See, Think, and Act! Diabetes California After School Resource Center (CASRC) Administered for the California Department of Education (C.D.E.) Hello. My name is Joan Edelstein. I am a health trainer for the California After School Resource Center. Welcome to the diabetes training. This training will take approximately 30 minutes to complete. Let s get started! 1
Training Objectives Recognize signs and symptoms of diabetes. Assist students with low/high blood sugar. Understand the management of diabetes. I d like to start this training by reviewing the training objectives. By the end of the training, you will be able to identify signs and symptoms of diabetes, appropriately assist students who have episodes of low blood sugar and high blood sugar, and understand the daily management of diabetes. 2
The Role of Insulin The pancreas produces insulin. Insulin allows glucose to be used for energy. Diabetes is a disease that is associated with the pancreas. The pancreas is a gland that produces several important hormones, including insulin. Insulin acts like a key to unlock the body s cells so glucose or sugar can enter the cells and be used for energy. 3
The Diabetes-Insulin Connection Diabetes: The pancreas stops making insulin. The pancreas doesn t produce enough insulin. Limited insulin: The body can t get energy from food. High blood sugar: High blood sugar can cause health problems. Diabetes results when the pancreas either stops making insulin or doesn t produce enough insulin. When insulin production isn t adequate, the body can t get energy from the food we eat. As a result, the level of sugar in the blood remains higher than normal. High blood sugar levels are a problem because they can cause a number of irreversible health problems to the circulatory system, kidneys, eyes, and other organs. So maintaining a stable blood glucose, also referred to as blood sugar, within normal range is important. 4
Type 1 Diabetes Type 1 diabetes occurs when: The pancreas stops making insulin. Children/teens with type 1 diabetes need: Daily insulin to control blood glucose levels. Low blood sugar is called hypoglycemia. There are two types of diabetes, referred to as type 1 and type 2. In type 1 diabetes, the person's own immune system attacks and destroys the cells in the pancreas that produce insulin. Once those cells are destroyed, they won't ever make insulin again. Children and teens with type 1 diabetes depend on daily insulin injections or insulin pumps and pens to control their blood glucose levels. Major shifts in blood sugar can be a problem, especially when the blood sugar is too low, a condition called hypoglycemia (hypo meaning low). Once a person has type 1 diabetes, it does not go away and requires lifelong treatment. As type 1 diabetes is usually diagnosed in children, you may know type 1 diabetes as juvenile diabetes. 5
Type 2 Diabetes Type 2 diabetes: The body does not respond to insulin normally. There is not enough insulin to meet needs. Type 2 diabetes is related to diet and obesity. Type 2 diabetes results from the body's inability to respond to insulin normally. Unlike people with type 1 diabetes, most people with type 2 diabetes can still produce insulin, but not enough to meet their body's needs. As type 2 diabetes is related to diet and obesity, it has most often been seen in adults, and you may know it as adult-onset diabetes. In the past, this was not seen in children. However, with the obesity epidemic, we are now seeing it in children along with related health problems. 6
Diabetes Health Care Plan Completed by the health care provider Includes doctor s orders Includes normal blood sugar range Includes medical orders for medications Outlines the need for assistance Now that we ve covered the basics, let s move on to what is needed for basic management of diabetes. A written Diabetes Health Plan completed by the provider must be available for each child so that you know exactly what to do for the child in all situations related to the child s diabetes. The Diabetes Health Plan is filled out by the health care provider, includes the doctor s orders, and indicates when the student needs to check his or her blood sugar during the day, as well as what the normal range should be for that child. The plan will also indicate the blood sugar levels at which insulin should be administered, and how much. Either the student will self-administer the insulin, or the parent, parent designee, or a licensed nurse may administer it. Find out your district s policy to determine who may administer insulin. 7
