Type 1 Diabetes: What You Need to Know

1. Type 1 Diabetes:What You Need to Know Angie Frey BSN, RN, CDE Fulton County Health Center

2. There are 29.1 million people with diabetes in the United States • 8.1 million people are undiagnosed • Approximately 208,000 people younger than 20 years old have been diagnosed with diabetes (Type 1 and Type 2) • During 2008 – 2009, approximately 18,436 people younger than 20 years old were newly diagnosed with Type 1 Diabetes while 5,089 people less than 20 years old were newly diagnosed with Type 2 Diabetes • The highest rate of new Type 1 Diabetes cases was amongst the non-Hispanic white children and adolescents in 2008-2009. • One in three American children born in 2000 and after will develop diabetes

3. Type 1 Diabetes – Body makes little to no insulin resulting in one needing to take insulin injections Approximately 5% of those diagnosed with Diabetes Type 2 Diabetes – Body unable to correctly use one’s insulin (Insulin Resistance) OR unable to produce enough insulin (Insulin Deficiency) Approximately 90-95% of those diagnosed with Diabetes

4. Management of Diabetes The 5 M’s of Diabetes Treatment: • Meals (Plate Method) • Medications Insulin (by injection or pump – Type 1 & possibly Type 2) Oral Diabetes Medications (possibly Type 2) • Monitoring Blood Sugar • Motion (Exercise) • Managing

5. Considerations When Managing Type 1 Diabetes at School • Current Diabetes Medical Management Plan • A 504 Plan • A “low box” for the classroom and the nurse’s office • Diabetes Supplies needed • Communication Plan to School Personnel • Classroom Buddy

6. Plan Takes information onDMMP and explains the school’s specific responsibilities Protect‘s child’s rights under federal laws Addressses who shall be trained to provide diabetes care tasks Diabetes Medical Management PlanDMMP • Personal care plan for each student with diabetes • Health Care Provider/Parent create this written and signed plan • Provides specific instructions for the school personnel in how to assist a child with diabetes at school (Start these plans during 3 month visit during late Spring / early Summer) 6

7. School Goal Provide nurturing environment that gives students the ability to safely care for their diabetes with minimal disruption of class time

8. Meals : Plate Method Each meal (9 inch plate) consists of: • 1 serving of protein • 3 servings of carbohydrates (1 starch, 1 fruit, and 1 milk) • ½ plate of non-starchy vegetables ( lunch & supper)

9. More Nutritious Eating • Since carbohydrates quickly raise blood glucose the most… you may need to reduce or spread out your daily carb intake.

10. Which foods contain carbohydrates? Skim milk Rice Diet cola Baked chicken Sugar-free pudding Turkey sandwich Cottage cheese Watermelon Spaghetti Mayonnaise Cookies Ice cream Scrambled eggs Peas Fat-free yogurt Peanuts Banana Baked potatoes Corn Tortilla chips Tuna fish Pizza Jelly beans Pork chops

11. Which foods contain carbohydrates? Skim milk Rice Diet cola Baked chicken Sugar-free pudding Turkey sandwich Cottage cheese Watermelon Spaghetti Mayonnaise Cookies Ice cream Scrambled eggs Peas Fat-free yogurt Peanuts Banana Baked potatoes Corn Tortilla chips Tuna fish Pizza Jelly beans Pork chops

12. Consider Timing of Meals and Snacks • Amount of carbs in meals/snacks are timed to work with the action of insulin and physical activity • If meals/snacks are skipped or delayed, the student may experience low blood glucose (hypoglycemia) • Refer to student’s diabetes care plan for meal and snack schedule

13. Tips Regarding Meals and Snacks • Take notice if child is eating meal or snacks – (may clue you in to abnormal symptoms later in the day) • Notify parents of field trips or events so plans can be made • Advance planning for class parties • Send a letter to other parents encouraging nutritious treats or other party ideas

14. Medication : Insulin • People with Type 1 DM have to take insulin injections to live. • Allows glucose in the bloodstream to enter each cell in the body to provide fuel for energy • Type 1 diabetes = insulin = energy = high blood glucose (> 250) • Correct insulin dose = energy = target blood glucose level

15. Types of Insulin Injections • Pens • Vial/syringe • Insulin Pump

16. Insulin Specifics

17. Monitoring Blood Sugar • Allows for adjustment of insulin, food, or activity to maintain target blood glucose level • Students with Type 1 Diabetes – Typically should be checking their blood sugar before each meal (and possibly before snack time) along with when they feel their blood sugar is high or low. - For monitoring frequency, check DMMP • Target blood sugar range is individual; but generally the goal before meals is between 80 – 150.

