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

2. 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.
Teaching Notes:
A seamless care environment flowing from the medical setting to home to school is vital for the child’s well-being and success with learning to self-manage diabetes.
The next slide demonstrates the training process going on in the state.

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

4. 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
Teaching Notes:
Although school and districts may vary in the level of available health care assistance, federal law requires that every public school provide adequate services for students with all chronic illnesses.
Federal laws require public schools to provide disabled students with a free, appropriate education in the least restrictive environment.
When a school’s administration is advised that a student has a chronic illness, personnel must evaluate the student’s special needs and develop a plan for satisfying any medical requirements.
Many schools have done a excellent job in accommodating students with diabetes and facilitating their self-management.
However, there are still occurrences happening in some schools. Examples are: making the child leave class to go to the office to test blood sugar, not allowing the child to eat a snack in the classroom or be excused to the bathroom when needed. Many schools have also required a parent to go on a field trip or the child cannot go.
The next slide covers the current state policy.

5. 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.

6. 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.

7. 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.
Teaching Notes:
A drop of blood well controlled is not an issue.
The lancet should be left in the lancing device and not exposed to the outside.
Insulin pumps should be on the student at all times unless reasons exist for disconnecting. Some students may quick-release for PE.
Those injecting insulin with a pen or syringe should be provided a safe place for injection according to their IHP and the student’s preference.
Sharps containers should be part of the school health room set up and provided by the school.
Glucose tablets are not medications, they are simply sugar.
Students with discipline problems or students that need assistance with diabetes care should be under supervision.
All individual needs should be written up in the student’s IHP.

8. 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.
Teaching Notes:
Diabetes effects over 17 million people in the US, 6.2% of the population, and 151,000 people less that 20 years of age have diabetes (year 2000 estimates)
(National Diabetes Fact Sheet, American Diabetes Association Web Site,
2. Diabetes costs the US an estimated $132 billion in medical expenditures and lost productivity.
(Diabetes Care 26: , 2003)

9. 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.
Teaching Notes:
Insulin was discovered in 1921.
Prior to 1921 a person with type 1 diabetes had about 18 months to live. He/She literally starved to death no matter how much was eaten.
So, thank goodness we have insulin!

10. 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.
Teaching Notes:
(Have the participants think about the young population they see in their schools. How many are overweight? These young people either have or are at risk for type 2 diabetes.)
This population is nicknamed the “Nintendo™” Generation.
The genes are generally there, especially in the minority populations.
A darkening of the skin around the back of the neck or in the armpits is a significant sign of insulin resistance (called acanthosis nigricans). It looks like the student has not washed his/her neck.

11. 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

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

13. High Blood Sugar “Hyperglycemia”

14. 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
Teaching Notes:
Hyperglycemia usually indicates a level of glucose in the blood that is greater than 240.
Many situations can precipitate an episode of hyperglycemia.
Hyperglycemia is usually a result of too little insulin, too much food, or too little exercise.
High blood sugar levels can also occur if the child has an illness or is in the process of becoming ill.
A simple infection such as a cold or yeast infection can elevate a student’s blood sugar level.
Extremely stressful situations can also cause a high blood sugar level. EOG testing periods are a good example of a high level of stress.
Typical hyperglycemia that is associated with short periods of stress is usually returned to target once the child has been given a correction dosage of insulin for the high blood sugar.
Other examples of protracted stress could revolve around family situations or discord among groups of students.

15. Insulin is given according to the student’s Diabetic Care Plan.
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.
Teaching Notes:
Because high blood sugars cause dehydration, it is extremely important that the student be allowed to drink calorie-free liquids such as water or sugar-free caffeine-free soda to help rehydrate him and prevent the development of ketones.
If the student is vomiting, medical attention should be sought immediately. Vomiting can be related to ketosis but may also be a symptom of another illness such as the flu.

16. Low Blood Sugar
“Hypoglycemia”

17. 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
Teaching Notes:
Keeping blood sugar in control is sometimes like playing “limbo”.
The student is trying to balance between being too high and touching the stick or too low and ending up on the ground.
In diabetes, however, being too low is no laughing matter. Low blood sugar or hypoglycemia has sometimes been called an insulin reaction.
Hypoglycemia can come on quickly and must be treated immediately by the person, family, teacher or friends.
Early treatment prevents a more serious reaction and possible hospitalization.
Hypoglycemia is usually defined as any blood sugar below 70-80, but depends on the age of the person. Some very young or very elderly people may have different blood sugar levels for hypoglycemia which should be defined in the IHP.
When the body does not have enough sugar to burn for energy the blood sugar drops too low. It is a challenge for the person with diabetes to keep their blood sugar in balance all of the time.
Low blood sugars often occur when there is not a correct balance of insulin, activity and carbohydrates.