Diabetic Emergency Kit Testing supplies Fast-acting sugars Glucagon injection Insulin Sharps container Non-perishable snacks In addition to the Health Plan, according to the American Diabetes Association, a diabetic emergency kit should be with a student with diabetes at all times, so that any needs or problems may be addressed immediately. The kit, provided by the parents, will include testing supplies, fast-acting sugars and glucagon for hypoglycemia, insulin to be used according to the doctor s orders, and supplies to give insulin and safely discard needles. Non-perishable snacks should be included so the student is never without food in case of low blood sugar. 8
Managing the Child with Hypoglycemia (Low Blood Sugar) Recognize: Know the normal range for blood sugar. Identify the symptoms of hypoglycemia. Assist the Child: Plan responses to hypoglycemia. Help effectively with blood sugar testing. Get Help: Access health resources. Now that we ve covered the essential materials that all students with diabetes must have, let s take a look at managing the child with hypoglycemia or low blood sugar. In order to do this, you must know what the normal range is for blood sugars and be able to recognize symptoms of hypoglycemia. To effectively assist the child, plan what you will do in a situation in which a child develops hypoglycemia, including helping the child test his or her blood sugars. Be sure you know how to get help by accessing health resources such as the Health Care Plan, the emergency kit, other personnel, and medical care. 9
Recognize: Hypoglycemia The normal range for blood sugar The symptoms of hypoglycemia Let s talk about recognizing the normal range for blood sugar and identifying the symptoms of hypoglycemia. 10
Recognize: Normal Blood Sugar Normal blood sugar: Blood sugar range is 80 to120. Blood sugar testing: Based on health care provider s orders Recommended for all people with diabetes The body maintains a normal blood sugar range of 80 to 120. Some students may need to test or monitor their blood sugar more often than others do. How often students use their glucose meter should be based on the recommendation of the health care provider found in the Diabetes Health Plan. Self-monitoring of blood glucose is recommended for all people with diabetes, but especially for those who take insulin. The Diabetes Health Plan will instruct the school nurse or school staff at what times blood glucose should be monitored. 11
Recognize: Low Blood Sugar Low blood sugar (hypoglycemia): Blood sugars are low--usually below 70. Treatment: Have the student eat or drink glucose-rich food. Hypoglycemia, low blood glucose or low blood sugar, occurs when blood glucose drops below normal levels, usually below 70. Hypoglycemia can happen suddenly. It is usually mild and can be treated quickly and easily by eating or drinking a small amount of glucose-rich food. If left untreated, hypoglycemia can get worse and cause confusion, clumsiness, or fainting. Severe hypoglycemia can lead to seizures, coma, and even death. 12
Recognize: Symptoms of Hypoglycemia Some common symptoms of hypoglycemia that will alert you to the situation include feelings of shakiness, hunger, rapid heartbeat, sweating, weakness, anxiety, irritability, dizziness, and impaired vision. Students with hypoglycemia may become confused and unable to follow directions. 13
Assist the Child with Hypoglycemia Refer to the Diabetes Health Care Plan. Oversee glucose testing. Assist with fast-acting sugars. So if a student with diabetes exhibits any symptoms of hypoglycemia, refer to the student s Diabetes Health Plan, and watch the student perform glucose testing. Follow the health care provider s orders once you have determined the blood glucose reading. If ordered, provide a fast-acting sugar to the student according to the Diabetes Health Plan. 14
Assist: Fast-Acting Sugars 4 ounces of fruit juice Two to five glucose tablets A tube of cake gel In most cases, the Diabetes Health Plan will list the appropriate snack to give for low blood sugar readings. Generally, students with diabetes will have extra snacks at school or in their backpack. Some common types of snacks that provide fastacting sugars are fruit juice, glucose tablets, and cake gel. 15
Get Help Access health resources for children with diabetes. Let s talk about how you can get help by accessing health resources, such as the Health Care Plan, the emergency kit, other personnel, and medical care. 16
