance the health and safety of students with diabetes, as well as their satisfaction with the educational experience, by providing information and direction to all parties regarding diabetes management; to limit anxiety for parents/guardians and school personnel by encouraging steps to increase communication and co-operation to ensure student safety; and to permit and encourage students to manage their diabetes effectively during school hours. Diabetes care is unique for everyone. It is important that the needs of each student with diabetes are recognized and accommodated. If school personnel lack accurate information about diabetes and how it is managed, many problems may likely result ultimately placing the student s health and safety at risk. Hyperglycemia and hypoglycemia will interfere with a student s ability to learn and participate in school activities. Students with diabetes may occasionally be required to attend medical appointments during school hours and/or be absent in order to address diabetes concerns. Important Information School-age students with diabetes most often have type 1 diabetes and require insulin by injection or by an insulin pump. School-age students with diabetes spend hours per week in the school setting; this represents more than half of their waking weekday hours. It is therefore vital that school personnel, parents/guardians and students are clear and confident in their roles and responsibilities during this time. 2 Canadian Diabetes Association diabetes.ca BANTING ( )

3 Communication and education Roles and responsibilities: It is important that regular and ongoing communication is established between the parties so an effective response can be made to changes in activities, special events, snacks at school, or to the student s diabetes management requirements. Parents/guardians or students Notify the school of their child s diabetes at the onset of his/her enrolment and/or start of the school year, and arrange a meeting with the school principal. In co-operation with the school, arrange for a diabetes education and training in-service for all school personnel who come into contact with the student with diabetes. The student should wear medical identification at all times. If the child is agreeable, arrange for a presentation to be made to classmates about diabetes and how to identify symptoms of hypoglycemia and hyperglycemia. School personnel Attend annual diabetes in-service to learn or be reminded on how to identify and treat hypoglycemia/hyperglycemia and the emergency procedures for treating moderate to severe hypoglycemia. Parents or caregivers and diabetes education teams and/or trained healthcare professionals should be invited to participate. Determine the student s Individual Care Plan for diabetes. The school principal should meet with the parents/guardians to discuss the student s diabetes management requirements while in school. Establish a formal communication system with all school personnel who come into contact with the student with diabetes. This should include appointing at least one staff member to notify a parent/guardian of hypoglycemia, hyperglycemia and any other issues and concerns. Identify the student with diabetes to all school personnel, including supply teachers. This can be done with photographs displayed in the staff room or office and/or emergency information folders made available to all personnel. These folders should contain information about diabetes as well as information specific to the student. Medical alert stickers can also be placed on student files to further identify them. Provide posters or cards identifying symptoms of hypoglycemia and hyperglycemia to all school personnel so they can be posted in key locations throughout the school. Permit flexibility in school rules so that the student with diabetes is able to check blood glucose conveniently and safely, wherever he/she is located in the school. A student must not be left alone or allowed to leave the class alone when hypoglycemia is suspected. If the student s blood glucose is higher than normal, he/she may need to go to the washroom or water fountain more frequently. Provide adequate supervision at events such as field trips, parties and intramural activities. Students with diabetes can participate in all school activities with proper planning. Provide reasonable notice to parents/guardians of any change in school routine or of upcoming special events BANTING ( ) diabetes.ca Canadian Diabetes Association 3

4 Blood glucose monitoring Roles and responsibilities: School personnel can only perform blood glucose monitoring if there is mutual agreement with parents or caregivers and training is provided. This may occur with very young children or children with special needs. Parents/guardians or students Make treatment decisions based on results of blood glucose monitoring unless they have provided very clear guidelines for the school to make these decisions when needed. Inform school personnel of the cognitive or behavioural effects (to the best of their knowledge) their child may experience as a result of hypoglycemia or hyperglycemia. School personnel Learn the law in their province or territory related to who is permitted to obtain a finger tip blood sample. Provide students with a clean, comfortable area and, if preferred by the student, a private location to do blood glucose monitoring. Arrange for safe disposal of sharps. NEVER leave a student alone who has or is suspected to have hypoglycemia. Students should not be left alone for at least 30 minutes after treatment for hypoglycemia. Notify parents/guardians of incidents of hypoglycemia or hyperglycemia. Preventing and treating mild to moderate hypoglycemia Roles and responsibilities: Mild to moderate hypoglycemia is common in school. Symptoms can easily be misinterpreted by the student and by school personnel, placing the student with diabetes at serious risk of severe hypoglycemia. It is important that students be treated for their hypoglycemia and not mistakenly disciplined for what looks like misbehaviour but may actually be symptoms of blood glucose fluctuations. Particularly in the case of teens, school personnel could easily misinterpret symptoms of hypoglycemia or hyperglycemia as fatigue or as being under the influence of drugs or alcohol. Students with diabetes may be physiologically unable to recognize an emergency situation. When children with diabetes have hypoglycemia, they are cognitively impaired. It is imperative that a school action plan is in place to quickly treat hypoglycemia before it becomes an emergency. Parents/guardians or students Communicate with school personnel the causes, prevention, identification and treatment of hypoglycemia as it pertains to the child. Review annually with the school student s Individual Care Plan for diabetes and the school s emergency procedures for treating moderate to severe hypoglycemia. Provide all snacks, as well as an ongoing supply of fast-acting glucose for treating hypoglycemia. Encourage the child to keep a source of fast-acting glucose with him/her at all times. 4 Canadian Diabetes Association diabetes.ca BANTING ( )

