The Student with The Student with Diabetes Diabetes
Feb 06, 2016
The Student with The Student with
DiabetesDiabetes
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AgendaAgenda
Types of diabetes
Management
Hypoglycemia
Hyperglycemia
Responsibilities
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What is DiabetesWhat is Diabetes
Much of the food eaten becomes a sugar called glucose
The pancreas makes a hormone called insulin
Insulin allows the body to use the glucose for energy
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Types of DiabetesTypes of Diabetes
Type 1 Auto-immune illness
• Pancreas not producing enough insulin
• Requires insulin injections
• Must test blood glucose (BG) at school
Usually diagnosed at a younger age Chronic condition Cannot be prevented
Type 2 Most common type of diabetes Can often control with diet, exercise or pills May also take insulin Usually diagnosed at an older age – infrequent in school age child May not need to test BG sugars at school
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Each Student with Diabetes is an Each Student with Diabetes is an
Individual – Individual Plan of Individual – Individual Plan of
CareCare
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General Diabetes Management General Diabetes Management
GoalsGoals Keep student safe from extreme lows and
highs
Balance of food choices, exercise, & insulin
Aim for majority of blood glucose levels in
target – this is challenging
Normal school routines for student
Optimal learning at school
Promote normal growth & development
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Target Blood Glucose (BG) RangeTarget Blood Glucose (BG) Range
< 5 years: 6-12 range 5-10 years old: 4-10 range
>10 years: 4-7 range
Hypoglycemia < 4 (must treat)
Hyperglycemia > 15 (additional information needed)
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Blood Glucose (BG) TestingBlood Glucose (BG) Testing
Tool to assess BG (meter)
Done routinely before meals and if a low is suspected
Must treat immediately if < 4
Avoid placing “judgment value” i.e. good or bad on high or low blood glucose readings
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Insulin Delivery SystemsInsulin Delivery Systems
Most children get insulin before breakfast, supper and bedtime
Some children get insulin at lunch Syringe Insulin pen Pump
Insulin Pump provides an almost continuous flow of insulin
ZJLMEQLA.cil
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Insulin Action – Insulin Action – around the clock around the clock
coveragecoverage
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Some Children Wear Insulin Some Children Wear Insulin
PumpsPumps
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School Nurse ConsiderationsSchool Nurse Considerations
Assess the level of assistance the student requires
Support with the development of independence
School Nurse Role Assist with BG testing if needed Assist with insulin administration via pen or syringe Assist with entering BG and carb amount into pump for pump bolus
Ideal is to bolus/give insulin pre food Hypoglycemia: identify and treat Prompt contact with care givers if concerns
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Age Appropriate ExpectationsAge Appropriate Expectations
Pre-Schooler washes hands before testing offers finger to be picked
School Age chose injection site identifies food groups tests independently - caregiver supervises younger child may need more direction
Teen independent with insulin, food choices, testing BUT - caregiver still involved to monitor and support
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Nutrition BasicsNutrition Basics Main nutrient that increases BG is carbohydrate
• grains, fruits, milk, sugars
Protein & Fat do not increase BG
Nutritious choices are encouraged, not always made!
