Diabetes Information for Schools

1. Diabetes Information for Schools Reviewed: July 2015

2. Diabetes Awareness • The aim of this talk is to raise awareness of diabetes and the management of diabetes at school. • What is diabetes ? • Types of Diabetes • Management of diabetes at school

3. Roles and responsibilities • Parents to liaise with school re child’s needs during school day. • Parent will discuss and agrees the individual healthcare plan for their child with school staff and paediatric diabetes specialist nurse (PDSN) • PDSN will complete training for school staff as required. ( this can take up to 5 visits). • School nurse/community nurse can provide awareness talks for all school staff

4. Diabetes • Affects 1 in 300 school age children and is a chronic condition. • It occurs when the amount of glucose (sugar) in the blood is too high because the body is not able to use it properly. • There are many different types of Diabetes but most commonly : Type1 and Type 2.

5. Early signs of Diabetes • Thirst • Toilet (frequency) • Thin (weight loss) • Tiredness and lack of concentration • ( may experience blurred vision) * N.B teachers can often identify the signs that a child may be developing diabetes.

6. Type 1 Diabetes • Auto immune condition causing the destruction of insulin producing cells in the pancreas. • Without insulin the child’s body cannot use glucose and the blood glucose levels rise. • Most common type in children but not due to poor diet or lack of exercise • Treated with subcutaneous insulin, careful monitoring, and promotion of healthy eating.

7. Management of Type 1 Diabetes • Diabetes cannot be cured but it can be treated effectively • Managed with a combination of insulin, healthy eating & frequent blood glucose monitoring. • Insulin is destroyed by the digestive juices of the stomach so must be given by injection. • Insulin lowers blood glucose level • Insulin doses need to be balanced with food intake • Aim is to keep blood glucose levels close to normal range 4 – 7mmol/l

8. Type 2 Diabetes • Body still makes some insulin but is insulin resistant • Usually occurs in people over 40 • Risk increased in children and young people who are overweight. • Treated by: • Healthy eating & exercise , +/- tablets • May require Insulin injections also.

9. Normal Regulation of Blood Glucose

10. Blood Glucose Testing • Children should test blood glucose levels regularly during school hours. • Young children may need assistance to test their blood glucose level. • N.B child’s hands must be washed prior to testing for accuracy. • Involves pricking finger with a special device • Blood placed on a reagent strip inserted in a meter, which gives result in 5 sec.

11. Blood glucose testing cont’d • Parent/carers should discuss their child’s needs during school hours. • Training will be provided by the PDSN for school staff who volunteer to assist children as needed. • Parents/carers are responsible for the provision and disposal of all equipment including sharps boxes.

12. Blood glucose levels • Normal blood glucose range : 4 - 7mmol/l • Hypoglycaemia is a blood glucose level below 4 mmols/l and requires immediate action • Hyperglycaemia is 14mmol/l and above ( too high) • Prolonged hyperglycaemia increases the risk of complications effecting long term health.

13. CGM – Continuous Glucose Monitoring • Increasingly popular method of checking interstitial glucose levels • Examples include Libre and Dexcom

14. Libre • A sensor is worn on the back of the upper arm. It enables monitoring between meals by scanning reader over sensor and reading will appear on screen

15. Scanning the Libre sensor should not replace finger prick blood sugar checks at mealtimes when insulin is being administered. A finger prick blood sugar should be carried out if Libre reading is either below 5, above 12 or trend arrow is straight up or down, to ensure accuracy.

16. Insulin delivery(injections) • Two/three injections daily – not in school or • 4-5 injections daily – (1 before lunch) • Injections usually given with pen device • Parents/carers arrange with school safe storage of insulin pen and a private area to inject. • Children who are unable to self inject will require assistance at school. • Training will be provided by the PDSN for volunteers who wish to help with this.

