Type 1 Diabetes:What You Need to KnowAngie Frey BSN, RN, CDE

Fulton County Health Center

• There are 29.1 million people with diabetes in the United States

• 8.1 million people are undiagnosed

• Approximately 208,000 people younger than 20 years old have been diagnosed with

diabetes (Type 1 and Type 2)

• During 2008 – 2009, approximately 18,436 people younger than 20 years old were

newly diagnosed with Type 1 Diabetes while 5,089 people less than 20 years old were

newly diagnosed with Type 2 Diabetes

• The highest rate of new Type 1 Diabetes cases was amongst the non-Hispanic white

children and adolescents in 2008-2009.

• One in three American children born in 2000

and after will develop diabetes

Type 1 Diabetes – Body makes little to no insulin resulting in one needing to take insulin injections

Approximately 5% of those diagnosed with Diabetes

Type 2 Diabetes – Body unable to correctly use one’s insulin (Insulin Resistance) OR unable to produce enough insulin (Insulin Deficiency)

Approximately 90-95% of those diagnosed with Diabetes

Management of Diabetes

The 5 M’s of Diabetes Treatment:

1. Meals (Plate Method)

2. Medications Insulin (by injection or pump – Type 1 & possibly Type 2)

Oral Diabetes Medications (possibly Type 2)

3. Monitoring Blood Sugar

4. Motion (Exercise)

5. Managing

Considerations When Managing Type 1 Diabetes at School

• Current Diabetes Medical Management Plan

• A 504 Plan

• A “low box” for the classroom and the nurse’s office

• Diabetes Supplies needed

• Communication Plan to School Personnel

• Classroom Buddy

Diabetes Medical Management PlanDMMP

• Personal care plan for each student with diabetes

• Health Care Provider/Parent create this written and signed plan

• Provides specific instructions for the school personnel in how to assist a child with diabetes at school

504 Plan

• Takes information on DMMP and explains the school’s specific responsibilities

• Protect‘s child’s rights under federal laws

• Addressses who shall be trained to provide diabetes care tasks

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(Start these plans during 3 month visit during late Spring / early Summer)

School Goal

• Provide nurturing environment that gives students the ability to safely care for their diabetes with minimal disruption of class time

Meals : Plate Method

Each meal (9 inch plate) consists of:

• 1 serving of protein

• 3 servings of carbohydrates (1 starch, 1 fruit, and 1

milk)

• ½ plate of non-starchy vegetables ( lunch & supper)

More Nutritious Eating

• Since carbohydrates quickly raise blood glucose the most… you may need to reduce or spread out your daily carb intake.

Which foods contain carbohydrates?

Skim milkRiceDiet colaBaked chickenSugar-free puddingTurkey sandwichCottage cheeseWatermelonSpaghettiMayonnaiseCookiesIce cream

Scrambled eggsPeasFat-free yogurtPeanutsBananaBaked potatoesCornTortilla chipsTuna fishPizzaJelly beansPork chops

Which foods contain carbohydrates?

Skim milkRiceDiet colaBaked chickenSugar-free puddingTurkey sandwichCottage cheeseWatermelonSpaghettiMayonnaiseCookiesIce cream

Scrambled eggsPeasFat-free yogurtPeanutsBananaBaked potatoesCornTortilla chipsTuna fishPizzaJelly beansPork chops

Consider Timing of Meals and Snacks

• Amount of carbs in meals/snacks are timed to work with the action of insulin and physical activity

• If meals/snacks are skipped or delayed, the student may experience low blood glucose (hypoglycemia)

• Refer to student’s diabetes care plan for meal and snack schedule

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Tips Regarding Meals and Snacks

• Take notice if child is eating meal or snacks – (may clue you in to abnormal symptoms later in the day)

• Notify parents of field trips or events so plans can be made

• Advance planning for class parties

• Send a letter to other parents encouraging nutritious treats or other party ideas

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Medication : Insulin• People with Type 1 DM have to take insulin injections to live.

• Allows glucose in the bloodstream to enter each cell in the body to provide fuel for energy

• Type 1 diabetes = insulin = energy

= high blood glucose (> 250)

• Correct insulin dose = energy

= target blood glucose level

Types of Insulin Injections

• Pens

• Vial/syringe

• Insulin Pump

Insulin SpecificsRapid Acting Apidra (insulin glulisine),

Humalog (insulin lispro),

Novolog (insulin aspart)

Give just

prior to

eating

Short Acting Humulin R (insulin regular)

Novolin R (regular human insulin)

Give about 30 min. prior to eating

Intermediate Acting/

Combination

Humulin N, Novolin N (NPH)

Humalog 75/25, Humalog 50/50

Novolog 70/30, Humulin 70/30

Novolin 70/30

Typically takes twice a day with breakfast & supper

Long Acting Lantus (insulin glargine)

Levemir (insulin detemir)

Typically taken once a day at about same time

Monitoring Blood Sugar

• Allows for adjustment of insulin, food, or activity to maintain target blood glucose level

• Students with Type 1 Diabetes – Typically should be checking their blood sugar before each meal (and possibly before snack time) along with when they feel their blood sugar is high or low.

