for education and childcare services

Transcription

1 Diabetes Planning and support guide for education and childcare services D i a b e t e s D i a b e t e s

2 Diabetes Planning and support guide for education and childcare services Diabetes: Planning and support guide for education and childcare services 1

3 Additional copies of this publication may be obtained from the Health Information Centre, Women s and Children s Hospital, Adelaide, telephone (08) , The State of South Australia, Department of Education and Children s Services This publication is protected by copyright. Except as permitted under the Copyright Act 1968 (Cth), no part of this publication may be reproduced or stored, whether electronically or by any other process, without the written permission of the Department of Education and Children s Services. Produced by DECS Publishing Banksia Avenue, Seacombe Gardens SA 5047 Edited by Gunta Groves Designed by Triple Image Design Printed by Gillingham Printers, South Australia ISBN R Diabetes: Planning and support guide for education and childcare services

4 Foreword This booklet, Diabetes Planning and support guide for education and childcare services, has been written to provide education and childcare workers with a broader understanding of the needs of children and adolescents with diabetes. It provides general information about diabetes and its management and then gives practical advice for planning support in education and childcare services. Management of diabetes requires lifelong daily routines and systems to maintain health and well-being. Education and childcare services have particular responsibilities in planning and providing diabetes support in partnership with families and health services. We commend this booklet to all education and childcare workers as a practical guide to planning support for young people living with diabetes. Steve Marshall CHIEF EXECUTIVE DEPARTMENT OF EDUCATION AND CHILDREN S SERVICES David Swan CHIEF EXECUTIVE WOMEN S AND CHILDREN S HOSPITAL Bill Taylor CHIEF EXECUTIVE ROYAL DISTRICT NURSING SERVICE Diabetes: Planning and support guide for education and childcare services 3

5 Copying Members of staff in schools, preschools and childcare and health services are permitted to copy relevant sections of this document to use in supporting families. Members of staff in schools, preschools and childcare or health services cannot sell, hire or otherwise derive revenue from copies of the material, nor distribute copies of the material for any other purpose. Permission to copy this material may be sought from the South Australian Department of Education and Children s Services. Acknowledgments This book has been developed in consultation with a wide range of education, childcare and health professionals, families and communities. Their contribution to continuity of education and care for children and students is gratefully acknowledged. Staff at the Department of Diabetes and Endocrinology, Women s and Children s Hospital and diabetes nurse educators at the Royal District Nursing Service provided expert advice in the development of this resource. Disclaimer The health-related information in this book is accurate at the time of going to print. Readers are encouraged to check with their doctor or local health service provider for more recent information. Further information In South Australia, families and health professionals can seek further information about health support planning from the manager of the service in which the child or student is enrolled or planning to enrol. The Department of Education and Children s Services has a wide range of education professionals who assist worksites to plan support for children and students with additional needs. These services can be contacted through district offices. General enquiries can be directed through the department s toll free telephone number: In South Australia, specialist support for diabetes management is available from: The Women s and Children s Hospital Department of Diabetes and Endocrinology, telephone (08) Royal District Nursing Service diabetes nurse educators, telephone Key to icons In the proformas you will find this icon to alert you to the need to speak with the emergency contacts nominated by the family of a child or student. The ambulance icon appears in proformas where there is a need to call for emergency assistance, especially an ambulance. 4 Diabetes: Planning and support guide for education and childcare services

6 Contents 1. Diabetes in childhood and adolescence Type 1 diabetes Type 2 diabetes Diabetes in education and childcare services Living with diabetes Management: Type 1 diabetes Routine care: Staff responsibilities Food and fluid Activity Monitoring blood glucose levels Medication Special events and circumstances First aid and emergency care: Staff responsibilities Low blood glucose levels (hypoglycaemia or hypo ) High blood glucose levels (hyperglycaemia or hyper ) Illness Management: Type 2 diabetes Sample forms and plans Diabetes care plan proforma Sample diabetes care plan Self-management checklist proforma Sample self-management checklist Health support plan proforma Sample health support plan Communication book proforma Sample communication book entries First aid flow chart Hypoglycaemia First aid flow chart Hyperglycaemia Diabetes: Planning and support guide for education and childcare services 5