17. Where injections are given: • Environment – clean, private area (not toilets) • Injection sites recommended are highlighted in the diagram as below and a new site used each time

18. Insulin delivery (pumps) • Increasingly popular method of insulin delivery, especially in younger age group. • Delivers insulin continuously through a cannula under the skin • Blood glucose levels must be tested before any food is taken • Boluses of insulin are delivered via buttons on the pump ( some children will need help with this) • Parents and children need to be accurately counting carbohydrates for this method to be effective. • Individualised training for school will be given as necessary.

19. Sharps Disposal • Parents responsibility to provide and dispose of sharps boxes • If child able , allow to remove own used pen needle and dispose in sharps box • If a needle stick injury occurs immediately bleed the wound, then place under cold running water for 5 minutes and seek medical advice.

20. Dietary advice • We promote healthy eating as recommended for whole of the population • Low in sugar & fat & high in fibre • Meals & snacks taken at regular intervals • Most are trained to count carbohydrates to give appropriate insulin doses. • Diabetic products are notrecommended

21. Meal times • Younger children will need one to one supervision at break and lunch. • School dinners- parents responsible for calculating the carbohydrate content of foods. • Some pupils may be permitted access to the top of the queue at lunch time.

22. Hypoglycaemia (Hypo) Hypoglycaemia is the most common complication in diabetes It occurs when the bloods glucose falls below 4mmols/l The symptoms vary from child to child and are documented within their individual health care plan Older children generally recognise their hypo and will take appropriate action themselves The very young or newly diagnosed will require assistance

23. Hypoglycaemic treatment kit • Each pupil should have an individual healthcare plan & hypoglycaemic kit which should be kept in school • Parents/carers are responsible for • Providing the hypoglycaemic kit, ensuring it is correctly labelled • Ensuring all medication and food supplies are within expiry dates • Replacing any used medication and food supplies • Ensuring any changes in medication or regimen are notified promptly • Ensuring any changes in contact details including emergency telephone numbers are notified promptly

24. Hypoglycaemia (causes) • Too much insulin • Not enough food eaten • Delayed food • Too much or too intense exercise • Unscheduled exercise • Hot weather • Alcohol • There may be no obvious cause

25. Mild Hypoglycaemia symptoms • Hunger • Shakiness • Weakness • Paleness • Personality change • Dizziness • Sweating • Drowsiness • Anxiety • Irritability Symptoms will be different for each individual pupil

26. Management of Mild Hypoglycaemia • Give a fast acting sugar (10- 15g CHO) • Lucozade OR • Coke (non diet) OR • Glucose tablets OR • Fruit pastilles , or jelly babies OR • fruit juice • Remain with pupil until fully recovered usually 10 – 15 minutes - retest blood glucose (B.G) • Repeat treatment above if symptoms persist • Give a biscuit e.g. digestive or hobnob or a piece of fruit if next meal or snack is not due within 30 minutes • Return to class if symptoms resolve and continue with normal activities including snacks and meals • Document hypo and inform parents/carers as previously agreed . Never use chocolate to treat a hypo, as it does not release the sugar quickly

27. Moderate Hypoglycaemia symptoms • Behaviour change • Headache • Blurred vision • Slurred speech • Poor co-ordination • Confusion Symptoms will be different for each individual pupil, these are recorded on their healthcare plan.

28. Management of Moderate Hypoglycaemia • If the pupil is cooperative treat as per mild hypoglycaemia • If uncooperative but able to swallow • Give GlucoGel as directed in healthcare plan. • Twist off cap to break the seal • Give one tube of glucogel into the mouth between the gum and cheek in small amounts and massage cheek DO NOT GIVE IF PUPIL CANNOT SWALLOW OR HAS “PASSED OUT” • Remain with pupil until fully recovered usually 10 – 15 minutes (retest) • Give a biscuit e.g. digestive or hobnob or a piece of fruit if next meal or snack is not due within 30 minutes • Return to class if symptoms resolve and continue with normal activities including snacks and meal • Inform parents/carers of hypoglycaemic episode • If the child deteriorates becoming drowsy & unable to swallow treat as per severe hypoglycaemia