- For monitoring frequency, check DMMP

• Target blood sugar range is individual; but generally the goal before meals is between 80 – 150.

Motion (Exercise)

Children with diabetes need to participate like all other children

Blood glucose sugar is affected by physical activity

Common school activities:Gym class

Recess/field days

After school sports

Planning Safe Exercise

Have easily accessible:

Student’s DMMP

Water/fluids

Snacks (carbs)

Insulin/pump supplies

Blood glucose monitor

Glucagon kit for emergency

Emergency phone numbers

Managing

• This is the combination of the first 4 Ms of treatment (Meals, Medication, Monitoring, Motion) that works for each person with Diabetes to keep their blood sugar within the recommended target ranges

• Different for each person –

Determined by “trial & error”

Emergency Situations

• High blood glucose (hyperglycemia &

diabetic ketoacidosis—DKA)• Blood glucose over 250 and ketones in urine

• Low blood glucose (hypoglycemia)

• Blood glucose 70 or less

Hyperglycemia

Signs & Symptoms

• Extreme thirst

• Frequent urination

• Dry, Flushed Skin

• Headache / Stomach ache

• Blurred Vision

• Feeling Tired or Not Well

Causes

• Not enough insulin or missed injections

• Eating too many carbs

• Illness or infection

• Emotional/physical stress

• Lack of exercise or activity

Effects of Hyperglycemia

Decreased ability to focus +

Decreased energy level +

Frequent trips out of the classroom =

Decreased school performance

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Diabetic Ketoacidosis (DKA)

• Most serious consequence of very high blood glucose levels

-- cells not being nourished

• Causes rapid breakdown of fat for energy; leads to ketones in the urine

• Ketones increase blood acidity; negative impact on all body organs

• Goal is prevention by regular blood glucose testing & extra insulin if needed

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When to Check for Urine Ketones

• Usually when glucose greater than 250

• Check student care plan

• Ketostix are usually foil-wrapped strips (the more glucose in urine the darker the color)

• Most students can do this themselves

• Assistance may be needed for smaller children

• Use disposable gloves if assisting child

• If moderate to large ketones parent usually contacted.

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Hypoglycemia(Low Blood Sugar)

• Occurs when the blood glucose is too low

• Happens quickly

• Needs immediate attention

• Give child fast acting sugar as directed in diabetes care plan

Causes of Hypoglycemia(Low blood glucose sugar)

• Too much insulin

• Meals or snacks are late or missed

• Extra or extreme exercise

• Excitement in young children (start and finish of school year, holidays, etc.)

• Alcohol experimentation (older children)

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Hypoglycemia(Low Blood Sugar)

Signs & Symptoms

• Shaking

• Pale skin

• Sweating

• Confusion

• Hunger / Irritable

• Impaired Vision

• Weakness/Fatigue

• Headache / Stomach ache

• Behavior / Personality Change

Treatment

• Check Blood Sugar

(If blood sugar less than 70)

• Treat with: (See DMMP)

½ cup juice , ½ cup regular pop, 4 glucose tabs, or3 rolls smarties (fat free candy)

• Recheck blood sugar in 15 minutes

• Follow with next meal or snack with protein

Prolonged low blood sugar can lead to:Unresponsiveness > Seizures > Unconsciousness

Glucagon

• Naturally occurring hormone made in the pancreas.

• A life-saving, injectable hormone that raises blood glucose level by stimulating the liver to release stored glucose sugar

• Can save a life. Cannot harm a student – cannot overdose

When to Give Glucagon

If authorized by the DMMP and if student exhibits:

• Unconsciousness, unresponsiveness

• Seizures

• Inability to safely eat or drink

(Monitor expiration date)

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Tips for Preparing in Event of an Emergency or Lockdown

1. Consider Supplies Having access to glucometer (meter), food, insulin, water, and the restroom

2. Hypoglycemia A quick–acting carbohydrate (glucose tabs, juice box) in classroom or kept with student

3. Insulin School’s plan for accessing medication in event of a rare lockdown or evacuation

4. Written Plans & School Protocals Include lockdown / emergency provision in DMMP and/or 504 plan

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Summary of Diabetes Care Activities in School

• Checking blood glucose (sugar) levels

• Timely eating of meals/snacks

• Taking insulin when needed

• Participating in physical activity

• Extra bathroom/water fountain breaks if needed

• Strong school personnel/family/student communication

• Emergency care

Diabetes Management at School Can Help:• Provide a supportive learning environment

• Reduce absences

• Reduce classroom disruption

• Provide support in the event of an emergency

• Achieve full participation in activities

• Foster self-esteem through independence

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Resources•American Diabetes Association

http://www.diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-at-school/

•National Diabetes Education Program http://ndep.nih.gov

•Diabetes Youth Services Bonnie Heatwole BSN, RN Telephone 419-291-1234

http://dys4kids.org

•Juvenile Diabetes Research Foundation http://nwohio.jdrf.org/life-with-t1d/