1. Type 1 diabetes management in education and children’s services

2. 2 Learning objectives >Understands how type 1 diabetes managed? >Can identify and manage low blood glucose as per care plan. >Can identify and manage high blood glucose as per care plan. >Is aware of the health support planning needs and responsibilities of the school, child and family.

3. 3 What happens in type 1 diabetes? >trigger is unknown; however a genetic predisposition may exist >autoimmune response >insulin producing (islet) cells in the pancreas are destroyed and no longer produce insulin >insulin is needed to move glucose out of the blood stream and into the cells for energy >insulin is needed 24 hours a day, 7 days a week, 365 days a year

4. 4 Psychosocial considerations >managing type 1 diabetes is extremely demanding for students and their families >it is normal for families to feel overwhelmed >students may often feel ‘burnt-out’, unmotivated or isolated >always be encouraging and supportive

5. 5 Daily care routines >insulin via injections (2-4) or a pump >balancing the insulin dose with carbohydrate intake and exercise >testing blood glucose levels (BGL’s) >managing low & high BGL’s

6. 6. Nutrition principles >General eating principles for children with type 1 diabetes are the same as for all children (Australian Guide to Healthy Eating). >There are 3 major food group. Carbohydrates, fat and protein. >Foods containing carbohydrates directly affect blood glucose. Insulin doses are matched to carbohydrate exchanges or serves.

7. 7 Lunch box example Can you identify the carbohydrate foods in this lunch box?

8. 8 Blood glucose monitoring BGL’s can change according to: > carbohydrate intake > exercise pattern > emotional state > infection. Refer to individual care plan re blood glucose level targets and testing times.

9. 9 Low blood glucose (hypoglycaemia) >hypoglycaemia occurs when the BGL is less than 4mmol/L or if there are symptoms of hypo >symptoms vary >if a hypo is left untreated the child can become very drowsy, may have a seizure or become unconscious.

10. 10 Causes of low blood glucose (hypoglycaemia) >delayed or missed meals >not eating enough carbohydrate >too much insulin >unplanned physical activity >vomiting and nausea >refer to care plan/flowchart instructions on how to treat

11. 11

12. 12

13. 13 High blood glucose levels (hyperglycaemia) >Hyperglycaemia is when the blood glucose is higher than the target range. >Start the child’s high blood glucose care plan once the BGL has reached 15mmol/L. >Symptoms include excessive thirst, frequency of urination, blurred vision, tired and lethargic, irritability, hunger.

14. 14 Causes of hyperglycaemia (high BGL’s) >not enough insulin >too much carbohydrate >illness/infection >stress >pump failure >refer to care plan/flowchart for instructions on how to treat

15. 15 High BGL’s at school If the student’s blood glucose level is above 15mmol/L: >allow free water intake >allow extra toilet breaks >if child is vomiting, feels unwell or has abdominal pain, contact parents >exercise is not encouraged. Remember: high blood glucose levels cause tiredness, reduce concentration and mood changes

16. 16

17. 17

18. 18

19. 19 Health support planning When preparing the care plan and flow charts consideration needs to be given to: >food at school >blood glucose monitoring >insulin administration >storage of meters >changes to routine >camps >exams eg special provisions in SACE.

20. 20

21. 21 Responsibilities Parent/guardian >primary responsiblity for child/student health and wellbeing >changes/updates to care plan >provides equipment including BGL kit, food (hypo kits) >discusses changes in care needs with staff >participates in assessment, planning and review >provides current emergency contact details. Student/child (depending on level of development) >engaged in their care >participates and takes responsibility for aspects of self management appropriate for their age.

22. 22 Responsibilities Principal, Director, Manager >has duty of care for child/student health and wellbeing >communicates care plan changes/updates to relevant staff >ensures systems are documented and in place for implementation of care plan >enables staff access to relevant training and information. Staff >participate in assessment, planning and review >provide health support to student according to care and support plans.

23. 23 Community resources SA Health >Your specialist diabetes service Country Health SA >Your local diabetes education service Country Health SA - Diabetes >(08) 8226 7168 >www.diabetesoutreach.org.auwww.diabetesoutreach.org.au Diabetes SA >(08) 8234 1977 >www.diabetessa.com.auwww.diabetessa.com.au Diabetes Kids and Teens >www.diabeteskidsandteens.comwww.diabeteskidsandteens.com