5 School personnel Ensure all snacks and meals are eaten on time. Students also require adequate time to finish their meals. A designated staff member may be required to supervise. Permit the student to treat hypoglycemia anywhere, at any time, and during any activity. Provide safe and readily accessible storage of the student s snack supply. Permit a supply of fast-acting glucose to be situated in several locations throughout the school. Do NOT leave the student alone for at least 30 minutes after the treatment of hypoglycemia or if hypoglycemia is suspected. Once fully recovered, the student can return to regular activities. Ensure the student does not participate in physical education or exams if blood glucose is below or above target limits as identified in student s Individual Care Plan for diabetes. Notify a parent/guardian immediately when treatment of moderate or severe hypoglycemia is required. Call 911 when treatment for severe hypoglycemia is required. Immediately notify parent/guardian if the student is unable to eat or vomits at school. If the student vomits and parents/guardians are unavailable, the student should be taken to the nearest hospital BANTING ( ) diabetes.ca Canadian Diabetes Association 5

6 Treating severe hypoglycemia Roles and responsibilities: Severe hypoglycaemia in the school setting is rare but it is important that staff understand how to respond quickly. Severe hypoglycemia is an emergency situation and often requires the administration of glucagon. School personnel should be trained to administer glucagon, particularly if the emergency response time is not guaranteed to be less than 20 minutes. Parents/guardians or students Provide for glucagon injection training by a medical professional. School personnel Ensure at least two staff are trained to administer glucagon. Provide for and safely store a readily accessible supply of glucagon. Replace glucagon kit by its expiration date. Call 911 and immediately notify parent or caregiver. Insulin administration Roles and responsibilities: Most students will be taking multiple doses of insulin by syringe, insulin pen or an insulin pump, which they must administer while in school. Parents/guardians or students Arrange for administering insulin during school hours. Provide training to school personnel if required. Safely dispose of sharps at school. Supply school with a sharps container. School personnel Supervise the student if there is mutual agreement with the parent or caregiver and training has been provided. Ensure the student is provided a clean and comfortable environment to administer insulin. Arrange for the safe disposal of sharps. 6 Canadian Diabetes Association diabetes.ca BANTING ( )

7 About diabetes What is diabetes? There are two main types of diabetes Type 1 diabetes occurs when the pancreas is unable to produce insulin. Insulin is essential for ensuring that the body s energy needs are met. Type 1 diabetes is managed by the regular administration of insulin to balance the body s blood glucose levels. The timing of insulin injections, meals and snacks, along with regular blood glucose monitoring, are important in managing type 1 diabetes. Type 2 diabetes occurs when the pancreas does not produce enough insulin or when the body does not effectively use the insulin that is produced. Type 2 diabetes is managed with healthy eating, physical activity, blood glucose monitoring and, often, medication (pills or insulin). Symptoms of diabetes Symptoms of diabetes can include unusual thirst, frequent urination, unusual weight loss, extreme fatigue or lack of energy, tingling or numbness in the hands or feet, and blurred vision. Insulin All students with type 1 diabetes use insulin to manage their diabetes. Insulin can be administered by syringe, pen or pump. Children with type 2 diabetes more commonly use oral medications to manage the disease, although some will require insulin. Insulin pumps Many students with type 1 diabetes choose to use a pump to administer their insulin. This can allow for more flexibility and eliminates the need for multiple daily insulin injections. The pump delivers a continuous infusion of insulin throughout the day plus a bolus (or burst ) of insulin when the student eats. In order for the pump to work properly, the student must wear it day and night, although it can be removed for short periods (e.g. during a one-hour physical education class). THE BALANCING ACT The treatment of diabetes can be viewed as a balance. On one side, food increases the amount of glucose in the blood. On the other side, exercise and insulin lower the blood glucose level by allowing glucose to be used for energy. Students with diabetes must test their blood glucose frequently to monitor this balance. When the blood glucose is in proper balance, the student will feel well. For pump therapy to be safe, people with diabetes must check their blood glucose a minimum of four to six times per day. (Note: An insulin pump, which looks very similar to an ipod or cell phone, must not be confiscated.) 7