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8 Diabetes in childhood and 1adolescence 1.1 Type 1 diabetes Type 1 diabetes occurs due to a severe deficiency of insulin. Insulin is the hormone which controls blood glucose levels or BGLs. Type 1 diabetes is an auto-immune disease in which the body s own immune system attacks the insulin-making cells in the pancreas and destroys them over time. There is no risk of contracting diabetes from affected individuals. Type 1 diabetes occurs mainly in childhood. Most secondary schools will have approximately one student with diabetes for each 500, whilst primary schools will have one per Signs and symptoms of diabetes occur over a period of days and weeks. They include lethargy, weight loss, increased urination and excessive thirst. Without insulin the disease progresses to a lifethreatening condition marked by dehydration, high blood glucose levels and a build up of acids (ketones) in the blood (ketoacidosis). Treatment for Type 1 diabetes involves insulin injections, blood glucose monitoring and food management. 1.2 Type 2 diabetes Type 2 diabetes usually does not emerge until adulthood and is associated with the following risk factors: being overweight, inactivity and a genetic predisposition. However, Type 2 diabetes affects some children, in particular children with identified risk factors which are compounded by disadvantaged socioeconomic conditions and/or other medical conditions. Type 2 diabetes is different from Type 1 diabetes. People with Type 2 diabetes are able to make insulin but when it is released into the blood stream it is unable to work efficiently (insulin resistance). This leads to high blood glucose levels (hyperglycaemia). Diabetes: Planning and support guide for education and childcare services 7

9 1.3 Diabetes in education and childcare services Children and adolescents with diabetes are no more likely to be sick than other young people and can generally be expected to do everything their peers do. Because of their diabetes, they may, however, need: special consideration when planning sport, excursions, camps and other activities extra toilet provisions extra consideration if unwell some individual supervision to eat at additional times, especially when involved in physical activity special provisions for privacy if testing for blood glucose levels and injecting insulin. Attendance is therefore largely unaffected apart from routine doctor or clinic visits every few months. Clinic visits are very important but can be negotiated to ensure young people do not miss out on special events. Occasionally, unstable diabetes will lead to hospital admission or more frequent visits to the doctor or clinic for a period of time. It is uncommon for diabetes to be the cause of significant absenteeism. This booklet details strategies for communication with families and supporting health services (see the proformas in section 4). Education and childcare workers should record absences in any communication to health professionals because significant absences may indicate the need for a diabetes management review. 1.4 Living with diabetes Diabetes is a diagnosis that has a significant impact on families. Children, their parents and other family members and close friends have to work at establishing routines and treatment. The family needs others caring for their child to understand the complexity and responsibilities of diabetes management. Young people with diabetes can be worried about and even avoid managing their diabetes in school because of concern about being different. This can in turn lead to problems such as social isolation and refusing to go to school which can be indicative of depression and/or anxiety. It is therefore important to establish a culture of inclusion and to support young people with diabetes so that they participate fully and safely. Parents and guardians must be able to discuss all aspects of routine and emergency care with the educator and others involved. It is important that communication is open between families and educators so that management of diabetes is optimal. Regular communication can work to ensure that all involved have a shared understanding of the diabetes care plan and education and childcare support plans. Communication can also assist in the development of an understanding of the roles and responsibilities of all involved in the care of the child or student. This can prevent anxiety and concerns for both educators and families. 8 Diabetes: Planning and support guide for education and childcare services

10 In younger children, management of diabetes is harder to achieve given their rapid development. The ability to perceive low blood sugar levels (hypoglycaemia), to eat correct exchanges and manage exercise output are difficult aspects to manage for anyone with diabetes, but for young children in early developmental stages these are extremely difficult tasks and they need support and guidance. Adjustment to diabetes for young people and their families is often an ongoing psychological process. Education and childcare workers can be supportive and mindful of the chronic nature of this condition and the nature of treatment which is continuous and demanding. Diabetes: Planning and support guide for education and childcare services 9

