Diabetes EducationDiabetes EducationDiabetes EducationDiabetes Education

Senate Bill 911• Requires schools to provide care to the

student with diabetes upon parent request.student w th d abetes upon parent request.• Requires that all school personnel have a

basic understanding of diabetesg• Requires that all schools have a designated

Diabetes Care Manager with a back up in g pcase that person is unavailable

• Requires the schools to have a diabetes care plan that is updated each school year.

Senate Bill 911h d h d b h ld • The student with diabetes should

have access to any medical h interventions that are necessary

(insulin, water, juice or source f )of sugar)

• The student should have access to the bathroom and water as needed.

Type I & Type IIType I & Type II• Type I: used to be known as Juvenile onset or

I li d d t Di b t M llit IDDMInsulin dependent Diabetes Mellitus IDDM– No insulin is being produced by the pancreas.

An external source of insulin must be An external source of insulin must be administered.

• Type II: used to be known as Adult onset or non i li d d t di b t llit NIDDMinsulin dependent diabetes mellitus NIDDM– Insulin resistance, “not enough”, or body is not

responsive to the insulin that it is producing responsive to the insulin that it is producing. Often can be controlled by medication that makes the body more responsive to insulin. After several years may become IDDMAfter several years may become IDDM.

Insulin• Insulin is a hormone.• Insulin is necessary to move the • Insulin is necessary to move the

glucose (sugar) that we get from our foods or drink from the blood our foods or drink from the blood stream to the cells where it can be used by the body as energyused by the body as energy.

• Insulin is the mechanism through hi h lu s nt s th lls which glucose enters the cells.

• Hyperglycemiahyper too much – hyper – too much

– Glycemia – glucose or sugar

• Hypoglycemia– Hypo – too little– Glycemia – glucose or sugar

High Blood Sugar (>240 mg/dl)(>240 mg/dl)

• Hyperglycemia (hyper - more)T littl i li t h f d t – Too little insulin, too much food, or too little exerciseMay occur at times of illness even if – May occur at times of illness even if there are appropriate levels of insulin, food or exercise (infection viruses)food or exercise. (infection, viruses)

– Stress from school, home, or peers can elevate blood sugar levels. elevate blood sugar levels.

– Adolescence is a time of unpredictable periods of hyperglycemia.p yp g y

Signs and symptoms of g y pHyperglycemia

F *• Frequent Urination*• Extreme Hungerg• Extreme Fatigue• Unusual Thirst*Unusual Thirst• Irritability

Bl d Vi i• Blurred Vision

Exercise• A Normal blood sugar range varies from

person to person. An average range is 80-person to person. n average range s 80120.

• If blood sugar is elevated > 300 mg/dl g gexercise should be delayed.

• When blood sugars are elevated the body g yuses muscle rather than carbohydrates as it’s energy source. Exercising when blood

l l l t d f th sugar levels are elevated can further damage muscle

HypoglycemiaL Bl d • Low Blood Sugar

Hypo lycemiaHypoglycemia• Sometimes called “insulin reaction”• Below target range (usually <70-80)• Can come on quickly• Can come on quickly• Caused by too much insulin, eating

t few cal ries r t much activitytoo few calories, or too much activity• Not enough sugar in the blood• Can become an immediate medical

emergency if not treated quickly.g y q y

Hypoglycemiayp g ysigns and symptoms

H F l blHunger Feeling irritable,Shakiness sad or angryg yDizzinessSweatiness NervousnessSweatiness NervousnessFast heart beat PallorD iDrowsiness

( <7yo pale glassy eyed)

More symptoms of h l ihypoglycemia

F li sl• Feeling sleepy• Being stubborn• Lack of coordination• Tingling or numbness of the Tingling or numbness of the

tongue• Personality changes• Personality changes• Passing out

• Seizure

What to do?• If possible check blood sugar• If Blood sugar is 70 or below target (See • If Blood sugar is 70 or below target (See

the diabetes care plan for specifics for each student) have the student eat or each student), have the student eat or drink a source of quick acting sugar (15 gms. Carbs)g

• If meter is not handy go ahead and have the student eat or drink a source of fasting acting sugar, then obtain the meter and check their blood sugar.

Fast-acting Carb’sFast acting Carb s• 2-4 glucose tabletsg• 4 oz apple or orange juice• 4-6 oz soda• 4-6 oz soda• 4-8 life savers

2 bl • 2 tablespoons raisins• 3-4 teaspoons sugar or syrupp g y p• 1 cup low fat milk

• 1 tube of cake gel1 tube of cake gel

Catch low blood sugar gEARLY

B l h l • Be alert to when lows may occur• Test if there is any doubty• Fast acting carb sources should

always be availablealways be available• Treat low blood sugar promptly or it

can turn into severe hypoglycemia- a can turn into severe hypoglycemia- a medical emergency!!

Treating SEVERE ghypoglycemia

N h h • Not enough sugar is getting to the brain

• May lose consciousness and/or have convulsions

• MEDICAL EMERGENCY• Glucose gel cake gel syrup or honey Glucose gel, cake gel, syrup, or honey

may be used only if the student is still consciousstill conscious

UnconsciousUnconscious• Call 911

Administer Glucagon injection • Administer Glucagon injection immediatelyD l hi i h i • Do not place anything into their mouth

• Glucagon is a hormone that makes the liver release sugar into the blood gstream. It is similar to an epi pen.

– Most people with diabetes will have Glucagon ordered in case of emergencyordered in case of emergency.

Hypoglycemia• REMEMBER!!

When in doubt treat the student as • When in doubt, treat the student as if he/she is LOW. Provide them a juice or source of quick acting sugar juice or source of quick acting sugar (sweet tarts, smarties). Avoid chocolate or sweets that have a high chocolate or sweets that have a high fat content as they are absorbed more slowly and are not considered more slowly and are not considered “fast acting sugars.”

Field Tripsp• Senate bill 911 requires that a diabetes

care manager or parent be present on all care manager or parent be present on all field trips that the student with diabetes participates in.participates in.

• A school can NOT require that the parent participate but must make accommodations p p m m mmfor the diabetes care manager or appropriate substitute (school nurse) be present for the trip.

Field TripsField Trips

If h d id i i i • If the parent decides to participate it must be clearly communicated to the parent that the diabetes care manager or parent that the diabetes care manager or nurse will not be there and that they are assuming full responsibility for the medical assuming full responsibility for the medical care of their child.

Class Parties• Planning ahead is the best thing.• Notify parent and diabetes care manager • Notify parent and diabetes care manager

in advance. • The parent may decide to be present and • The parent may decide to be present and

to handle the balancing of food and insulin• The student should be allowed whatever is The student should be allowed whatever is

offered to the other students.

Class parties• The diabetes care manager can decide how to

cover extra foods by administering insulin cover extra foods by administering insulin. • Students with diabetes can eat foods with sugar.

They just need to adjust for it.y j j• Sugar Free foods are not carbohydrate free and

will still need to be covered with insulin.S f f d th t d t t i • Sources of foods that do not contain carbohydrates and will not need to be adjusted for include: Cheese, meats, diet sodas and most , ,vegetables.

Thank you!