8 Food The maintenance of a proper balance of food and insulin is essential to achieving good blood glucose control in students with type 1 diabetes. When the doctor and parents/guardians decide on an insulin regimen for the student, they are assuming that either the student s food intake will be relatively consistent or that the insulin dose will be administered based on food intake. The school staff s role is to ensure that the carbohydrate-containing foods from meals and snacks are eaten completely and on time. Students with diabetes who take insulin by syringe or pen should: eat the amount of carbohydrate-containing food (bread, pasta, rice, fruit, etc.) as packed by the student s parent/guardian each day, OR have the insulin dose adjusted for differing meals and snacks; parents are responsible for any changes of insulin. eat meals and snacks at the same times each day. not trade or dispose of food. (Note: Students with diabetes who use an insulin pump or take oral medications may have more flexibility in their eating habits.) The student s meal and snack times can usually coordinate with typical daily school schedules. The student can often eat a snack at recess or class snack time, but occasionally he/she may need to eat during class; the student should not be singled out for doing so. Young students with diabetes may require extra supervision in the lunchroom to ensure that they eat what their parents/guardians have provided. Missing a meal or snack, or eating less than planned, can result in hypoglycemia, or low blood glucose levels, a situation that requires immediate treatment with fast-acting glucose. For more information, refer to the Signs, Symptoms and Treatment of Hypoglycemia (Low Blood Glucose) card in this booklet. Although teachers do not have to police a student s eating habits, they should advise parents/guardians if they notice that a student with diabetes is giving food away to, or accepting food from, other students. Eating too much or too little carbohydrate, or eating at the wrong times, can cause high or low blood glucose. With planning, students with diabetes can eat many of the foods they love, even sweets and candy. If parents/guardians are notified prior to events involving food, they can often take steps to ensure that their student can enjoy these events as much as everybody else. The sick student When students with diabetes become ill with the usual childhood sicknesses, their blood glucose balance is likely to change. Parents/guardians will need to carefully monitor the student s blood glucose and urine, and the student may require a fluid diet and altered insulin dose. Such illness management is the responsibility of the parents/guardians, not school staff. When students with diabetes become ill at school, the parents/guardians should be notified immediately so that they can take appropriate action. Vomiting can be a serious situation because it may result in hypoglycemia. If the student vomits, contact the parents/guardians immediately. If you are unable to reach the parents/guardians or the alternate emergency contact person identified by the parent, take the student directly to the nearest hospital or call Canadian Diabetes Association diabetes.ca BANTING ( )

9 For students with diabetes who wish to participate in vigorous physical activity, planning is essential so that their blood glucose levels are maintained. Sports and extracurricular activities It is critical that teachers, especially physical education teachers and coaches, are familiar with the symptoms, treatment and prevention of hypoglycemia. For more information, refer to the Signs, Symptoms and Treatment of Hypoglycemia (Low Blood Glucose) card in this booklet. Students with diabetes, as any student in school, should be encouraged to participate in as many activities as they choose. Trips, sports and extracurricular activities can promote self-esteem and a sense of wellbeing. For students with diabetes who wish to participate in vigorous physical activity, planning is essential so that their blood glucose levels are maintained. The major risk of unplanned vigorous activity is hypoglycemia eating extra carbohydrate can prevent this. For a physical education class or a very active recess, many students with diabetes may require an extra snack or juice box before, during or after the class in order to prevent hypoglycemia. The family should discuss their plan with teachers at the beginning of the school year. Parents/guardians should be aware of special days that involve extra activity (e.g. field trips, sports days) so they can ensure that the student has extra carbohydrate to compensate. Sports and other activities that take place during mealtime require extra planning. The timing of meals and snacks may need to be varied and insulin doses adjusted. It is the parents /guardians responsibility to adjust the student s insulin dose if needed. Also notify the parent of any special events, such as special lunches or birthday parties, so that the parents can adjust the meal plan to allow their child to participate. When travelling off site, it is important to bring the student s Kids with Diabetes information card in case of an emergency BANTING ( ) diabetes.ca Canadian Diabetes Association 9