11 2 Type Management: 1 diabetes The management of diabetes depends on balancing the effects on blood glucose of: carbohydrate food exercise insulin. Maintaining this balance, so the level of glucose in the blood is neither too high nor too low, is very important but can be difficult to achieve. Diabetes control is commonly less stable during infections, emotional stresses and puberty. Changing hormonal patterns are partly responsible, but it is also often more difficult to adhere to diabetes routines, treatment and testing schedules during emotional stresses. Blood glucose control is assessed on the basis of being within a target range. Target ranges are specified and monitored through the diabetes care plan. They are not the same for everybody. Effective diabetes management is not about maintaining an exact number rather, the target ranges are a guide to monitoring blood glucose levels while getting on with life. In some care plans instructions will even indicate that if the young person s behaviour or symptoms show they are well, blood glucose readings outside the target range are acceptable. 2.1 Routine care: Staff responsibilities Food and fluid The foods routinely recommended for diabetes are based on the same healthy eating principles recommended for all people. Families are responsible for providing education and childcare services with the food and drink needed by their child. Low joule or diet products can be used freely by a person with diabetes. 10 Diabetes: Planning and support guide for education and childcare services

12 The food plan for diabetes includes the: type of food Food containing slowly absorbed carbohydrates must be eaten at each meal. timing of meals Most food plans are based on three major meals (breakfast, lunch and evening meal) and three snacks (morning, afternoon tea and at bedtime). If the interval between meals and snacks is too long, a low blood glucose level can occur and an additional snack may have to be eaten. quantities of food The amount of food for each meal is also important and meals should never be skipped. Families are taught to count carbohydrate quantities using the exchange system (15g carbohydrate equals 1 exchange). Carbohydrate foods have been given an exchange value and the young person with diabetes will be eating a specific number of exchanges at main meals and snacks. Very young children may require extra supervision at meal and snack times. Most students will have a food plan that fits in with regular school routines, avoiding the need to eat regularly in class or at odd times. Young people with diabetes usually cannot delay meal times. If an activity is running overtime, they may need to eat during the activity. The following foods are a good source of slowly absorbed carbohydrates which maintain blood glucose levels: bread potato chips biscuits and crackers rice cereals pasta fruit milk. ice-cream and yoghurt Details of foods and drinks and the timing should be included in the young person s diabetes care plan and health support plan. Food and fluids used for low blood glucose levels should be provided by the family. Management of low blood glucose levels (hypoglycaemia or hypo ) involves giving glucose containing products such as a fruit box drink followed by a slowly absorbed carbohydrate, in the recommended quantities below (see also the flow chart on page 50). Glucose-containing products are: fruit box style drinks (125ml) jellybeans (5 6) glucose tablets (2 3) glucose gel normal lemonade (125ml). Slowly absorbed carbohydrates are: muesli bars (1) biscuits (2 3) milk (1 cup) fruit (1 piece). The diabetes care plan will specify the preferred glucose containing products and carbohydrates for each individual. In an emergency, if the young person s hypo kit cannot be located, alternative glucose containing products and carbohydrate products can be offered. Diabetes: Planning and support guide for education and childcare services 11

