1. Diabetes in Schools LVN Training
By:
Cata Ingalls
Jan Okimura
Nina Withers

2. At the end of this lesson, the learner should be able to:
Define Diabetes Type I and factors affecting blood glucose levels.
Apply the laws affecting students with medical conditions and disabilities
Classify the Six Rights of Medication Administration.
Familiarize and accurately read the new Diabetes Medical Management
Plan (DMMP).

3. Objectives continued
Differentiate between hypoglycemia and hyperglycemia and its signs and symptoms.
Understand and apply Emergency Care Plans, when needed
Successfully monitor blood glucose, administer insulin via syringe and pen, deliver glucagon during emergency, calculate carbohydrate, and to determine amount of insulin based on carb:insulin ratio and/or BG correction.
Check ketones in urine, if needed.
Document accurately using Meal worksheets and Diabetes Monitor Log for Schools.

4. Statistics Diabetes is the 7th leading cause of death in the US
9.3 % of the American Population have diabetes
This is up 1% from 2010
From the National Diabetes Statistics June 2014

5. LAWS Section 504 of the Rehabilitation Act of 1973
Laws affecting students
(all students, not just students who
have diabetes):
Section 504 of the Rehabilitation Act of 1973
Americans with Disabilities Act of 1990
IDEA- Individuals with Disabilities Education Act of 2006

6. Other Laws affecting students:
FERPA- Family Educational Rights and Privacy Act. This is a federal law that protects the privacy of student educational records
HIPAA- Health Insurance Portability and Accountability. This law assures that individuals’ health information is properly protected while allowing the flow of health information needed to promote high quality health care.
Now you know diabetes is a serious disease that’s not going away AND we have laws that allow us to take care of the student at school let’s look at the basics of diabetes

7. Basic Diabetes Information
From YouTube Video on Diabetes Made Simple

8. At School we cannot give medications or perform procedures unless we have doctors orders
Once we have orders the School Nurse will develop a Health Care Plan
You cannot legally deviate from the orders or the Health Care Plan
Case of LVN who comes for lunch time Insulin dose
If you see new orders you need to contact the school nurse
If we don’t have orders you need to contact the school nurse
When we have orders AND a Health Care Plan you may administer medication and/or perform a procedure

9. THE NEW DMMP AS OF 5/2014

10. NEW DMMP page 2

11. A Balancing Act

12. Emergency Care Plan

13. Treatment at School Hypoglycemia Hyperglycemia
YouTube Video Hypoglycemia Safe at School
Hyperglycemia
YouTube Video Hyperglycemia Safe at School

14. Treatment at school Six Rights of Medication Administration
Right Patient
Right Dose
Right Medication
Right Time
Right Route
Right Documentation
New Diabetes Medical Management Plan – Doctor’s Orders developed in collaboration with Kaiser, Sutter & UCDMC

15. LVN Scope of Practice
Business & Professions code, Section 2859, LVN’s work
under the direction of a RN
must report data to RN
Title 16, Section , LVN does not initiate, evaluate
or change the student’s treatment/nursing care plan
No Rx changes from parents/verbal orders
Any problem, call your school nurse. If not available,
call Health programs. Jan R. will be able to connect you
with another nurse
RN’s must decide if student can be independent
Document/log results (BG, amount of insulin, amount of carbohydrates, ketones, site, etc.) appropriately

16. Review of Procedures Using skills checklist
Blood glucose check (cannot share glucometers & strips)
If child has no strips, he/she will be sent home
Insulin administration
Syringe
Pen
Pump
Glucagon Administration
Carbohydrate/Insulin ratio calculation
Urine ketone check

17. DOCUMENTATION Each student you are providing care to should have an
individual binder which should include the following:
DMMP
Emergency Care Plan
Monitor Log
Meal Worksheets (breakfast & lunch)
Documentation must be done right after each intervention,
before leaving the premise.
NOT DOCUMENTED = NOT DONE

18. Example of Meal Worksheet:
Name ___________________________________________ Date _______________________
TIME___________________ Blood Glucose _______________
BLOOD GLUCOSE CORRECTION- BREAKFAST
0 units if BG is 100 to 150 mg/dl units if BG is 301 to 350 mg/dl
½ unit if BG is 151 to 200 mg/dl units if BG is 351 to 400 mg/dl
1 units if BG is 201 to 250 mg/dl Call parent if Blood Glucose is OVER 350
1.5 units if BG is 251 to 300 mg
 Correction for Blood Glucose reading: A. _____________
CARB COUNT-BREAKFAST- 1 TO 15 RATIO
FOOD CARBS
__________________ ____________________
____________________ ____________________
TOTAL CARBS: ____________________/ = B. ______________
A.___________ + B.__________ = C. _________ TOTAL INSULIN DOSE
Calculate/Verified by: ___________________________/________________________
 Insulin drawn up/Verified by_____________________/________________________

19. Meal Worksheet cont.
Meal Worksheets will be provided by your school nurse,
reflecting Doctor’s orders
One worksheet per meal
Breakfast meal worksheet (if applicable) is different from
Lunch meal worksheet (make sure you use the correct form)
Calculation/amount of insulin drawn must be verified &
initialed by nurse AND student

20. Diabetes Monitor Log for School
Monitor Log student information should include the
following:
Student’s name
Date of birth
Grade/Teacher
Parent/Guardian
Phone #’s
School Nurse & cell #

21. Example of Diabetes Monitor Log

22. REFERENCES American Diabetes Association http://www.diabetes.org
Americans with Disabilities Act of 1990
Center for Disease Control and Prevention
Diabetes Made Simple YouTube Video
Family Educational Rights & Privacy Act
Health Insurance Portability and Accountability
Hyperglycemia Safe at School YouTube Video
Hypoglycemia Safe at School YouTube Video
Individuals with Disabilities Education Act
   LVN Scope of Practice

23. References National Diabetes Educational Program http://ndep.nih.gov
Sacramento City Unified School district Health e-training courses
Section 504 of Rehabilitation Act of 1973