10 Hypoglycemia (Low Blood Glucose): Guidelines and Procedures The key concern when caring for students with diabetes during the school day is preventing, identifying and treating hypoglycemia. Parents, teachers and school administrators should review these key guidelines. PREVENTION PARENTS/GUARDIANS: Teach school personnel about your child s signs and symptoms of low blood glucose (hypoglycemia). Instruct school personnel on how to treat low blood glucose and provide a supply of fast-acting carbohydrate (e.g. glucose tablets, candy, juice boxes). Provide extra food guidelines for physical education and active events. Tell the school when and how to contact you (e.g. when your student does not finish meals/snacks; after a moderate low blood glucose resulting in confusion; or when your child is having frequent low blood glucose levels). TEACHERS AND SCHOOL ADMINISTRATORS: Understand your role in supervising students with diabetes, including: Know the student s symptoms of hypoglycemia and encourage the student to tell you when he/she feels low. Know the specific needs and routines of each student (ensure that you have current information from parents/guardians and from the school office). Ensure the safety of students with diabetes during special events you are supervising, such as school trips, parties, intramural sports, etc. (specifically, have fast-acting carbohydrate on hand, watch for signs of hypoglycemia). Ensure that the student completes all meals/snacks on time during the school day. Contact the parents/guardians if the student with diabetes: does not finish all of his/her meal or snacks. has more than two low blood glucoses per week while at school. has a moderate low blood glucose resulting in confusion. Call 911 if the student has a severe low blood glucose resulting in loss of consciousness or a seizure. If 911 service not available, follow plans as outlined by parents. IDENTIFICATION Complete the Kids with Diabetes information card in this booklet, and tell the school about any special needs or concerns regarding the health and care of your child. Ensure that your child wears diabetes identification (i.e., a MedicAlert bracelet) during the school day. Know the names of students with diabetes under your supervision. Ensure that students wear diabetes identification during the school day (including during sports and gym activities) if possible. Find a method to ensure substitute teachers are aware of key details for diabetes in the classroom. TREATMENT / EMERGENCY PROCEDURES Supply the school with fast-acting carbohydrate for prevention and treatment of hypoglycemia (the school should contact you when new supplies are needed). Label food supplies with your child s name and room number. Discuss with school staff the emergency steps for treating moderate or severe hypoglycemia. Ask the school to post a copy of the Signs, Symptoms and Treatment of Hypoglycemia (Low Blood Glucose) two-sided card included with this booklet in the staff room, school office, gymnasium, etc. Ask school staff to call you immediately after treatment of moderate or severe hypoglycemia. Ensure your contact information is current as listed on the Kids with Diabetes information card. Review procedures (specifically staff roles) for responding to mild, moderate or severe hypoglycemia. Post copies of the Signs, Symptoms and Treatment of Hypoglycemia (Low Blood Glucose) two-sided card included with this booklet in classrooms, the staff room, school office, gym office, etc. Ensure that emergency treatment supplies are labelled with the student s name and will be stored in safe, accessible locations (e.g. the student s homeroom, gym, main office, teacher s room and bus) and that staff know the locations of these supplies. Permit the student with diabetes to take action to prevent or treat hypoglycemia during the school day (allow flexibility in the class routine and school rules as necessary). Know the emergency contact procedures (including which school personnel are responsible for contacting parents/guardians and/or emergency services). Notify parents/guardians immediately after treatment of moderate or severe hypoglycemia. 10 Canadian Diabetes Association diabetes.ca BANTING ( )

11 Signs, Symptoms and Treatment of Hypoglycemia (Low Blood Glucose) What is hypoglycemia (low blood glucose)? Hypoglycemia occurs when the blood glucose drops below 4.0 mmol/l What are the signs and symptoms of mild hypoglycemia? Cold, clammy or sweaty skin Pallor Difficulty concentrating Shakiness, lack of coordination (e.g. deterioration in writing or printing skills) Irritability, hostility and poor behaviour Fatigue Nervousness Excessive hunger Headache Blurred vision and dizziness Abdominal pain and/or nausea Important: Hypoglycemia can happen very quickly. What are the signs and symptoms of moderate hypoglycemia? The symptoms of mild hypoglycemia, plus: Staggered walking Confusion What are the signs and symptoms of severe hypoglycemia? The symptoms of moderate hypoglycemia, plus: Loss of consciousness Fainting A seizure What causes hypoglycemia? Hypoglycemia can be caused by: More physical activity than usual Not eating on time Missing or delaying meals Taking too much insulin Important: Call 911 for Emergency Medical Services. Treatment of mild or moderate hypoglycemia Hypoglycemia can occur very quickly and needs to be treated immediately. If the parents/guardians have not provided you with more specific instructions, give the student one of the following: 15 grams of glucose in the form of glucose tablets 15 ml (1 tablespoon) or 3 packets of table sugar dissolved in water 175 ml (3/4 cup) of juice or regular soft drink Soft candy (e.g. 15 skittles or 2 packages of rockets) 15 ml (1 tablespoon) of honey Wait 10 to 15 minutes. If there is no improvement, treat again. Ensure that the student eats his/her next regular meal or snack. It may take some coaxing to get the student to eat or drink, but you must insist. If the next meal is more than one hour away or the student is going to be active, ensure that he/she eats a snack, such as half of a sandwich or cheese and crackers (something with carbohydrates and protein, such as a granola bar). For students on an insulin pump, an extra snack may not be required. This should be discussed with parents. Clip and save BANTING ( ) diabetes.ca Canadian Diabetes Association 11