13 If any difficulties are noted with the food plan, the family s emergency contacts should be notified, or the difficulty communicated through the communication book. In South Australia, specialist support for diabetes management is available from: The Women s and Children s Hospital Department of Diabetes and Endocrinology, telephone (08) Royal District Nursing Service diabetes nurse educators, telephone Activity The child or student with diabetes should be encouraged to exercise because it: improves fitness and well-being encourages a lifelong healthy lifestyle builds self-esteem, confidence and teamwork improves the action of insulin and helps with blood glucose control. Exercise and low blood glucose levels (hypoglycaemia or hypo ) Exercising muscles use more glucose for energy. This may cause the blood glucose level to fall during exercise, immediately after, or, in the case of prolonged or intensive exercise, hours later. If the exercise is intensive and sustained, extra carbohydrates may be needed before the sport. If the sport has been particularly vigorous or lengthy, extra carbohydrates may be needed after the sport as well. This will be detailed in the young person s diabetes care plan. Special precautions for exercise Education and childcare workers need to discuss a plan with families regarding the implications for management of the diabetes during physical activity. There are many ways in which this could be done. The agreed strategies should be written in the individual diabetes care plan and health support plan and monitored through the communication book. The support plan should determine how staff will ensure that food and drinks for the treatment of low blood glucose levels (hypoglycaemia or hypo ) are available at the place of physical activity and sport. Sports uniforms or clothing will need to have a pocket to allow a young person with diabetes to carry foods to treat low blood glucose levels. For some young children, the supervising adult should carry the hypo kit. Young people with diabetes need additional supervision during exercise. The younger child may also need to have meals supervised, especially before exercise. Any sport in which a low blood glucose level would cause a risk to the child or student should be carefully planned and always occur under strict supervision. Water sports need very careful planning and supervision because a low blood glucose may increase the risk of drowning. Some features of a low blood glucose level may be masked by cooler body temperatures experienced during waterbased activity. An adult should be located on the edge of the water-based activity as a safety watch. This should be documented on the swimming and aquatics consent form. Exercise and high blood glucose It should be noted that exercise may not reduce high blood glucose levels, despite a common belief that this is the case and the general guidelines above. Exercise is not recommended during poor diabetes control, particularly when ketones are present in the urine or when the person feels unwell from high blood glucose levels. Exercise can cause blood glucose levels to become even more elevated. 12 Diabetes: Planning and support guide for education and childcare services

14 2.1.3 Monitoring blood glucose levels Monitoring signs and symptoms Signs are observable indicators; symptoms are what the person can feel and report. Monitoring a young person with diabetes for signs and symptoms of high or low blood glucose levels is very important if he or she is unable to test the blood glucose level using a blood glucose meter. Education and childcare workers should be trained in what signs to look for and when to take action. The family and staff need to have a system in place so that the symptoms are reported and any action taken is communicated (for example, through the communications book, see pages 48 and 49). Families will use the record of signs, symptoms and action to make changes to the management of the young person s diabetes. Blood glucose testing Blood glucose testing is used to monitor whether the insulin doses being taken are the right amounts. It also enables safe management of sick days and exercise. Some young people will know how to prick their finger and measure the blood glucose using their own blood glucose meter. Education and childcare staff are not expected to do blood glucose tests but should be trained on how to supervise this to support this aspect of the young person s self-management. Blood glucose testing may be needed at school and childcare if the young person: is newly diagnosed needs to adjust the dosage of an insulin injection taken at school has unstable diabetes does tests/examinations does strenuous sport feels unwell. If blood glucose level tests are needed discussion should take place between the family, the treating health professional and education and childcare staff about how often and what time the tests should be done and what tasks of the blood glucose test the young person is capable of doing. The diabetes care plan, health support plan and the self-management checklist would assist with this (see section 4 sample forms and plans). Some children are too young to manage the blood-letting device ( finger-pricker ). Generally these children will be supported by a visiting nurse. Occasionally (for example in some rural and remote communities), education and childcare staff may be asked to assist short-term with this procedure. In these cases, the staff should be trained and supported by a registered nurse who remains immediately available, at least by telephone, to provide advice. Storage of equipment Blood glucose monitoring equipment should be safely stored so that it is accessible as required by the young person and supervising adult but is not accessed by others. Typically this equipment is stored with the young person s hypo kit (see section 2.2 First aid and emergency care). Ideally, one hypo kit should be kept in the classroom and another with the first aid officer. The young person should also carry a form of glucose on him or her, for immediate access Medication The medication used to treat Type 1 diabetes is called insulin and is given by injections or by an insulin pump. Insulin lowers the blood glucose levels. Insulin is not a cure and must never be omitted unless instructed by a medical officer. Young people with Type 1 diabetes are treated each day with two to four injections of insulin or with insulin given continuously by an insulin pump. The dose of insulin is adjusted according to blood Diabetes: Planning and support guide for education and childcare services 13

