Diabetes for educators
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Diabetes for Educators. Prepared by Rhonda Philliber, RN. Overall Goal: Optimal Student Health and Learning. Hypoglycemia & Hyperglycemia. Monitoring Blood Glucose. Ketones. Health & Learning. Legal Rights. Glucagon Administration. Exercise. Insulin Regimen. Nutrition.

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Diabetes for Educators

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Diabetes for educators

Diabetes for Educators

Prepared by

Rhonda Philliber, RN


Overall goal optimal student health and learning

Overall Goal: Optimal Student Health and Learning

Hypoglycemia & Hyperglycemia

Monitoring

Blood Glucose

Ketones

Health

&

Learning

Legal

Rights

Glucagon

Administration

Exercise

Insulin

Regimen

Nutrition


What is diabetes

What is Diabetes?

Body does not make or properly use insulin:

  • no insulin production

  • insufficient insulin production

  • resistance to insulin’s effects

    No insulin to move glucose from blood into cells:

  • high blood glucose means:

    • fuel loss.

    • cells starve

    • short and long-term complications


Type 1 diabetes

Type 1 Diabetes

  • auto immune disorder

  • insulin-producing cells destroyed

  • daily insulin replacement necessary

  • age of onset: usually childhood, young adulthood

  • most prevalent type in children and adolescents


Type 2 diabetes

Type 2 Diabetes

  • Insulin resistance – first step

  • Age at onset:

  • Most common in adults

  • Increasingly common in children

  • overweight

  • inactivity


Diabetes is managed but it does not go away

Diabetes is Managed,But it Does Not Go Away

GOAL:

To maintain target blood glucose


Diabetes management 24 7

Diabetes Management 24/7

Constant Juggling:

Insulin/medication

with:

Exercise

Food intake

BG

BG

&

BG


Vocabulary

Vocabulary

Glucose - a simple sugar found in the blood; the fuel that all body cells need to function.

HYPOglycemia - a LOW level of glucose in the blood.

Quick-acting glucose - foods containing simple sugar that raises blood glucose levels

Glucose tablets or gel - special products that deliver a pre-measured amount of pure glucose; a fast-acting form of glucose used to counteract hypoglycemia

Glucagon - a hormone given by injection that raises the level of glucose in the blood

Carbohydrate - source of energy for the body


Vocabulary1

Vocabulary

HYPERglycemia - too high a level of glucose in the blood

Ketones - (ketone bodies) Chemicals that the body makes when there is not enough insulin in the blood and the body must break down fat for its energy

Diabetic ketoacidosis (DKA) -the build up of ketones in the body that can lead to serious illness and coma

Ketone testing - a procedure for measuring the level of ketones in the urine or blood


Hypoglycemia possible signs symptoms

Hypoglycemia:Possible Signs & Symptoms

Mild Symptoms

Hunger

Sleepiness

Shakiness

Changed behavior

Weakness

Sweating

Paleness

Anxiety

Blurry vision

Dilated pupils

Increased heart rate/palpitations

Moderate to Severe Symptoms

Yawning

Confusion

Irritability/frustration

Restlessness

Extreme tiredness/fatigue

Dazed appearance

Inability to swallow

Unconsciousness/coma

Sudden crying

Seizures


Diabetes for educators

Hypoglycemia: Risks & Complications

  • Greatest immediate danger

  • Not always preventable

  • Impairs cognitive and motor functioning

  • Early recognition and intervention can prevent an emergency


Hypoglycemia possible causes

Hypoglycemia: Possible Causes

  • Too much insulin

  • Too little food or delayed meal or snack

  • Extra physical activity

  • Illness

  • Medications


Mild hypoglycemia what to do

Mild Hypoglycemia: What to do

  • Intervene promptly!

    Have student eat or drink fast acting carbs (15g)

  • Test blood glucose 10-15 minutes after treatment

  • Repeat treatment if blood glucose level remains low or if symptoms persist

  • Duration of symptoms depends on how low the blood glucose was and for how long

  • If symptoms continue, call school nurse or parents


Quick acting glucose for hypoglycemia

Quick Acting Glucose for Hypoglycemia

Treatment for Lows: 15 g Carbohydrate

  • 4 oz. fruit juice

  • 15 gm glucose tablets (2-3 tablets)

  • 1 tube of glucose gel

  • 4-6 small hard candies

  • 1-2 tablespoons of honey

  • 6 oz. regular (not diet) soda (about half a can)