12 Emergency treatment of severe hypoglycemia DO NOT give food or drink if the student is: Unconscious Having a seizure Unable to swallow DO: Roll the student on his/her side Call 911 or emergency medical services After calling 911, contact the parent or guardian identified on the Kids with Diabetes information card. Important: If the student is confused you will have to coax him/her to eat or drink. It the student will not eat or drink, call 911. Do not leave the student alone for at least 30 minutes after the treatment of hypoglycemia. If hypoglycemia is suspected and you cannot confirm it with a blood glucose check, treat it immediately. If you are unsure whether the student is having an episode of hypoglycemia, always give sugar! A temporary excess of sugar will not harm the student, but hypoglycemia is potentially serious. Don t leave the student unsupervised until recovery is complete. The student can remain in the classroom. The student can then resume regular class work. Emergency medical identification MedicAlert or other emergency medical identification can help speed up diagnosis and treatment of hypoglycemia. Check for a bracelet/ necklace on an unresponsive person. Immediate treatment can be aided by the crucial medical information found on the back of the jewellery. What is hyperglycemia (high blood glucose)? Hyperglycemia occurs when blood glucose levels are higher than the student s target range. The student will be thirsty, urinate more often and be tired. Emergency treatment is generally not required, but if you suspect hyperglycemia, refer to the parents / guardians instructions on the Kids with Diabetes information card. Treatment of Hyperglycemia Notify parents if the student has consistently high blood glucose levels. Discuss the treatment of hyperglycemia with the parents/guardians. For children wearing insulin pumps, untreated hyperglycemia may lead to diabetic ketoacidosis (DKA). DKA is an emergency state that must be treated immediately. Call parent/guardian whenever the blood glucose level is over 15 mmol/l. It is imperative that the student be accompanied by a responsible person if he/she goes home. Parents/guardians should be notified of all incidents of moderate and severe hypoglycemia or repeated episodes of mild hypoglycemia. Repeated low blood glucose levels are undesirable and unnecessary, and should be brought to the parents /guardians attention so that they can discuss the problem with their family doctor or diabetes care team. 12 Canadian Diabetes Association diabetes.ca BANTING ( ) Clip and save

13 Kids with Diabetes information card Special instructions PERSONAL INFORMATION OBTAINED FROM PARENT INSERT YOUTH S PICTURE HERE Student s name: Age: Grade/Room Number: Teacher s name: Parents names: Home telephone: Parent/Guardian 1 Business: Parent/Guardian 1 Cell: Parent/Guardian 2 Business: Parent/Guardian 2 Cell: Emergency contact number: Address: Address: Alternate person to call in an emergency: Relationship to student: SPORTS AND EXTRACURRICULAR ACTIVITIES It is critical that the people who have students with diabetes in their care, especially gym teachers and coaches, are familiar with the symptoms, treatment and prevention of hypoglycemia. For more information about hypoglycemia, refer to the About Diabetes section and the Signs, Symptoms and Treatment of Hypoglycemia (Low Blood Glucose) tear-out card. Telephone: Type of diabetes: Type 1 Type 2 Does the child take: Insulin by injection (if so, are any injections required during school hours) Yes No Insulin by pump Oral diabetes medications Clip and save 13

14 What should be done when blood glucose checks are higher than target range? Hyperglycemia occurs when blood glucose levels are higher than the student s target range. The student will be thirsty, urinate more often and be tired. Emergency treatment is generally not required, but if you suspect hyperglycemia, see below. Treatment of Hyperglycemia Notify parents/guardians if the student has consistently high blood glucose levels or is requesting frequent water and washroom breaks. Discuss the treatment of hyperglycemia with the parents/ guardians. Allow the child to drink lots of water and have washroom breaks when requested. Kids with Diabetes information card Special instructions PERSONAL INFORMATION OBTAINED FROM PARENT Names and grades of siblings in the school: 1. Name: Teacher s name: 2. Name: Teacher s name: 3. Name: Teacher s name: 4. Name: Teacher s name: Doctor s name: Telephone: Nearest hospital: ADDITIONAL NOTES AND INSTRUCTIONS Attach a separate sheet if necessary. Student s health insurance number: Time of day when low blood glucose is most likely to occur: Symptoms commonly experienced: What has been provided to treat hypoglycemia (low blood glucose)? Where it is located? Type of morning snack: Type of afternoon snack: Suggested substitution if meal or snack is not finished: Suggested treats for in-school parties/events: 14 Clip and save

15 Communication/education checklist Before a student with diabetes begins classes, parents/guardians, teachers and school administrators should meet for about 30 to 60 minutes to review his or her needs. This information review should include essential information about supervising students with diabetes, including: The Frequently Asked Questions and Answers section. The Test Your Diabetes Knowledge quiz. Canadian Diabetes Association guidelines regarding prevention, identification and emergency procedures/treatment for hypoglycemia episodes from the Signs, Symptoms and Treatment of Hypoglycemia (Low Blood Glucose) pull-out card in this booklet. Information about dealing with hypoglycemia (specifically the guidelines in this booklet, as well as school policies, procedures and expectations regarding the supervision of students with diabetes, how to respond to episodes of hypoglycemia, contacting parents/guardians and related concerns). The general daily routine for the student with diabetes. The completed Kids with Diabetes information card. Parents /guardians checklist Provide the school with copies of the Canadian Diabetes Association Kids with Diabetes in Your Care Resource Kit. Complete the Kids with Diabetes information card in this booklet and give it to the school. Be sure to update this information annually and as needed. Notify the school regarding special needs or changes in your child s health, lifestyle or diabetes management (e.g. typical signs and treatment of hypoglycemia, meal and snack times), emergency contact numbers, etc. Review school policies regarding diabetes. Educate teachers and other school staff about diabetes (especially the role of insulin, diet and exercise) and emergency actions for treating hypoglycemia. Encourage school administrators to have an in-service presentation for school staff about diabetes and the treatment of hypoglycemia and hyperglycemia. Ask the school to find a safe, hygienic and private space in the school for your child to do his/her blood glucose monitoring and insulin injections throughout the school day. Discuss the need for safe disposal of sharps, lancets and testing strips. Ask the school to find a safe place to store insulin, syringes and blood glucose testing supplies, as well as multiple places to store emergency food supplies (snacks). Provide information about local support and resources for the school, including contact information for the Canadian Diabetes Association BANTING ( ) diabetes.ca Canadian Diabetes Association 15