15 glucose levels. Most young people are on two injections a day (before breakfast and before the evening meal) and do not need to inject at school or childcare. Older students are frequently on three or four injections per day and may need to have an injection at school. Education and childcare workers are not expected to give insulin injections but may need to help in arranging some privacy for young people who need to administer their insulin. If insulin injections are required in education and childcare services, adult support and supervision should be provided. A discussion needs to take place between the family, health professionals and staff about how often and what time the injections need to happen and what tasks of performing the insulin injection the young person can self-manage. The diabetes care plan, the health support plan and the self-management checklist would assist with this (see section 4 Sample forms and plans). The timing of injections is as important as the timing of food. The carbohydrate exchanges such as bread, fruit and milk are essential and raise blood glucose levels, while insulin and exercise lower them. Maintaining a balance within the target blood glucose level range so the level is neither too high nor too low is very important. The health support plan should detail safe storage of insulin and equipment and, where necessary, safe disposal of sharps. The other medication that may be used is called the Glucagen Hypo Kit. This is used for severe hypoglycaemia and is a synthetic version of the hormone glucagon. This hormone enables the liver to release stored glucose, raising the blood glucose level. Education and childcare workers are not expected to give Glucagen injections Special events and circumstances Young people with diabetes need to be able to join in special events such as parties, celebrations, camps, excursions, competitions and exams. Consideration needs to be given to the type of activity, food, monitoring of the diabetes, emergency management and medication requirements. The details about how this will be achieved should be discussed with the family and education and childcare staff and specifically addressed in the health support plan. Attending boarding school is also a special circumstance requiring preparation and planning. Parties and celebrations Foods like sandwiches, pizza, popcorn, fruit and ice-cream are all suitable. Low joule diet soft drinks can be provided or brought from home if desired. Camps Camps enhance self-esteem, are fun, and promote confidence and independence. Young people with diabetes can participate fully within a camp program. Usually young people attend camp when they are reliably independent in the care of their diabetes. This includes the ability to: inject insulin do blood glucose tests recognise and treat hypos early understand the food plan and exchanges of carbohydrates understand the need for meals to be on time understand the need for extra food before, during and after exercise. Families need to meet with camp organisers well beforehand to discuss any special needs. Occasionally a parent or guardian may be invited to attend the camp if the young person with diabetes is not fully independent. Given sufficient time, the camp organisers can arrange additional supervision. Camp organisers should be mindful of their choice of location if young people eligible to attend might need health service support. 14 Diabetes: Planning and support guide for education and childcare services

16 Support planning Families and the staff need to discuss the care and support plans for the camp including: food planning prevention of hypos blood glucose testing recognising and treating hypos (including the availability of glucagon to be administered by nursing, medical or paramedical personnel) strategies if the person becomes unwell (including the potential for urine ketone testing) when to call for help and 24 hour emergency medical access. In general, the young person s friends and room-mates should be aware of the diabetes. All members of staff must be informed about the support plan. The extra exercise at camps increases the risk of hypos. Insulin dosages are usually reduced, but staff members are not expected to be involved with adjusting doses. Slowly absorbed carbohydrate foods such as breads should be served at every meal and snack time. Meals need to be served at the regular times. Additional carbohydrate foods (dried fruit is excellent) are needed for exercise and must be readily available where the exercise is taking place. Supplies for camping The young person with diabetes needs to make sure that he or she has all the required diabetes equipment, hypo foods, and contact details of doctor/hospital. He or she also needs to be able to keep the insulin cool in hot weather if a refrigerator is not available. Safe sharps disposal (for syringes) should also be arranged. Diabetes camps Diabetes camps for children and adolescents are held annually. Details of times, venues, ages catered for and costs may be obtained from Diabetes Australia South Australia. These camps are specifically designed for young people with diabetes and are run by staff knowledgeable in diabetes. Excursions Planning is the key to trouble-free excursions. Details which need to be considered include the: timing of meals timing of insulin injections and blood glucose tests need to carry an adequate supply of food (for example sandwiches, chips, biscuits, dried fruit) without relying on purchasing food or snacks when needed exercise or activities included. Competitions, tests and exams Young people perform best at tests and examinations when their diabetes is in good control. When blood glucose levels are high, there is a need to urinate more frequently. Easy access to toilets must to be granted. When blood glucose levels are low, the brain is deprived of glucose for energy, causing cognitive and other changes. Blood glucose levels should be measured immediately before important tests and examinations and measures taken as outlined in the diabetes care plan. Young people with diabetes need to be allowed to have access to their food and blood glucose monitoring equipment in case of hypos during a test or examination. Discussions should occur beforehand to determine whether an additional few minutes will be allowed if a mild low blood glucose level has occurred immediately before or during a test or examination. Diabetes: Planning and support guide for education and childcare services 15

