1. DIABETES
Ardeana Kowalski &
Amy Grant-Rau
School Health MCHD

2. Diabetes Info Fast and Furious Facts …
23 million have diabetes in the US
5-10%Type 1
1 in every 400 kids have Type I diabetes
Type II diabetes is significantly rising in children
CMS has about 400 children with Type1
(unknown how many with Type11)
Diabetes is the 5th leading cause of death
Three types of diabetes
Type I (Insulin Dependent)
Type II (Diet Controlled)
Gestational (Pregnancy Onset)
The number of students and staff with Type 2 is most likely significant. Many of them are not aware that they have diabetes…at least not yet!
The major cause of blindness, nontraumatic amputations, and kidney failure
Major cause of heart attacks and strokes
Possible cause of lack of normal growth and development if not controlled prior to puberty
Diabetes cost the US about $132 billion in medical expenses and lost productivity each year.

3. What Is Diabetes? A disorder of the pancreas
-The pancreas stops making insulin, an essential hormone in the body.
Insulin is the key that allows glucose to enter the cells.
Glucose is used by every cell in the body for energy
Use the analogy cars need gas to run and the body needs energy from glucose/sugar
You get the gas from the ground via using a pump…the gas pump is insulin…the car cells in your body.

4. Diabetes occurs when either:
The body produces no keys (no insulin production)
( Type 1 Diabetes)
Or, the body produces defective keys that will not open, the cell door locks.
(Type 2 Diabetes-Insulin Resistance)

5. Diabetes is: NOT contagious NOT caused by eating too much sugar
Is caused by the body’s inability to make insulin
Results in high blood sugar levels
Can be treated only with a combination of insulin, diet and exercise
NOT contagious
NOT caused by eating too much sugar
The Diabetes Control and Complications Trial of 1993 did a study and it showed that 56-76% of microvascular (small vessel) , kidney, eye and nerve complications can be prevented!
The United Kingdom Prospective Diabetes Study demonstrated the same results for the type 2 population
Further research is currently being done to determine the relationship between diabetes control and prevention of heart attacks & strokes (large vessel complications)

6. Type 1 Diabetes Auto-immune component Cannot be prevented
Defect in carbohydrate metabolism
Pancreas unable to make insulin
Need insulin injections
Insulin was discovered in 1921
Prior to 1921 a person with type 1 diabetes has 18 months to live…basically they starved to death no matter how much was eaten
A person cannot live without insulin.
Type 1 is more prevalent in Caucasian population. It is growing in the incidence of those being diagnosed under age of 20, though it can occur at any age. These children are typically thin, but being overweight does not rule it out.
Other ways that are currently being researched are inhaled insulin, a mouth or nose spray insulin, and an insulin patch. They are also trying to develop an insulin pill. Islet cell transplant is also on the forefront.

7. Type 2 Diabetes
Accounts for more than 90% of the diabetes population in the world!
Cells become resistant to
insulin
Usually because of insulin
deficiency
Can usually control with diet & exercise
80% of Type 2 cases are preventable
Exercise makes insulin resistance better….insulin works better
Improve IR with 5-10% weight reduction or even lack of weight gain
There is a natural history for diabetes…and that is for it to progress….to get worse.

8. Blood Sugar Monitoring
Tips for assisting a child with blood sugar monitoring:
Make sure the hands are warm, clean & dry
Wear gloves (Universal Precautions)
Set up meter with the test strip (most meters turn on when you place the strip in)
Make sure the meter is coded for the test strip used
BS test is one snap shot of the day. It takes several snapshots to get a look at the bigger picutre of how the day is going. Type 1 generally test before lunch….type 2 most often do not test at school.
Most meters take anywhere from 3-15 seconds to give a reading
The Contour and the Breeze types do not require coding, but many still do.

9. Treatment Options: Type 1
Currently most students are taking insulin by:
syringe
insulin pen device
INSULIN PUMP
Insulin pump is a machine that uses a small catheter under the skin to deliver insulin. (The pump is about the size of a pager)
Most take 2-3 shots a day….combination of Long Acting (1-2; peak 6-14; 18-24) and Rapid Acting (30min; 90min; 3-4hr)/ Fast Acting (Regular insulin) 30-60min; 2-4 peak; lasts 5-7 hr)
Tiny shot…short needle… straight in…SQ
Pumps are very sophisticated…can calculate the amt of Insulin needed when the BS and grams of carb are programmed into the pump!....MINI COMPUTER
Some insulin pumps even make music…cool…pumps deliver a basal rate of insulin. Which means the acts more like the insulin that occurs naturally in the bodies of those of us who do not have diabetes. The effect generally lasts for 24 hours and usually does not have a peak.