18. Motion (Exercise) Children with diabetes need to participate like all other children Blood glucose sugar is affected by physical activity Common school activities: Gym class Recess/field days After school sports

19. Planning Safe Exercise Have easily accessible: Student’s DMMP Water/fluids Snacks (carbs) Insulin/pump supplies Blood glucose monitor Glucagon kit for emergency Emergency phone numbers

20. Managing • This is the combination of the first 4 Ms of treatment (Meals, Medication, Monitoring, Motion) that works for each person with Diabetes to keep their blood sugar within the recommended target ranges • Different for each person – Determined by “trial & error”

21. Emergency Situations • High blood glucose (hyperglycemia & diabetic ketoacidosis—DKA) • Blood glucose over 250 and ketones in urine • Low blood glucose (hypoglycemia) • Blood glucose 70 or less

22. Signs & Symptoms Extreme thirst Frequent urination Dry, Flushed Skin Headache / Stomach ache Blurred Vision Feeling Tired or Not Well Causes Not enough insulin or missed injections Eating too many carbs Illness or infection Emotional/physical stress Lack of exercise or activity Hyperglycemia

23. Effects of Hyperglycemia Decreased ability to focus • + Decreased energy level • + Frequent trips out of the classroom • = Decreased school performance

24. Diabetic Ketoacidosis (DKA) • Most serious consequence of very high blood glucose levels -- cells not being nourished • Causes rapid breakdown of fat for energy; leads to ketones in the urine • Ketones increase blood acidity; negative impact on all body organs • Goal is prevention by regular blood glucose testing & extra insulin if needed

25. When to Check for Urine Ketones • Usually when glucose greater than 250 • Check student care plan • Ketostix are usually foil-wrapped strips (the more glucose in urine the darker the color) • Most students can do this themselves • Assistance may be needed for smaller children • Use disposable gloves if assisting child • If moderate to large ketones parent usually contacted.

26. Hypoglycemia(Low Blood Sugar) • Occurs when the blood glucose is too low • Happens quickly • Needs immediate attention • Give child fast acting sugar as directed in diabetes care plan

27. Causes of Hypoglycemia(Low blood glucose sugar) • Too much insulin • Meals or snacks are late or missed • Extra or extreme exercise • Excitement in young children (start and finish of school year, holidays, etc.) • Alcohol experimentation (older children)

28. Signs & Symptoms Shaking Pale skin Sweating Confusion Hunger / Irritable Impaired Vision Weakness/Fatigue Headache / Stomach ache Behavior / Personality Change Treatment Check Blood Sugar (If blood sugar less than 70) Treat with: (See DMMP) ½ cup juice , ½ cup regular pop, 4 glucose tabs, or 3 rolls smarties (fatfree candy) Recheck blood sugar in 15 minutes Follow with next meal or snack with protein Hypoglycemia(Low Blood Sugar)

29. Prolonged low blood sugar can lead to:Unresponsiveness > Seizures > Unconsciousness Glucagon • Naturally occurring hormone made in the pancreas. • A life-saving, injectable hormone that raises blood glucose level by stimulating the liver to release stored glucose sugar • Can save a life. Cannot harm a student – cannot overdose

30. When to Give Glucagon If authorized by the DMMP and if student exhibits: • Unconsciousness, unresponsiveness • Seizures • Inability to safely eat or drink (Monitor expiration date)

31. Tips for Preparing in Event of an Emergency or Lockdown • Consider Supplies Having access to glucometer (meter), food, insulin, water, and the restroom • Hypoglycemia A quick–acting carbohydrate (glucose tabs, juice box) in classroom or kept with student • Insulin School’s plan for accessing medication in event of a rare lockdown or evacuation • Written Plans & School Protocals Include lockdown / emergency provision in DMMP and/or 504 plan 2.

32. Summary of Diabetes Care Activities in School • Checking blood glucose (sugar) levels • Timely eating of meals/snacks • Taking insulin when needed • Participating in physical activity • Extra bathroom/water fountain breaks if needed • Strong school personnel/family/student communication • Emergency care

33. Diabetes Management at School Can Help: • Provide a supportive learning environment • Reduce absences • Reduce classroom disruption • Provide support in the event of an emergency • Achieve full participation in activities • Foster self-esteem through independence

34. Resources American Diabetes Association http://www.diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-at-school/ National Diabetes Education Program http://ndep.nih.gov Diabetes Youth Services Bonnie Heatwole BSN, RN Telephone 419-291-1234 http://dys4kids.org • Juvenile Diabetes Research Foundation http://nwohio.jdrf.org/life-with-t1d/