DATA Program Diabetes Awareness, Training, and Action Online Training for School Staff Public Schools of Robeson County Care of School Children with Diabetes

Introduction When a student with diabetes is part of the school system, the school staff automatically becomes a part of the student’s health care team. A student with diabetes can have special challenges for which teachers and staff must be prepared. This program is designed to train school personnel in general diabetes care to allow the student to have a successful day at school. Students’ health information is confidential and should only be discussed on a “need to know” basis.

Part 1 Overview of Senate Bill 911 Care of School Children With Diabetes

Overview of SB 911: Care of School Children with Diabetes –September 5, 2002-became law –Provides a standardized diabetic care plan (DCP) for children with diabetes (parent’s responsibility to complete) –Parents must request in writing that a diabetic care plan be developed –PSRC must ensure that the DCP and/or emergency action plan (EAP) are implemented –The completed DCP clearly describes the responsibilities of the student, parent, and school staff –If no DCP is completed by the parent/guardian, the student will follow EAP for self-care, parent-care, and 911 care procedure –In an emergency with a diabetic student, 911 must be called –All PSRC employees must receive basic diabetes awareness training –Each school with a diabetic student must have at least 2 individuals trained as a diabetic care manager (DCM) to assist students with diabetes and handle emergencies –Students with diabetes are allowed to carry necessary supplies at all times and are allowed access to water and the bathroom

Guidelines for PE Teacher and Coach Encourage exercise and participation in sports and physical activities for students with diabetes. Treat the student with diabetes the same as other students, except to meet medical needs. Encourage the student to have blood glucose equipment and treatment for low blood sugar available. Understand and be aware that hypoglycemia can occur during and after physical activity. Recognize any changes in student’s behaviors which could be a symptom of low blood sugar.

Guidelines for Bus Drivers At the beginning of the school year, identify any students on the bus who have diabetes. Be familiar with their DCP (Diabetic Care Plan) or EAP (Emergency Action Plan). Be prepared to recognize & respond to signs/symptoms of low blood sugar Student may carry BS monitor, Insulin, Glucagon, & snacks on bus. Student, teacher, and parent should communicate with bus driver. Bus driver may consider carrying extra snacks in case of bus breakdown, traffic jam, etc.

Liability Concerns and Issues So what about sharps, blood, carrying medication around the school? –Self-monitoring of blood sugar should be supported. –Students should discard used needles in an approved sharps container. –Students injecting insulin with pens or syringes should be provided a safe place for injecting.

Part 2: Diabetes Overview Diabetes Defined: “Diabetes is a chronic disease that affects the body’s ability to use sugar. Sugar is what fuels our body. Insulin is made in the pancreas and is needed to get the sugar from the blood stream into the cell so it can be used for energy. With diabetes, either the body doesn’t make insulin or the body can’t use it properly. Without insulin, glucose (sugar)- the body’s main energy source-builds up in the blood. There are 2 types of diabetes.

Diabetes Overview continued… Type 1: *Has been called Juvenile-Onset or Insulin Dependent Diabetes in the past. *Results from the destruction of the part of the pancreas that makes insulin. *The body does not make insulin or does not make enough insulin. *Sugar builds up in the blood and the student will become very sick. *The student with Type I diabetes must take insulin by injection for the remainder of his/her life.

Diabetes Overview continued… Type 2: * Has been called Adult-Onset or Non-Insulin- Dependent Diabetes. * The body makes insulin. The body either doesn’t use the insulin it makes or doesn’t make enough. *Central abdominal obesity is directly related to insulin resistance. *Type 2 diabetes is a fast-growing epidemic in our young population. *Type 2 diabetes is related to family history of diabetes, weight gain, and sedentary lifestyle. *Usually improves with weight loss, exercise, and diet *May require oral medication if diet and exercise don’t improve blood sugars, and eventually insulin may be needed.

Necessary Tools for Diabetes Management Blood sugar monitor (glucometer) for self- monitoring of blood sugar Carbohydrate counting and the meal plan Type I – Insulin is needed to control blood sugar levels Type II - important to promote weight loss

Part 3 Acute Complications of Diabetes Hyperglycemia (High Blood Sugar) Hypoglycemia (Low Blood Sugar)

High Blood Sugar “Hyperglycemia”

Hyperglycemia High blood glucose (hyperglycemia) occurs when the body gets too little insulin, too much food, or too little exercise. Definition-blood sugar greater than 240 Signs/symptoms: frequent urination, extreme hunger, extreme fatigue, unusual thirst, irritability, blurred vision

In all cases of high blood sugar, if the student is able, he should drink calorie-free, caffeine-free liquids such as water. If the student is unable to drink liquids because of nausea or vomiting, you should seek medical attention immediately according to the student’s DCP(Diabetic Care Plan) or EAP (Emergency Action Plan). Insulin is given according to the student’s Diabetic Care Plan. The urine may be tested for ketones, if ordered. Do not have the student exercise in order to bring the blood sugar level down.

Low Blood Sugar “Hypoglycemia”

What Is Hypoglycemia or Low Blood Sugar? Sometimes called an insulin reaction Occurs when blood sugar is below the target range (under 70-80) Can be caused by too much insulin, unplanned increased activity, eating too few carbohydrates, missing/delayed meals, changes in school schedule

Low blood glucose levels, which can be life-threatening, present the greatest immediate danger to people with diabetes.

Signs and Symptoms of Low Blood Sugar Hunger Shakiness Dizziness Sweatiness Fast heartbeat Drowsiness Feeling irritable, sad or angry Nervousness Pallor

More Signs and Symptoms of Low Blood Sugars Feeling sleepy Being stubborn Lack of coordination Tingling or numbness of the tongue Personality change Passing out Seizure

Recognizing Low Blood Sugar It is important to recognize a low blood sugar as soon as possible so that it does not progress to a severe reaction. Early signs are caused by the release of the hormone epinephrine. Our bodies make this hormone when we are excited or stressed.

What To Do When Hypoglycemia Occurs If meter is unavailable and the child feels sick, treat as if sugar is low. Student should immediately eat or drink about 15 grams of fast-acting carbohydrate. Notify DCM (Diabetic Care Manager) or school nurse

Treatment of Hypoglycemia Fast Acting Sugar Sources (15 gram carbohydrates) 2-4 glucose tablets 4 ounces of apple or orange juice 4-6 ounces of regular soda 2 tablespoons of raisins 3-4 teaspoons of sugar or syrup 1 cup of low fat milk 1 tube of cake gel 1 carton chocolate milk

Treating Severe Hypoglycemia When severe hypoglycemia occurs, not enough sugar is in the brain. The student may lose consciousness and/or have convulsions. At this time the student will need the assistance of someone else.

What Happens when the Child is Unconscious? 1.Drinking soda or eating glucose tablets is not possible and would be dangerous when the child is unconscious. 2.Glucagon injection may then be necessary. Glucagon is a substance (hormone) that makes the liver release sugar into the blood stream. 3.Turn student to their side, administer Glucagon if ordered, call 911 and parent. 4.Remain with student until help arrives.

Only designated, trained school staff will administer Glucagon. Orders for its use must be included on the child’s Diabetes Care Plan.

Contact the school nurse with any questions/concerns relating to students with diabetes. Diabetes Awareness Post-test Diabetes Awareness Post-test