1. Diabetes Care Tasks at School: What Key Personnel Need to Know Diabetes Care Tasks at School: What Key Personnel Need to Know NUTRITION AND EXERCISE

2. 2 Overall goal: Optimal student health and learning Managing nutrition and exercise are critical to student success. But just two pieces of a comprehensive management plan. Exercise Legal Rights Glucagon Administration Health & Learning Nutrition Insulin Administration Hypoglycemia & Hyperglycemia Ketones Monitoring Blood Glucose

3. 3 Learning Objectives Participants will learn: 4 Basic meal plans for students with diabetes 4 Nutrition calculation methods 4 Exercise benefits for students with diabetes 4 Exercise guidelines for students with diabetes

4. 4 Nutrition: Why be concerned?  Good nutrition is important for everyone for optimal health.  Nutrition planning is essential for good diabetes control:  maintain blood-glucose within target range  to prevent or delay complications  to help children and teens grow and develop properly

5. 5 School Nutrition Management Student’s family and health care team determine an individualized meal plan. Meals & snacks need to be carefully timed to balance exercise and insulin/medications. Encourage healthy eating for all students.

6. 6 6 Basic Meal Plans Key: Balance insulin/medications with carbohydrate intake Most students have flexibility in WHAT to eat. Exchange System Basic Carbohydrate Counting Advanced Carbohydrate Counting Many students have flexibility in WHEN to eat. More precise insulin delivery (pumps, pens) New insulins

7. 7 Exchange System Meal Plan Meal plan comprised of a given number of servings from each of major food groups: carbohydrates (fruit, starch, milk) meat/meat substitutes vegetables fat Itemizes number of exchanges from each category for each meal/snack.

8. 8 8 Basic Carbohydrate Counting Calories from: carbohydrate protein fat Each nutrient type affects blood sugar differently. Carbohydrate has the biggest effect on blood sugar. TOTAL carbohydrate matters more than the source (sugar or starch.)

9. 9 Advanced Carbohydrate Counting The insulin-to-carb ratio: Varies from student to student. Is determined by the student’s health care team. Should be included in the DMMP. Usually stated as a ratio of 1 unit of insulin to x grams carbohydrate. USING THE INSULIN-TO-CARB RATIO

10. 10 Using Insulin-to-Carb Ratio Example: 1:10 Ratio 1 unit of insulin to be given per 10 gms carbohydrate eaten 60 gm meal / 10 gms = 6 units of insulin needed

11. 11 School Meals & Snacks Provide school menus and nutrition information to student/family in advance. Provide sufficient time for eating. Monitor actual food intake per DMMP young, or newly diagnosed picky eaters Respect, encourage independence.

12. 12 School Meals The approximate carbohydrate content of school meals can be determined in advance by the school nutrition director and can be indicated on the school menu for each item.

13. 13 Beyond the Routine: School Parties  Provide parent/guardian with advance notice of parties/special events.  Follow the student’s DMMP and 504 Plan or IEP  Some students may prefer to bring their own foods, but may eat what is available.  Provide nutritious party snacks to encourage healthy eating habits for all.

14. 14 What every student with diabetes wants you to remember: Sugar is NOT the Enemy There is no justification for complete restriction of sugar: Sometimes sugar can be a life-saving friend! However, timing matters a lot with diabetes, and sometimes sugar (or any carbohydrate) is not a good choice at all. Consider portion size.

15. 15 Beyond the Routine: Field Trips Bring plenty of snacks to treat hypoglycemia. Bring lunch as appropriate. Consult with parent/guardian about food and/or insulin adjustments for extra activity level. Bring diabetes equipment and supplies. Bring list of emergency contacts.

16. 16 Exercise & Diabetes Everyone benefits from exercise and physical activity. Students with diabetes should fully participate. In general, exercise lowers blood sugar levels. May need to make adjustments to insulin/medications and food intake. A quick-acting source of glucose, glucose meter, and water should always be available. PE teachers and coaches must be familiar with symptoms of both high and low blood glucose.

17. 17 Exercise & Blood Glucose Monitoring Check before, during, and after exercise per DMMP. Especially when trying a new activity or sport If blood sugar starts to fall, student should stop and have a snack Students with pumps may disconnect or adjust the basal rate downward, in lieu of snacking (per DMMP)

18. 18 Exercise & Insulin/Medication Physical activity can raise blood glucose levels if there is insufficient insulin.  follow DMMP for exercise restrictions when ketones are present Work with parent/guardian to determine the best times for physical activity and to adjust snacks, insulin, or timing of activity to prevent low or high blood glucose levels.