16 GENERAL NOTES: School administrators and teachers checklist Ensure that school personnel who are in contact with students with diabetes during the school day (e.g. teachers, substitute teachers, office staff, volunteers, bus drivers, lunchroom supervisors) are adequately prepared to respond effectively to hypoglycemia incidents and other emergency situations. Facilitate in-service training. Provide a safe, hygienic and private space in the school for students to perform self-blood glucose monitoring and insulin injections throughout the school day. Establish procedures for the safe disposal of sharps, lancets and testing strips. Designate a secure, accessible and appropriate place to store insulin, blood glucose and testing supplies, as well as multiple places to store emergency food supplies (snacks). 16

17 Glossary Blood glucose: The amount of glucose (sugar) in the blood at a given time. Blood glucose monitoring, or self-monitoring of blood glucose: People with diabetes must monitor their blood glucose regularly as part of the process for achieving their target blood glucose level. Levels will change depending on food consumption, physical activity, stress, illness, problems with the insulin delivery system and many other unknown factors. To test blood glucose, the individual pricks his or her finger with a lancing device and places a drop of blood on a blood glucose strip, which is inserted into a blood glucose meter to obtain a reading. Carbohydrate: One of the main sources of energy (calories). All forms of carbohydrate are broken down into glucose during digestion and increase blood glucose. Carbohydrates are found in fruits, vegetables, milk and grains/starches such as rice, potatoes, corn and legumes, and refined sugars. Diabetic ketoacidosis (DKA): An acute and severe complication of diabetes that is the result of high levels of blood glucose and ketones. It is often associated with poor control of diabetes or occurs as a complication of other illnesses. It can be life threatening and requires emergency treatment. Signs and symptoms include fruity odour on the breath, shortness of breath, confusion, nausea, vomiting and weight loss. Fast-acting carbohydrate: A carbohydrate to eat or drink for the treatment of mild to moderate hypoglycemia (e.g. juice, glucose tablets). Glucagon: A hormone that raises blood glucose. An injectable form of glucagon is used to treat severe hypoglycemia. Glucose: The fuel that the body needs to produce energy. Glucose (sugar) comes from carbohydrates such as breads, cereal, fruit and milk. Hyperglycemia, or high blood glucose: A situation that occurs when the amount of blood glucose (sugar) is higher than an individual s target range. Hypoglycemia, or low blood glucose: Occurs when the amount of blood glucose (sugar) is lower than 4.0 mmol/l. Hypoglycemia can be mild, moderate or severe. Severe hypoglycemia: Typically occurs when the amount of blood glucose (sugar) is lower than 2.8 mmol/l. Severe hypoglycemia requires the assistance of another person as unconsciousness may occur. Guardians should call emergency services immediately. Symptoms of severe hypoglycemia include fainting, a seizure and difficulty speaking. Insulin: A hormone that facilitates the conversion of glucose to energy. Since people with type 1 diabetes cannot produce their own insulin, glucose builds up in the blood instead of being used for energy. They must therefore administer insulin by syringe, insulin pen or insulin pump. Sharps: Used syringes, insulin pen needles, and lancets. These items must be carefully disposed of in appropriate containers. Target blood glucose range: Acceptable blood glucose levels based on the Canadian Diabetes Association s Clinical Practice Guidelines and personalized for the student, by their diabetes care team and their parent or guardian. Type 1 diabetes: An autoimmune disease that occurs when the pancreas no longer produces any insulin or produces very little insulin. Type 1 diabetes usually develops in childhood or adolescence and affects approximately 10% of people with diabetes. There is no cure. It is usually treated with lifelong insulin injections and careful attention to diet and physical activity. Type 2 diabetes: A disease that occurs when the pancreas does not produce enough insulin to meet the body s needs and/or the body is unable to respond properly to the actions of insulin (insulin resistance). Type 2 diabetes usually occurs later in life (although it can occur in children) and affects approximately 90% of people with diabetes. There is no cure. It is treated with careful attention to diet and exercise and usually requires medication (oral antihyperglycemic agents) and/or insulin BANTING ( ) diabetes.ca Canadian Diabetes Association 17