29. Severe Hypoglycaemia • Unconscious • Unresponsive • Seizure with possible incontinence • Rarely occurs at school

30. Management of Severe Hypoglycaemia • Do not give anything to eat or drink • Place in recovery position if possible • Remain with pupil • Call paramedic ambulance • State hypoglycaemic episode • Give name & location of school • State where ambulance will be met • Assign someone to meet ambulance • Ensure pupil is accompanied in ambulance by a responsible adult e.g. parent/teacher • Advise ambulance crew of treatment administered • Give all used medication to ambulance crew • Contact parents/carers ASAP

31. Summary of progression of hypoglycaemia Mild hypoglycaemia goes untreated Moderate hypoglycaemia goes untreated Severe hypoglycaemia goes untreated Can result in unconsciousness & coma Promptness of diagnosis in early stages is essential in preventing progression of hypoglycaemia

32. Recovery Position

33. Hyperglycaemia Blood glucose level above 14mmol/l Pupil may feel thirsty Will need the toilet more frequently May complain of a sore tummy or head and feel lethargic Contact the parent for further advice May become unwell if not managed as agreed in healthcare plan

34. Exercise • All pupils should be able to participate fully in all activities • Exercise uses up glucose • Exercise will not always drop blood glucose at the time of activity due to adrenaline. • Effects of exercise can last in the body for up to 18 – 24hrs depending on duration and intensity. • Blood glucose will fall if • Not enough glucose has been taken prior to exercise • Too much energy is used during exercise and not replaced. • This may lead to hypoglycaemia

35. Preparation for Exercise • Before exercise blood glucose levels should be tested and their hypo kit should be brought with the child. • A small snack may need to be taken before, during or after activity e.g. Mini chocolate bar or Cereal bar or 2 plain biscuits N.B. Some pupils will adjust their insulin prior to sport and may not need a snack • Hypo kit should include • Glucose tablets or • Sugary drink • Following exercise more food may need to be taken depending on the level of exercise, duration and intensity.

36. Myths • A diabetic diet does not exist (just healthy eating for general population advised) • Diabetes is not caused by eating too many sweets • No one just has “A touch of diabetes” • No one grows out of diabetes

37. School Trips – Day Trips • Reasonable steps should be taken by schools to encourage pupils with medical needs to participate in school trips wherever safety permits, for further guidance refer to Supporting Pupils With Medication Needs DOE & DHSSPSNI 2007. • Take hypoglycaemic kit & action plan • All diabetes medication and equipment required must taken • Food for journey in case of delays and contact numbers • Mobile phone can be considered.

38. School Trips – Overnight Stays • Most pupils should be able to go on school trips provided reasonable steps are taken • Parents/carers/school staff should contact Paediatric Diabetes Nurse Specialist at least a month prior to trip to discuss supervision and plan of care whilst away. • Take hypoglycaemic kit & healthcare plan • Food for journey in case of delays • Insulin injections/ pump supplies • Blood glucose monitoring equipment • Take double supplies which should be carried separately in case of lost luggage etc. • Mobile phone must be taken

39. Examinations • Emotional stress and anxiety can cause fluctuations in blood glucose levels • Children/young people perform at their best when diabetes is well controlled • Blood glucose should be checked before each exam • Hypo treatment must be available • Letter can be requested from their consultant for special consideration in case of hypoglycaemic episode.

40. Useful links: Diabetes UK Children with Type1diabetes at school :what all staff need to know www.diabetes.org.uk DHPPS/DENI(2008) Supporting pupils with medication needs www.deni.gov.uk/support_with_medical_needs.pdf RCN(2013) Supporting children and young people with diabetes www.org.rcn.uk What Diabetes care to Expect in schools . (2015)compiled by DUK, PHA, Education and library boards NI