Diabetes Care Tasks at School:

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Diabetes Care Tasks at School What Key
Personnel Need to Know
DIABETES BASICS
Gregory E. Peterson, DO, FACP
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Gregory E Peterson, DO, FACP Medical Director,
Diabetes Center American Diabetes Association
Recognition Program since 1993 Adjunct Professor
Internal Medicine Des Moines University Health
Policy Fellow and Advisor Governors Council on
Fitness and Nutrtion Chairman
DIABETES BASICS
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Diabetes Care in the School

• Description Diabetes care in the school setting
  is necessary for the childs immediate safety,
  long-term well being, and optimal academic
  performance. The DCCT (The Diabetes Control and
  Complications Trial), proved that normalization
  of blood glucose (glycemic) control would reduce
  the complications of diabetes.
• DCCT/EDIC (The Epidmiology of Diabetes
  Interventions and Complications) the 17 year
  follow up demonstrated dramatic differences
• In order to achieve the most optimal glycemic
  control, a child must monitor blood glucose
  frequently, follow a meal plan, and take
  medications., like insulin, which is usually
  taken in multiple daily injections or through an
  infusion pump.

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Objectives

• Blood glucose monitoring, including the frequency
  and circumstances requiring blood glucose checks.
  
• Insulin administration (if necessary), including
  doses/injection times prescribed for specific
  blood glucose values and the storage of insulin.
• Meals and snacks, including food content,
  amounts, and timing.
• Symptoms and treatment of hypoglycemia (low blood
  glucose), including the administration of
  glucagon if recommended by the students treating
  physician.
• Symptoms and treatment of hyperglycemia (high
  blood glucose).
• Checking for ketones and appropriate actions to
  take for abnormal ketone levels, if requested by
  the students health care provider.

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Overall Goal Optimal Student Health and Learning
Hypoglycemia Hyperglycemia
Monitoring Blood Glucose
Ketones
Health Learning
Legal Rights
Glucagon Administration
Exercise
Insulin Regimen
Nutrition
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Learning Objectives

• Participants will learn
• What is diabetes?
• Why care at school is required
• Basic components of diabetes care at school
• Short and long term consequences of diabetes

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What is Diabetes?

• Body does not make or properly use insulin
• no insulin production
• insufficient insulin production
• resistance to insulins effects
• No insulin to move glucose from blood into cells
  
• high blood glucose means
• fuel loss. cells starve
• short and long-term complications

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Type 1 Diabetes

• auto immune disorder
• insulin-producing cells destroyed

• daily insulin replacement necessary

• age of onset usually childhood, young adulthood

• most prevalent type of diabetes in children and
  adolescents

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Type 1 Diabetes
ONSET
relatively quick
increased thirst hunger blurred vision

• increased urination
• tiredness
• weight loss

• SYMPTOMS

uncertain, likely both genetic and environmental
factors
CAUSE
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Type 2 Diabetes

• Insulin resistance first step
• Age at onset

• Most common in adults
• Increasingly common in children

• overweight
• inactivity

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Type 2 Diabetes
in children variable timeframe
ONSET
tired, thirsty, hunger, increased urination
SYMPTOMS

• some children show no symptoms at diagnosis

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Diabetes is Managed,But it Does Not Go Away.

• GOAL

To maintain target blood glucose
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Diabetes Management 24/7

• Constant Juggling
• Insulin/medication
• with
• Exercise
• Food intake

BG
BG

BG
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Diabetes Management

• Proactive

• keep juggling the balls

Reactive

• a response is indicated
• corrective actions for highs or low
• emergency intervention

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Assistance in Diabetes Management

• Routine Care
• Many students will be able to handle all or
  almost all routine diabetes care by themselves
• Some students, because of age, developmental
  level, or inexperience, will need help from
  school staff.
• Urgent Care
• Any student with diabetes may need help with
  emergency medical care.

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Care in the Schools School Nurses and Others

• Nurse most appropriate to
• Supervise diabetes care
• Provide direct care (when available)
• However, a nurse is not always available.
• Non-medical school staff can be trained to assist
  students
• For both routine and emergency care
• Including insulin and glucagon injections

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Diabetes Medical Management Plan

• A Diabetes Medical Management Plan (DMMP) should
  be implemented for every student with diabetes.
• DMMP is
• developed by the students personal health care
  team and family and signed by a member of
  students personal health care team
• implemented collaboratively by the school
  diabetes team, including
• school nurse
• the student
• parents/guardians
• other school personnel

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Elements of a DMMP

• Date of diagnosis
• Emergency contact information
• Students ability to perform self-management
  tasks at school
• List of diabetes equipment and supplies
• Specific medical orders for blood glucose
  monitoring, insulin, glucagon, and other
  medications to be given at school
• Meal and snack plan
• Exercise requirements
• Actions to be taken in response to hypoglycemia
  and
  hyperglycemia

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Quick Reference Plan

• Development based on information from students
  DMMP
• Summarizes how to recognize and treat
  hypoglycemia and hyperglycemia
• Distribute to all personnel who have
  responsibility for students with diabetes

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Where to Get More Information

• American Diabetes Association
• 1-800- DIABETES
• www.diabetes.org
• National Diabetes Education Program/NIH
• www.ndep.nih.gov