No Forbidden Foods
Normalize with same eating times /routines/ food choices as other students
Allow child to eat all food as provided by caregivers
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Special Occasions at SchoolSpecial Occasions at School
Children with diabetes can and should participate in all school activities
With advanced planning, diabetes can be managed around all special events and treats
If uncertain how to proceed, contact caregiver for management advice or send the treat home
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ExerciseExercise
Children with diabetes can be involved in all school activities with some additional precautions
Exercise can lower BG• Consider checking BG levels before, during and after activity• May need additional glucose or carbohydrate
Important for school staff to be aware of impact of exercise on diabetes
Medical Alert Bracelet
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HypoglycemiaHypoglycemia Low Blood GlucoseLow Blood Glucose
Treat every BG less than 4 Causes
• Too much insulin• Too little Food
Delayed, inadequate or skipped meal or snack
Extra exercise without extra food or a decrease in insulin
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Hypoglycemia SymptomsHypoglycemia Symptoms
Shaking Headache Stomach ache Pale skin Hunger
Fatigue Irritability Blurred vision Slurred speech Decreased level of consciousness
• Important to understand students individual symptoms• If unsure if student is low, do a BG test. • If unable to test, always treat.• Occurrence of a severe low is rare in the school setting
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HypoglycemiaHypoglycemia Treatment for Mild or Moderate Treatment for Mild or Moderate HypoglycemiaHypoglycemia
Junior juice (125 ml) 3-4 dex glucose tablets 2 rolls of rockets 2 tsp. honey 3 tsp. sugar 1/3 cup regular soda
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HyperglycemiaHyperglycemia High Blood GlucoseHigh Blood Glucose
Above 15 is considered warning of hyperglycemia
Causes• Too much food• Too little insulin• Inaccurate BG test result• Decreased activity• Illness/infection• Stress
If BG is > 15mmol/L and child is feeling unwell (flu like symptoms) notify caregivers.
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HyperglycemiaHyperglycemia
Mild - Moderate Symptoms
Increased urination Increased thirst Blurry vision Increased hunger
Recommendations• Fluids and washroom access• Inform parent• Contact parent if unwell
Severe Symptoms
Fruity breath Vomiting Stomach cramps or pain Extreme weakness Sleepiness Difficulty breathing Coma Medical emergency Contact parent and/or 911
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Hyperglycemia ManagementHyperglycemia Management
If the BG > 15mmol and the child feels unwell with flu like symptoms, contact the caregivers immediately
If the BG is > 15mmol and the child is well (able to eat, drink, and be involved in school routines) contact the caregivers if part of plan of care continue with the usual school activities of meals and snacks as provided by caregivers
continue with usual activity plan (no additional activity required)
encourage water intake if child is agreeable expect increased use of the washroom document BG and any concerns in agenda or planner
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Emergency SituationsEmergency Situations
If at any time a student experiences a decreased level of consciousness, call 911
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Psychosocial AspectsPsychosocial Aspects
Challenging regimen with limitations & restrictions
How you can help• treat diabetes matter-of-factly• BG variability is common – diabetes is hard to control• appreciate no one makes ideal food choices at all times• provide encouragement & understanding• accommodate diabetes management within classroom
routines as much as possible
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School’s ResponsibilitySchool’s Responsibility Learn about diabetes Ensure all meals and snacks, as provided by parents, are completed on time Know symptoms and management of hypo/ hyperglycemia Communicate regularly with parents Provide space for testing and storage of diabetes supplies in the classroom Know when to contact parents/guardians Educate other students Consider best location for diabetes care – may prefer privacy Update annually using Trillium website: http://www.trilliumhealthcentre.org/programs_services/womens_childrens_services/childrensHealth/familyCareCentre/paediatricDiabetesClinic.html
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Student’s ResponsibilityStudent’s Responsibility
Notify teacher when feeling unwell Accurately document BG in planner/agenda Take sharps home for safe disposal Eat all food provided by parents in a timely manner Educate other students Participate in all school activities Tell adults - parents, teacher – when supplies are low Wear medic alert
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Caregiver’s ResponsibilitiesCaregiver’s Responsibilities
Establish positive relationship with school Take sharps home for safe disposal Provide nutritious lunch and snack choices Ensure extra supplies are stored at school Communicate as needed with school and educate
as required Advocate for child’s best care Update school staff each year:http://www.trilliumhealthcentre.org/programs_services/
womens_childrens_services/childrensHealth/familyCareCentre/paediatricDiabetesClinic.html
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Diabetes WebsitesDiabetes Websites
For additional information on Type 1 diabetes:
Canadian Diabetes Association www.diabetes.ca
Juvenile Diabetes Research Foundation www.jdrf.ca
Trillium Health Centre//www.trilliumhealthcentre.org/
programs_services/womens_childrens_services/childrensHealth/familyCareCentre/paediatricDiabetesClinic.html