17 If a severe hypo occurs, a claim for special consideration due to misadventure should be lodged with the testing authority. Special provisions for senior examinations are available in most states for students with diabetes. The provision must be applied for in writing well before the examination date. Boarding schools Students with diabetes can attend boarding schools. Parents or guardians need to inform the school administrators, nurse, catering officer and school doctor about the diabetes and provide any special information concerning the diabetes. A 24 hour diabetes care plan must be formulated with the staff. Details of emergency contacts and arrangements for sick days need to be provided before the initial attendance at school. Clear guidelines should be available. The school nurse should be provided with a Glucagen Hypo Kit in case of a severe hypo, as well as ketone testing sticks for use during sick days. 2.2 First aid and emergency care: Staff responsibilities Low blood glucose levels (hypoglycaemia or hypo ) A low blood glucose level is when there is not enough glucose in the blood stream for normal functioning. The number is usually below 4.0mmol/L. A hypo can be caused by: too much insulin exercise not eating enough exchanges (carbohydrates). Hypoglycaemia may occur at any time, but there is a greater chance of this happening with exercise or before the next meal is due (usually morning tea or lunch). Hypoglycaemia may be dangerous. The signs can progress from mild to severe very quickly prompt first aid treatment is crucial. SIGNS OF HYPOGLYCAEMIA MILD MODERATE SEVERE Sweating, paleness, trembling, hunger, weakness Changes in mood and behaviour (eg crying, argumentative outbursts, aggressiveness) Inability to think clearly, lack of coordination Inability to help oneself Glazed expression Being disorientated, unaware or seemingly intoxicated Inability to drink and swallow without much encouragement Headache, abdominal pain or nausea Inability to stand Inability to respond to instructions Extreme disorientation Inability to drink and swallow (leading to danger of inhaling food into the lungs) Unconsciousness or seizures (jerking or twitching of face, body or limbs) 16 Diabetes: Planning and support guide for education and childcare services

18 First aid for hypoglycaemia Mild to moderate hypos can be treated by giving foods or drinks by mouth. Parents and guardians should provide education and childcare staff with their child s preferred hypo kit. Anyone having a hypo needs to be supervised through to recovery (see also page 50: First aid Hypoglycaemia). The essentials in the treatment of mild to moderate hypos are the following: Give glucose immediately to raise the blood glucose level (eg half a can of normal (with sugar) soft or fruit drink, or 5 6 jellybeans if child over 3 years of age) Wait 5 minutes If there is no improvement, repeat giving glucose (eg half a can of normal (with sugar) soft or fruit drink, or 5 6 jellybeans if child over 3 years of age) If the condition improves, follow up with a snack of one piece of fruit or one slice of bread or dried biscuits, only when recovered (usually 5 minutes) If there is still no improvement, call an ambulance. State clearly that the person has diabetes, and whether he or she is conscious. Inform emergency contacts If unconscious, maintain airway, breathing and circulation (the ABC of first aid) while awaiting the ambulance Document the event by following site policy in recording the details appropriately. Treatment of a severe hypo Never put food or drink in the mouth of a person who is unconscious, convulsing or unable to swallow, in case it is inhaled. The only treatment for a severe hypo is either an injection of glucose into the vein (this can be given only by a doctor or a trained paramedic) or the intramuscular injection from the Glucagen Hypo Kit given by a doctor, a paramedic, a school nurse or a parent or guardian. In severe hypoglycaemia: Lie the student on one side and protect from injury Provide first aid, checking that there is no danger around, and maintain airway, breathing and circulation (the ABC of first aid). Check that the mouth is clear to allow unobstructed breathing. Skin colour should remain pale to normal if the person is breathing properly Call an ambulance and inform the operator that there is a diabetic emergency Inform emergency contacts Document the event following site policy in recording the details appropriately. Discussion needs to take place between the family, education and childcare staff and the family s health professional about what to treat the hypo with, what signs and symptoms are specific to the child or student, where the hypo kits are to be kept, and who to call in an emergency. This should be documented in the healthcare plan and the support plan. The parents or guardians should be contacted and the communication book should be used to document the hypo: what was done about it and the child s or student s response. This enables the family to ensure daily management is adjusted accordingly High blood glucose levels (hyperglycaemia or hyper ) A high blood glucose level is when there is too much glucose in the blood stream. The number is usually above 15.0mmol/L. High blood glucose levels can be caused by: not enough insulin common illness such as a cold or infection eating too many exchanges (carbohydrates) stress. Diabetes: Planning and support guide for education and childcare services 17

