DIABETES

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DIABETES
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Presented by Chatham County School Nurses

• Shirley Cotton Sonya Dunn
• Tina Harris Phyllis Wilkie
• Special thank you to Dawn Bussey, student nurse
  from UNC Chapel Hill, for her assistance in
  preparing the presentation

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What youll learn from this presentation

• What Senate Bill 911 requires
• Diabetes--- Type 1 and Type 2
• How to recognize and treat
• High blood sugar (Hyperglycemia)
• Low blood sugar (Hypoglycemia)

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LAW

• SENATE BILL 911

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Diabetes is considered a disability therefore

• Diabetes is covered under many federal and state
  mandates and laws
• It is important to understand what diabetes is in
  order to
• Comply with legal mandates and laws
• Facilitate care for students with diabetes

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NC Bill 911 We all need to work together

• Parents are required by law to
• Provide pertinent information needed to develop a
  diabetes care plan for the student
• Communicate with the school staff, including the
  bus drivers, about any changes or developments
  concerning the students diabetes care regimen

• The School is required by law to
• Provide diabetes training and education to school
  staff
• Train two or more Diabetes Care Mangers (DCMs)

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Responsibilities of the Diabetes Care Manager

• Plan and participate in conferences with the
  student, parents, and school staff to develop an
  individualized diabetes care plan
• Assist student with diabetes care and maintenance
  
• Be accessible in case of an emergency
• Be up-to-date on diabetes information about
  individual student and diabetes in general
• Go on field trips or school sponsored activities
• Have open lines of communication with those
  involved with student, including
• Teachers
• Substitute teaches
• Parents
• School nurse
• Bus drivers
• Other members of school staff that may be
  involved with care of student

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Basic Facts about Diabetes Mellitus

• Diabetes Mellitus is the 7th leading cause of
  death in the United States
• Diabetes is a major contributor to the
  development and risk of
• Cardiovascular disease
• Heart Attacks
• Stroke
• Blindness
• Kidney failure
• Amputations
• Normal growth and development in children may be
  delayed or stunted
• There are two types of Diabetes, and both types
  have a problem with the balance between glucose
  (sugar) and insulin (anti-sugar)

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Insulin Versus Glucose

• Insulin is a hormone produced by the pancreas
• Insulin interacts with glucose to maintain the
  right balance of glucose in the body
• Carbohydrates are metabolized into glucose
• Glucose is required by the bodys cells for
  energy
• Insulin and glucose have an inverse relationship
• If one is up the other is down
• The Goal is to find the right BALANCE between
  Glucose and Insulin

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Type 1 Diabetes

• Commonly known as juvenile or childhood diabetes
• The pancreas does not produce insulin
• Type 1 Diabetics are INSULIN-DEPENDANT
• They must have daily injections of insulin
• Type 1 accounts for 10 of all cases of diabetes
  cases in the US
• 1 in 400 children have Type 1 diabetes
• Usually discovered during childhood or before the
  age of 30

INSULIN
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Type 2 Diabetes

• The pancreas does not produce enough insulin or
  does not use the insulin properly, they are
  INSULIN RESISTANT
• More common in adults, but there is a rising
  epidemic of children developing Type 2 diabetes
• Those most at risk
• Hispanics
• African-Americans
• Native Americans
• A family history of diabetes
• Obesity
• Apple shaped bodies are more prone to diabetes
  than pear shaped bodies

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Managing DiabetesWhen diabetes is kept in
control complications can be prevented and
controlled

• Type 1 Diabetes
• Require daily insulin injections
• Maintain a balance between
• Amount of insulin taken,
• Food intake (especially carbohydrates), and
• Exercise
• The balance in measured by self monitoring blood
  sugar readings

• Type 2 Diabetes
• If caught early, Type 2 can usually be managed by
  lifestyle modifications including
• Weight loss
• Healthier eating habits
• Oral medications
• Regular exercise

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Treatment of Diabetes

• Self monitoring of glucose levels
• Place a drop of blood on a test strip that is
  read by a blood glucose monitor
• Important assessment for anyone with diabetes
• Usually done at least twice during school day
• Insulin
• Type 1 diabetes requires insulin by injection
  using one or a combination of
• Insulin pump,
• Syringe, or
• Pen device
• Carbohydrate counting
• Exercise

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Insulin

• Most students require at least two injections a
  day unless they are using an insulin pump
• There are many combinations of insulin used
  depending on activity level, time of day, etc.
• Some work faster while some last longer
• Insulin pumps are battery operated devices that
  automatically deliver insulin
• Insulin pumps are the size of a pager

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Carbohydrate Counting

• Type 1 diabetics need to Carb Count to balance
  insulin with food and activity
• Type 2 diabetics need to Carb Count to record
  what they eat in an effort to eat a balanced diet
  and promote weight loss
• The goal for Type 2 diabetics is to ward off the
  need for insulin injections with lifestyle
  modifications

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Regular Exercise

• 30 minutes of cardiovascular exercise into most
  days of the week
• Promotes weight loss
• Helps increase self esteem

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Signs and Symptoms of Diabetes

• Hyperglycemia
• Too much glucose (sugar)
• Not enough insulin
• Think Ate too much

• Hypoglycemia
• Not enough glucose (sugar)
• Too much insulin
• Think about how you feel when youre really hungry