  • 3 tsp. table sugar

  • One-half tube of cake mate


Severe hypoglycemia symptoms

Severe Hypoglycemia Symptoms

Rare, but life threatening, if not treated promptly:

  • Convulsions (seizures)

  • Loss of consciousness

  • Inability to swallow

  • What to do:

    • Place student on his or her side

    • Lift chin to keep airway open

    • Never attempt to give food or put anything in the student’s mouth

    • Call School Nurse and 911, then parent/guardian

    • Remain with the student until help arrives


Hypoglycemia prevention

Hypoglycemia: Prevention

  • Keep a quick-acting sugar source with the student ALWAYS

  • Treat at onset of symptoms

  • Eat, Insulin, Test, Exercise

    ON TIME

  • Ensure reliable insulin dosing

  • Ensure insulin dosing matches food eaten

    • Watch picky eaters

    • Provide nutritional information to families

    • May give insulin after eating if intake uncertain


Hypoglycemia prevention1

Hypoglycemia: Prevention

Monitor blood-glucose variations on gym days, an extra snack may be required ½ hour before gym or during prolonged vigorous exercise.

  • A student should never be unattended when a low blood glucose is suspected. Maintain adult supervision.


Diabetes for educators

Hyperglycemia:Possible Signs &Symptoms

Dry mouth Vomiting

Stomach cramps Nausea

Mild Symptoms

Lack of concentration Thirst

Frequent urination Blurred vision

Flushing of skin Increased hunger

Sweet, fruity breath Weight loss

Fatigue/sleepiness Stomach pains


Hyperglycemia risks complications

Hyperglycemia: Risks & Complications

  • Hyperglycemia due to inadequate insulin can lead to DKA and/or coma or death (mainly in type 1).

  • Interferes with a student’s ability to learn and participate.

  • Serious complications develop when glucose levels remain above target range over time or are recurring.


Hyperglycemia possible causes

Hyperglycemia: Possible Causes

  • Late, missed or too little insulin

  • Expired insulin

  • Food not covered by insulin

  • Decreased physical activity

  • Illness, injury

  • Stress

  • Other hormones or medications

  • Menstrual periods

  • Any combination of the above


Hyperglycemia what to do

Hyperglycemia: What to do

Goal: lower the blood glucose to a target range

  • Verify with blood glucose test

  • Allow free use of bathroom and access to water

  • Administer insulin

  • Recheck blood glucose

  • Notify nurse, call parents

  • Note patterns: may need a change in regimen


Hyperglycemia prevention

Hyperglycemia: Prevention

  • Eat, insulin, check BG, exercise

    ON TIME

  • Reliable and accurate insulin dosing

  • Ensure that food eaten matches insulin dosing:

    • Monitor food intake

    • Report binge eating

  • Teachers consult parent/guardian prior to extra snacks

  • Consult with parent/guardian when snack, meal, or exercise times must be changed


Hyperglycemia prevention1

Hyperglycemia: Prevention

  • Take appropriate action if a missed dose is suspected or if an insulin pump malfunctions

  • Avoid “over treating” low blood sugar reactions

  • Respect the students; realize their limits

  • Exercise on a regular basis


Practical implications for educators

Practical Implications for Educators

  • Students with hyperglycemia or hypoglycemia often do not concentrate well.

  • During academic testing:

    • Check blood glucose before and during testing, per educational plan.

    • Access to food/drink and restroom.

    • If a serious high or low blood glucose episode occurs, students should be excused with an opportunity for retake.

  • Students should have adequate time for taking medication, checking blood glucose, and eating.


Practical implications for educators1

Practical Implications for Educators

  • “Make the right choice the easy choice” by eliminating barriers to:

    • snacking

    • blood glucose checks

    • access to water and bathrooms

    • insulin administration

  • Avoid making judgments based on individual blood glucose readings.


Needs addressed by iep plan

Needs Addressed by IEP Plan

  • Location and timing of blood glucose monitoring

  • Identity of trained diabetes personnel

  • Location of diabetes supplies

  • Free access to water and restroom

  • Nutritional needs, meals and snacks

  • Full participation in all school-sponsored activities

  • Alternative times for academic exams if student is experiencing hypoglycemia or hyperglycemia

  • Absences without penalty for doctors’ appointments and diabetes-related illness

  • Maintenance of confidentiality and student’s right to privacy


Where to get more information

Where to Get More Information

American Diabetes Association

1-800- DIABETES

www.diabetes.org

National Diabetes Education Program/NIH

www.ndep.nih.gov


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