Emergency! It is an emergency if a child with diabetes: Becomes unconscious. Has a seizure. Starts vomiting. Cannot swallow liquids or food. He/she has extremely low blood sugar (severe hypoglycemia). If a child with diabetes becomes unconscious, has a seizure, starts vomiting, and/or loses the ability to swallow, these are severe symptoms of hypoglycemia and should be considered an emergency situation requiring fast action! 17
Get Help: This is an Emergency Situation! Give glucagon if you have been trained. Call 9-1-1. Stay with the child until paramedics arrive. Call the parents/guardians. Remain with the child until parents arrive. So what should you do in an emergency situation? First, if you or another staff member have been trained, give the student a glucagon injection. Remember that at least three school staff need to be trained by a school nurse in how to administer a glucagon injection. This injection is part of a diabetic emergency kit that is provided by the parent. California law allows trained, non-licensed staff to administer life-saving glucagon. You or another staff member should also call 9-1-1 and inform them the child has diabetes. Tell them what has happened. Stay with the child until paramedics arrive. You or another staff member should also call the parents. If the parents are unavailable, you or another staff member need to accompany the child to the hospital with the emergency card and remain with the child until a parent arrives. 18
Hypoglycemia Summary Recognize the symptoms of hypoglycemia. Assist the child: Oversee glucose testing. Provide fast-acting sugars. Get help: Call a trained staff member to give glucagon. Call 9-1-1. In summary, be sure you can recognize symptoms of hypoglycemia, assist the child by overseeing testing and, if needed, providing fast-acting sugars. Get help by calling a staff member trained in giving glucagon, if you are not trained, and call 9-1- 1 if the situation is an emergency requiring fast action. 19
Introducing Jenny Jenny, who is seven-years old, has recently been diagnosed with type 1 diabetes. She arrives at your program at 3:00 p.m. You notice that her skin is pale. She is sweating and complaining of a headache. Now, let s apply what we ve reviewed so far to a real-life situation. Jenny, a sevenyear old with type 1 diabetes, arrives at your program at 3:00 p.m. You notice she has pale skin, she s sweating, and complaining of a headache. What should you do? 20
Hypoglycemia: Recognize Symptoms, Assist the Child, and Get Help Recognize Symptoms: Jenny may be experiencing hypoglycemia. Assist the Child: Observe Jenny perform a blood glucose test. Follow the Diabetes Health Care Plan. If indicated, assist with a fast-acting sugar. Get Help: If severe hypoglycemia develops, give glucagon. Call 9-1-1. Jenny may be experiencing hypoglycemia. Make sure to observe Jenny perform a blood glucose test. Always follow the Diabetes Health Plan. If the Health Plan indicates, assist Jenny in taking a fast-acting sugar. If severe hypoglycemia should develop, call 9-1-1 and be sure glucagon is given. Great job with Jenny! 21
Managing the Child with Hyperglycemia (High Blood Sugar) Recognize: Know the normal range for blood sugar. Identify the symptoms of hyperglycemia. Assist the Child: Plan responses to hyperglycemia. Help effectively with blood sugar testing. Get Help: Access health resources. Now, let s talk about how you help the child with hyperglycemia or high blood sugar. This occurs when blood glucose rises above normal levels, usually over 180. It's important to treat the symptoms of hyperglycemia promptly to prevent complications. When a student with diabetes has frequent high blood sugar, damage to nerves, blood vessels, kidneys, and other body organs can occur. By recognizing the early symptoms of hyperglycemia, these serious health problems can be prevented. So be sure to plan your response to hyperglycemia, watch the student test blood sugar, and get help by accessing health resources. 22
Recognize: Hyperglycemia The normal range for blood sugar The symptoms of hyperglycemia Let s review the normal range for blood sugar and talk about the symptoms of hyperglycemia. 23
Recognize: Normal Blood Sugar Normal blood sugar: Blood sugar range is 80 to120. Remember, the normal range for blood sugar is 80 to 120. 24