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HyperglycemiaToo Much Glucose

• Too much sugar in the blood
• Happens when
• Eat too much food
• Dont exercise enough
• Body trying to compensate for
• Illness or
• Physical and/or mental stress

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Signs and Symptoms of Hyperglycemia

• Usually these are the first signs of developing
  diabetes
• Frequent urination
• Extreme hunger or thirst
• Extreme fatigue
• Dry itchy skin
• Blurred vision
• Frequent infections
• Slow healing wounds
• Teachers and school staff are key in identifying
  students with these symptoms

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Treating Hyperglycemia

• Drink water or other calorie free/ caffeine free
  liquid to dilute the blood and sugar
• This will also help hydrate the body
• Seek immediate medical assistance if person
  unable to eat or drink
• If high blood sugar goes untreated for a long
  period of time Diabetic Ketoacidosis can result

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Diabetic Ketoacidosis (DKA)

• High blood sugar that goes untreated for a long
  period of time
• Signs and symptoms include
• Nausea
• Vomiting
• High levels of ketones in urine and blood
• Life threatening, so if you suspect DKA get
  immediate medical attention
• CAUTION Students with insulin pumps use rapid
  acting insulin, so they may develop DKA very
  rapidly if pump is not working properly

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HypoglycemiaNot enough sugar

• Also called low or insulin reaction
• Usually symptoms occur when blood sugar below
  70-80 on blood glucose reading
• Usual causes
• Too much insulin
• Increased activity
• Eating too few carbohydrates
• Too much time between snacks and meals

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Signs and Symptoms of Hypoglycemia

• Early signs
• Hunger
• Shakiness
• Dizziness
• Sweating
• Fast heartbeat
• Drowsiness
• Irritable, sad, or angry
• Nervous
• Pale, clammy skin
• Important to recognize these
• symptoms before late signs develop

• Late Signs
• Feeling sleepy
• Being unusually stubborn
• Lack of coordination
• Tingling or numbness in tongue
• Personality change
• Passing out
• Seizure

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Recognizing Hypoglycemia (low blood sugar)

• Frequent causes
• Late or missed meals
• Exercise or activity
• Change in school schedule (be on the lookout)
• Fire drill
• Assemblies
• End of grade testing
• Anything that may cause stress or alters normal
  patterns

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Treating HypoglycemiaSometimes it is hard to
tell the difference between high and low blood
sugar, but rememberYOU WILL NOT HURT ANYONE BY
GIVING THEM FOOD

• If you suspect low blood sugar
• If possible, test their blood sugar with a
  glucose monitor
• Give juice or another source of easily ingested
  carbohydrates
• Wait 15 minutes and test blood sugar again, or
  reassess signs and symptoms
• If blood sugar is still low, give more
  carbohydrates and start over with testing blood
  sugar

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Hypoglycemia Busters

• What to give someone with low blood sugar
• 2-4 glucose tablets
• 4 oz of apple or orange juice
• 4-6 oz of regular soda
• 4-8 Life Savers
• 2 tablespoons of raisins
• 3-4 teaspoons of sugar or syrup
• 1 cup of low fat milk
• 1 tube of cake gel
• Resist the urge to give them too much food or
  drink as this can cause them to have too much
  sugar in their blood resulting in hyperglycemia
  (high blood sugar)

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If early signs of hypoglycemia develop into late
signs,

• The student may have seizures or become
  unconscious
• A medication called Glucagon must be given by the
  school nurse, the trained diabetes care manager,
  or emergency medical personnel
• Try not to let this become an emergency, be on
  the lookout for early signs of low blood sugar
  (hypoglycemia)

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Bus Drivers have Important Responsibilities

• When a student is acting unusual, always assume
  they have low blood sugar and treat according to
  diabetes care plan
• The bus driver should have contact numbers for
  the parents and diabetes care manager for the
  student
• Diabetic students should have a blood sugar
  monitor, insulin, glucagon, and snacks on the bus
• The teacher and parents need to have open
  communication with the bus driver about any
  changes in students care plan
• The bus driver should always have extra snacks in
  case of a brake down, traffic jam, or unexpected
  delay
• These guidelines apply to any and all personnel
  involved in extracurricular activities involving
  a diabetic student

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Questions

• 1 .Diabetes is the major leading cause of
  strokes, heart attacks and kidney failure.
• true
• false
• 2. Insulin helps the body to maintain the right
  amount of sugar in the body.
• true
• false
• 3. Food , Insulin and activity is essential for
  the Type 1 diabetic to maintain good blood sugar
  control.
• true
• false
• 4, Type 2 diabetes can usually be controlled with
  diet and oral medication.
• true
• false
• 5. Hyperglycemia (high blood sugar) happens when
  the body gets too little exercise, too much
  insulin or too much food.
• true
• false

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• 6. Hunger, shakiness, dizziness, drowsiness are
  early signs of low blood sugar.
• true
• false
• 7. If possible do a blood sugar check for low
  blood sugar. Give 4 oz of juice, tube of cake
  icing or 4-6 oz of regular soda to treat low
  blood sugar.
• true
• false
• 8 Frequent urination, extreme hunger and thirst
  are all symptoms of high blood sugar.
• true
• false
• 9. If unsure of high or low blood sugar, you
  should treat as high blood sugar.
• true
• false
• ________________________________
  _____________________
• Signature
  Date