18 Frequently asked questions Does diabetes affect a student s performance? Academic performance and physical activity at school should be the same as a student who does not have diabetes, providing that blood glucose levels are within an acceptable target blood glucose range. Hypoglycemia (low blood sugar) can affect concentration and ability to think clearly, and may negatively impact exam performance. Sustained hyperglycemia (high blood sugar) can result in tiredness and lack of concentration. Students with diabetes are no more susceptible to infection or illness than their classmates, so classroom attendance should not be affected. What questions should I ask the parents/caregivers of a student with diabetes? Parents/caregivers of a student with diabetes should meet with teachers at the beginning of the school year to address questions and issues. Parents/caregivers should complete the Kids with Diabetes information card and ensure that it is kept up to date throughout the school year. To complete this card, teachers should ask parents/caregivers questions such as: What do I do if the student won t eat or finish a snack, refuses glucose checks or has high blood glucose (hyperglycemia)? How often might I expect these situations to occur? How do I help your child with low blood glucose (hypoglycemia)? Does the student need extra snacks for physical education classes or activities? What is the plan for reporting incidents to you (e.g. should I write a note in the student s agenda or a journal that the student takes home each day)? What do I do if the student won t eat or finish a snack? You should remain calm and attempt to understand the reason for refusal. Is the student s blood glucose level low (hypoglycemia)? Does the student not like or want the food provided? Is the student ill? 18 Canadian Diabetes Association diabetes.ca BANTING ( )

19 Refer to the Kids with Diabetes information card that was completed by the student s parents/ caregivers for additional instructions. This should include written directions for an emergency. Report the incident to the parents/caregivers as directed in the parent-teacher interview and on the Kids with Diabetes information card. If the situation happens again, work with the parents/caregivers to develop strategies such as teaching the student the importance of eating, reassessing the meal plan with the student s diabetes care team, and reminding the student to finish the snack before going out for recess. It is also a good idea to always have non-perishable snacks (such as granola bars or juice boxes) readily available in case the student s food becomes inedible (e.g. if it is dropped on the floor). It is the parent s responsibility to provide these snacks. How can I remember a student s snack times? Attempts are generally made to schedule snacks and lunch at usual school break times, making it easier to remember that the student with diabetes eats when others eat, and their schedule is as normal as possible. If this is not possible, ask parents/caregivers to provide their student with a digital watch with an alarm to remind both the student and teachers of snack time. A student is unusually tired before lunch and is unable to concentrate. Could this be because of low blood glucose? Yes, ask the student to check his/her blood glucose level and to treat it if necessary (a blood glucose level of less than 4.0 mmol/l requires treatment with glucose tablets, juice, candy, etc.). Refer to the Signs, Symptoms and Treatment of Hypoglycemia (Low Blood Glucose) card. Communicate any low blood glucose, especially a pattern of lows, to parents/caregivers, as this information will assist them in adjusting the student s insulin dose and meal plan to prevent further lows. As the student s teacher, do I have to check his/her blood glucose? Teachers are not required to do blood glucose checks, but can agree to assist or supervise the student. Checking the blood glucose involves pricking the student s finger with a lancet to obtain a drop of blood that is placed on a strip. You are not required to do the finger prick. You may need to supervise younger students with blood glucose monitoring before lunch or when low blood glucose (hypoglycemia) is suspected. If the blood glucose level is below 4.0 mmol/l, treat it immediately with a fast-acting glucose (juice, candy or glucose tablets) BANTING ( ) diabetes.ca Canadian Diabetes Association 19

20 If in doubt, treat low blood glucose (hypoglycemia)! If the student is unable to perform the finger-prick procedure and you suspect he/she has hypoglycemia, treat it immediately with a fastacting glucose (juice, candy or glucose tablets). You won t hurt the student if your assumption is wrong, and you will have kept the student safe. Always inform the student s parents/caregivers about the situation. Refer to the Signs, Symptoms and Treatment of Hypoglycemia (Low Blood Glucose) card. Can the student s blood glucose monitoring equipment be used on other people? The individual s blood glucose monitoring equipment should never be used on anyone else as blood-borne infections can be transmitted on the lancing device s end cap. As the student s teacher, do I have to learn how to give the student s insulin injection? Teachers are not responsible for giving insulin. Most insulin injections are administered outside school hours before breakfast, supper, and at bedtime. Some students require an insulin injection before lunch, but this is the family s and student s responsibility. 20 Canadian Diabetes Association diabetes.ca BANTING ( )