Recognize: High Blood Sugar High blood sugar (hyperglycemia): Blood sugars are high--greater than 180. Treatment: Administer insulin according to the Health Care Plan. Hyperglycemia is a condition in which an excessive amount of glucose or sugar circulates in the blood. It is associated with blood glucose levels greater than 180. Some common causes of high blood sugar include eating too much food or highsugar foods, not taking the right amount of insulin, forgetting to take insulin, illness or stress, and limited exercise. Generally, the treatment for hyperglycemia for students with type 1 diabetes is insulin administration according to the Diabetes Health Plan. 25
Recognize: Symptoms of Hyperglycemia It's important to treat the symptoms of hyperglycemia promptly to prevent complications from diabetes. Some symptoms of high blood sugar include extreme thirst, frequent urination, hunger, dry skin, drowsiness, blurred vision, and nausea. 26
Assist the Child with Hyperglycemia Refer to the Diabetes Health Care Plan. Oversee glucose testing. Assist with insulin as indicated in the Diabetes Health Care Plan. If a student with diabetes exhibits any symptoms of hyperglycemia, refer to the student s Diabetes Health Plan, and watch the student perform glucose testing. Follow the health care provider orders once you have determined the blood glucose reading. If the student is experiencing high blood sugar, insulin may be needed. 27
Administering Insulin Who can administer insulin? The student (check the Diabetes Health Plan) Licensed nurses, parents, and/or parent designees Check with your district s policy to determine who can administer medication. If indicated in the Diabetes Health Plan, the student may self-administer insulin. However, if the student is not able to self-administer insulin, licensed nurses, parents, and/or parent designees who are not employees of the district or agency may administer insulin to students. If you are unsure of who can administer medication at your school site, check with your district s policy. 28
Hyperglycemia Summary Recognize symptoms of hyperglycemia. Assist the child: Oversee glucose testing. Refer to the Diabetes Health Care Plan. Get help: Call the parents/guardians. To summarize, be sure you can recognize symptoms of hyperglycemia, watch the child test blood sugar, and respond according to the Diabetes Health Plan, understanding who may give insulin. Get help if the child is feeling ill or blood sugar is higher than an amount specified in the Diabetes Health Plan. You ll want to call the parents or other person identified in the plan. 29
Introducing Maria Maria, who is eight-years old, has type 1 diabetes. She is extremely thirsty, and you notice she has to go to the bathroom more frequently than usual. What do you think Maria is experiencing? Once again, let s take what we ve learned and apply it to a real life situation. Maria, who is eight-years old and has type 1 diabetes is extremely thirsty. You notice she has to go to the bathroom to urinate more frequently than usual. What do you think Maria is experiencing? What should you do? 30
Hyperglycemia: Recognize Symptoms, Assist the Child, and Get Help Recognize Symptoms Maria may be experiencing hyperglycemia. Assist the Child Observe Maria perform a blood glucose test. Follow the Diabetes Health Care Plan. Get Help Maria or a qualified person may administer insulin according to the doctor s orders. Maria may be experiencing hyperglycemia. Observe Maria perform a blood glucose test. Based on the results, follow the Diabetes Health Plan. If the Health Plan indicates, Maria or a qualified person may administer insulin. Great job with Maria! 31
Summary of Objectives Recognize signs and symptoms of diabetes. Assist students with high/low blood sugar. Understand the management of diabetes. To review, we ve learned how to identify the signs and symptoms of hypo and hyperglycemia. We ve also learned how to respond appropriately to these situations and how to assist the child with diabetes to manage these situations. Finally, we ve learned about the daily management of diabetes and how to access health resources. That concludes our discussion of diabetes. 32
Congratulations! You have reached the end of the training. You will now have the opportunity to take a quiz to test the knowledge you have acquired in this training. If you receive a passing score, a completion certificate will be e-mailed to you at the e-mail address you provided. If you don t receive a passing score, you will have the opportunity to take the test again at any time. Following the quiz, you will be asked to complete a brief feedback survey. After you complete the survey, you will be able to access sample CASRC library resources and additional information about diabetes and the care of children with diabetes, including a sample Diabetes Health Plan. Thank you for your participation. 33