10. Carbohydrate Counting
Carbohydrate is found in the
food we eat.
When digested, carbohydrates breakdown into sugar.
Examples of carbohydrate include breads, rice, cereal, potatoes, cake, fruit and many others!
CHO yogurt, desserts, milk, pasta, crackers, bread, corn, peas, dry beans, non starchy veggies usu. Do not have many CHO….
Proteins, fat, other veggies (broccoli, lettuce, tgreens, green beans, squash) meats/ cheeses…these foods are generally not counted as having CHO….HIGH FAT meals digest slowly and may raise BS later, as well as high fat meals affect how insulin works.
Label reading and serving size…
“NO ADDED SUGAR” ice cream… means no sugar was added, but still has milk as natural sugar lactose in it.
“SUGAR FREE” does not necessarily mean it is…read the label and look at serving size.
ALL CHO choices are =; 1 CHO choice =15g CHO
Insulin Carb Ratio: 1:10 6U regular acting Insulin to cover 60g CHO.
Lower fat is for everyone and this is always emphasized with learning to carb count.
Encourage them to eat same amount everyday
Look at the CHO (Total CHO) do not adjust for fiber etc…
Amt of CHO and Amt of Insulin should be matched with a special formula as noted in their order

11. Hyperglycemia May occur if student: HIGH Is becoming ill (even a cold)
(High Blood Sugar Is NOT A Medical Emergency)
May occur if student:
Is becoming ill (even a cold)
Eats too much
Misses insulin dose
Or not enough insulin on board
Is under a lot of stress (exams, emotional, etc)
Certain medications
Can result in ketoacidosis
Too little insulin
Too much food
Too little exercise
Many situations can precipitate an episode of hyperglycemia
The body growing…

12. Treatment of Hyperglycemia
HIGH
Treatment of Hyperglycemia
Test blood sugar
Check Health Care Plan.
Notify parents if over 250mg/dL
Drink water
Insulin
Ketone testing with urine…if greater than trace and less than large then refer to the IHP…generally encourage water…perhaps insulin
If the student has positive ketones then they should be excused from PE for that day. The added stress of exercise on top of an already stressed body, could make the BS go even higher!
Since the production of ketones indicates a lack of insulin or presence of illness, a “large” ketone level could be a medical emergency.

13. Hypoglycemia Most likely to occur: LOW (Low Blood Sugar)
When meals or snacks are missed or delayed
An insulin dose that is too high
Extra exercise or activity
When strenuous activity occurs just before lunch
During a lengthy field trip or field day activity. (Remember to have a snack when going out for fire drills)
Sometimes called an insulin reaction…Can come on very quickly & must be treated QUICKLY
When the body does not have enough sugar to burn for energy the blood sugar drops too low. BALANCING ACT
Low BS occur when there is not a correct balance of insulin, activity and CHO
People without diabetes, our bodies stop releasing insulin automatically, when our body has had enough.
Diabetics…must figure out how much insulin their bodies will need.
Once insulin is injected it keeps working until it is gone, even if the BS goes too low.
Unplanned changes in school schedules: Bomb threats, fire drills, lock downs, assemblies, menu changes, 2 hr delay, in-school detention, standardized exams…

14. SYMPTOMS OF LOW BLOOD SUGAR
Weakness or tiredness
Shaking
Headache
Anxious, Pale
Personality Changes
Each person responds to hypoglycemia differently
May not even be aware that they are going low. Especially if it is a gradual drop
Always encourage the student to let the teacher know if they feel different in any way.
Mild—Stomach—early signs are actually caused by epinephrine or adrenalin. Causes sweating shakiness, dilated pupils, rapid heartbeat
Moderate---stems from the brain…

15. Treatment of Hypoglycemia
LOW
Conscious and able to swallow:
Glucose tablets--start with 2-4
4 oz. Juice (apple or OJ)
Wheat Crackers & cheese or Ritz Crackers (with Cheese)
Milk
Regular soda (not diet) is an option though just like a candy bar it will spike up the BS quickly, but not last
Symptoms should improve within minutes. If not, repeat.
If longer than 1 hour until next meal or snack, give small snack containing protein (cheese crackers or milk)
IF NO METER IS AVAILABLE & THE STUDENT FEELS SICK, GO AHEAD & TREAT AS IF STUDENT IS LOW
15 gms of CHO
Glucose tab (each one 3-4 gm CHO)
2 T of raisins
1T sugar, honey, jelly (3-4 tsp)
1 package fruit chew
3 Jolly Ranchers
1 cup Light yogurt
Can happen anytime or anywhere
Most orders will state to check BS; give CHO; recheck BS ---Give CHO again repeat…

16. Treatment of Hypoglycemia
LOW
Conscious, but uncooperative, or disoriented
Give glucose gel, tube of clear frosting or packet of honey
Lay student on side and squeeze into pocket of the cheek (just like Skol !)
Severe hypoglycemia is a medical emergency and occurs when the brain is lacking enough sugar to function
Glucose gel, cake gel, syrup, honey

17. Treatment of Hypoglycemia
LOW
Unconscious or having a seizure
Not enough sugar is getting to brain!
Call 911 immediately
Give Glucagon if ordered
Give nothing by mouth
Notify parents
NEVER put anything in the mouth of a convulsing person
Glucagon if ordered…regardless call 911
Glucagon is a hormone made in the pancreas like insulin. INSULIN makes the BS go down…GLUCAGON makes the BS go up because it tells the liver to release sugar into the bloodstream!

18. Hints for Success
Develop good relationship with parents/guardians; they know your student’s health concerns well.
Follow accommodations as listed in the health care plan &/or 504/IEP.
Notify family early of field trip plans.
Notify family of special events that may involve classroom treats or changes in the school lunch schedule.
Don’t hesitate to ask questions about care.
Good communication between home and school…always focus on what is best, what is safest for the student
How can we make it a win-win situation…where can we be flexible?

19. ...Please Remember Never allow student to walk
alone when feeling low (to go
check blood sugar)
Allow free bathroom privileges
Allow water bottle or access to fluids
Allow snacks when feeling low &/or certain snack break
Encourage BS testing prior to big exams (EOGs) or allow to re-test if it is felt BS affected the results