21 Will I be held responsible if something happens to the student with diabetes while he/she is in my care? You are not liable and will not be held responsible if you do what is reasonable under the circumstances. Ensure that you: Allow your student to eat meals and snacks fully and on time. Treat low blood glucose (hypoglycemia) promptly. Help the student treat low blood glucose if necessary. For more information, refer to the section School Employee as Good Samaritan: Assisting Students with Diabetes on page 26, and the teacher s roles and responsibilities as listed in the Standards of Care for Students with Type 1 Diabetes in School. What do I do if I think the student has hypoglycemia (low blood glucose)? Refer to the Signs, Symptoms and Treatment of Hypoglycemia (Low Blood Glucose) card in this booklet. It provides all the information you will need to treat a student with hypoglycemia. Also make sure that you have reviewed the Kids with Diabetes information card for individualized instructions from the parents/caregivers. Is it appropriate for students with diabetes to give presentations to groups at their school on the topic of diabetes? It is a great idea to encourage students with diabetes to explain their condition to other students and teachers. Some students with diabetes will embrace the opportunity to share their knowledge of diabetes, while others might not be interested; this decision must also be respected. The student with diabetes may wish to demonstrate how he/she checks blood glucose; however the blood glucose monitoring equipment should never be used on anyone else. Should students with diabetes wear diabetes identification? The Canadian Diabetes Association strongly encourages students with diabetes to wear MedicAlert bracelets or necklaces, or other emergency identification. Many students report that coaches and referees ask them to remove their identification bracelet or neck chain during sports activities, to protect other players from injury. The sports bracelet has reportedly become more accepted during sporting events than chain-style bracelets. If a student is required to remove identification, the coach should be aware of the identification, and can therefore assist the student if and when necessary. The medical identification can then be attached to the handles of the student s gym bag, or carried by the coach and returned to the student when the event is over. Some students dislike wearing emergency identification such as MedicAlert, but will carry wallet cards identifying them as having diabetes. Often students dislike the idea of being identified as having diabetes because they feel it is a very private matter. Discuss this issue with the student and family, and encourage the student to find a form of identification that he/she finds acceptable BANTING ( ) diabetes.ca Canadian Diabetes Association 21

22 Test your diabetes knowledge 1. Type 1 diabetes: a) affects 10% of people with diabetes and usually occurs before age 40 b) is also called brittle diabetes c) is more serious than other types of diabetes d) can be cured with insulin injections 2. The management of type 1 diabetes involves balancing: a) food and insulin b) food, physical activity and insulin c) insulin and physical activity d) I don t know 3. If insulin is not available, the glucose level in the bloodstream: a) increases b) decreases c) stays the same d) I don t know 4. A student with type 1 diabetes should eat: a) all the meals and snacks prepared by his parents/caregivers b) foods that are natural and contain no sugar c) only when hungry d) high-protein, low-fat foods 7. Treatment for hypoglycemia is: a) half a can of diet pop b) crackers and cheese c) 15 grams of glucose tablets or 3/4 cup (175 ml) of fruit juice d) kept in the nurse s office 8. If hypoglycemia is untreated, a student with diabetes may: a) have staggered walking b) become irritable c) lose consciousness d) all of the above 9. A student with diabetes comes to you in gym class and says I feel low. You would: a) call her parents/caregivers right away b) tell her to sit down until she feels better c) give her some sugar, such as glucose tablets or a small juice box d) have a friend escort her to the nurse s office 5. Blood glucose monitoring: a) is done using a blood glucose meter b) tells a student what his/her blood glucose level has been for several hours c) should be done once per week d) I don t know 6. Common symptoms of hypoglycemia are: a) paleness, shakiness, clamminess, sweating b) increased thirst and urination c) fever and loss of appetite d) I don t know 22 Canadian Diabetes Association diabetes.ca BANTING ( )

23 People with diabetes can eat the same foods as anyone else, but to avoid low and high blood glucose, they should eat according to their meal plan. 10. One day, a student with diabetes requests frequent trips to the bathroom and water fountain. You would: a) ask him to wait until the next scheduled break b) allow him to go to the bathroom and water fountain c) give him a detention for disrupting the class d) call his parents/caregivers right away 11. You find a student with diabetes unconscious. The first thing you should do is: a) roll her on her side and call for an ambulance b) rub honey on her gums and call her parents/ caregivers c) tell her to wake up and drink some juice d) I don t know 12. The class is having pizza for lunch. A student with diabetes: a) should have his regular lunch from home b) can have the pizza, provided it fits into his meal plan c) cannot eat pizza d) I don t know 13. A student with diabetes wants to participate on the track and field team. To do this, she must: a) always carry some form of fast-acting sugar b) know which days the events are scheduled so she can bring extra food c) take extra insulin d) both a and b 14. Which of the following activities would NOT result in hypoglycemia? a) eating extra food at snack time b) more activity than usual c) throwing away or not eating part of lunch d) I don t know 15. You should meet with the parents/caregivers of a student with diabetes to: a) review his usual symptoms of hypoglycemia b) discuss the preferred treatment for hypoglycemia c) become familiar with how often he requires snacks d) all of the above BANTING ( ) diabetes.ca Canadian Diabetes Association 23

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