18. Low blood glucose levels, which can be life-threatening, present the greatest immediate danger to people with diabetes.
1. Hypoglycemia usually can be treated easily and effectively.
2. If not treated promptly, it can lead to unconsciousness and convulsions and can be life threatening. Early recognition of its symptoms and prompt treatment, in accordance with the student’s Diabetes Medical Management Plan, are necessary for preventing severe symptoms that may place the student in danger.

19. Signs and Symptoms of Low Blood Sugar
Hunger
Shakiness
Dizziness
Sweatiness
Fast heartbeat
Drowsiness
Feeling irritable, sad or angry
Nervousness
Pallor
Teaching Notes:
Each person reacts to hypoglycemia differently.
The student’s most common symptom should be outlined in the IHP.
Always encourage the student to let the teacher know if they feel low or different in any way.

20. 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
Teaching Notes:
If the reaction is not treated soon enough the student may actually become unconscious and a seizure or convulsion may occur.
It is especially important to prevent severe lows in children age 7 or younger because the brain is still growing.

21. 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.
Teaching Notes:
Early signs of low blood sugar are actually caused by epinephrine or adrenalin. This hormone is released when people are excited and it causes sweating, shakiness, dilated pupils and a rapid heartbeat.
Some people are able to recognize symptoms of low blood sugar very early and may have only mild reactions.
Others who have had diabetes for several years may have fewer early symptoms. This may be called hypoglycemia unawareness.
Others may not be able to detect a small drop from 80 to 60 which occurs gradually , but are able to feel a drop from 180 to 60 which occurs rapidly.
Younger children may have difficulty with detecting a low blood sugar and may need to be trained to recognize certain signs. For example, they may need to be reminded about how they felt when they were shaky and the need to tell an adult when they are feeling shaky again.
Be sure to praise the child for letting you know if they feel shaky or low, or however they describe it.

22. 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
Teaching Notes:
When someone is having symptoms of hypoglycemia it is important for the child or responsible adult to treat right away. If it is possible and the person is not feeling too bad a blood sugar check should be done first.
If the child feels very sick or does not have a meter available, go ahead and treat for hypoglycemia. Have the child eat or drink about 15 grams of carbohydrate.
Wait about 15 minutes and test again.
If the blood sugar remains below 70 or the target for individual child, treat again with 15 grams of carbohydrate.
Once the child’s blood sugar begins returning to normal range, have them eat an extra snack of carbohydrate and protein, such as peanut butter and crackers. If the child is scheduled to eat a meal or snack within 30 minutes it would not be necessary to eat the extra protein and carbohydrate.

23. Treatment of Hypoglycemia Fast Acting Sugar Sources (15 gram carbohydrates)
3-4 teaspoons of sugar or syrup
1 cup of low fat milk
1 tube of cake gel
1 carton chocolate milk
2-4 glucose tablets
4 ounces of apple or orange juice
4-6 ounces of regular soda
2 tablespoons of raisins
Teaching Notes:
A person with diabetes needs to have something containing sugar with them at all times to treat hypoglycemia.
There are many options available which contain about grams of carbohydrate.
Glucose tablets are available which each contain 4-5 grams of carbohydrate. Children younger than 5 may actually need 2 tablets while a child over 10 may need 4 tablets.
It would be important to consult the IHP for further information for an individual child.
A juice box of 4 ounces or a small box of raisins would be helpful when the child is away from home. About one-half of a can of regular soda would also be appropriate. Candy is also a possible choice but may be too tempting for the child or may be taken by other children. There are commercial products which come in containers similar to toothpaste and contain about 15 grams of carbohydrate. A tube of cake gel which is available at the grocery store is convenient and would also work well.
After taking in the 15 grams of carbohydrate it is necessary to wait at least 10 before eating solid foods, such as peanut butter and crackers. This will allow the sugar to be absorbed more quickly.

24. 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.
Teaching Notes:
Severe hypoglycemia is a medical emergency and occurs when the brain is lacking enough sugar to function.
Glucose gel, cake gel, syrup, or honey may be used if the child is still conscious.

25. What Happens when the Child is Unconscious?
Drinking soda or eating glucose tablets is not possible and would be dangerous when the child is unconscious .
Glucagon injection may then be necessary. Glucagon is a substance (hormone) that makes the liver release sugar into the blood stream.
Turn student to their side, administer Glucagon if ordered, call 911 and parent.
Remain with student until help arrives.
Teaching Notes:
When someone is unconscious or having a seizure, it is not possible for them to swallow gel, soda, or glucose tablets.
Swallowing at this time would be dangerous and could lead to choking or aspiration into the lungs. Never put anything in the mouth of a convulsing person.
At this time the person should be placed on their side and glucagon should be administered if it is available for that student. Regardless, call
Glucagon is a hormone made in the pancreas like insulin. While insulin makes the blood sugar go down, glucagon makes the liver release sugar into the bloodstream.
You will learn more about glucagon in the skills station this afternoon.

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

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