19 Signs for hyperglycaemia include: frequent urination weight loss excessive thirst lethargy change in behaviour (usually irritable) lack of concentration ketones in urine and sometimes detectable on the breath. When blood glucose levels are high for a long period of time, the body starts to break down fat and muscle for energy. When this happens, the body makes ketones. A urine test can detect ketones. Educators often become aware of these signs when the child or student constantly asks for permission to go to the toilet and to obtain a drink. Educators may also notice the child s or student s ability to concentrate or to complete tasks has decreased. If this occurs, the emergency contacts should be notified (see also page 51: First aid Hyperglycaemia) Emergency care An ambulance should be called immediately if any of the following is observed: rapid, laboured breathing abdominal pains flushed cheeks severe dehydration sweet acetone smell to breath vomiting. In severe hyperglycaemia: Lie the person on one side and protect from injury Provide first aid, checking that there is no danger around, and maintain airway, breathing and circulation (the ABC of first aid). Check that the mouth is clear to allow unobstructed breathing. Skin colour should remain pale to normal if the person is breathing properly Call an ambulance and inform the operator that there is a diabetic emergency Inform emergency contacts Document the event following site policy in recording the details appropriately. Hospitalisation is needed urgently. This is often the mode of presentation in a previously undiagnosed person with diabetes Illness Occasionally, other illnesses may cause nausea and vomiting. Food may then not be absorbed and a low blood glucose level will result. During illness (for example influenza and tonsillitis) the body needs more insulin, and diabetes control becomes less stable for a period of time. Unless more insulin is taken, not only will blood glucose levels rise, but the body may make ketones and a life-threatening condition called ketoacidosis can develop. Young people with diabetes should never be sent by themselves to seek first aid assistance or left unattended when feeling unwell, whether from high or low blood glucose levels or for some other reason. Generally it is safer to send for adult assistance to come to the child or student. It is not safe practice to send the person, with another young person, to find assistance. Vomiting is a danger signal. Young people with diabetes who are unwell, especially when vomiting, need to be seen by a doctor urgently. If emergency contacts are not available, then a transfer by ambulance to hospital is needed. 18 Diabetes: Planning and support guide for education and childcare services

20 3 Type Management: 2 diabetes Lifestyle modifications such as diet, nutrition and exercise are the key factors in the management of Type 2 diabetes, including for young people with Type 2 diabetes. Other treatment options which may be employed include tablets and insulin therapy. If a young person with Type 2 diabetes is not on tablets or insulin, he or she will not experience hypoglycaemia. The health support plan should cover special needs and considerations including: creating a safe environment for the child or student assistance with recognition of signs and symptoms and appropriate treatment of hypoglycaemia (low blood glucose level) and hyperglycaemia (high blood glucose level) adequate supervision of and ability to perform blood glucose testing taking of medication and/or insulin injections advocating and positively supporting healthy dietary behaviour encouraging physical activity. The challenge of the future lies in the prevention of Type 2 diabetes in young people as well as supporting those already diagnosed to live a healthy and fulfilling life free of diabetes health-related complications. Diabetes: Planning and support guide for education and childcare services 19