Scroll down to begin reading the Diabetes Training
Or click on the first link on the left (Purpose of this Training)

Purpose of this training:
•   To ensure a safe, therapeutic, learning environment for the student with diabetes.
•   Meet the legal requirements identified by Washington State Laws.

Overview of Diabetes
•    It is a chronic illness.
•    The pancreas does not make insulin or the body does not effectively absorb insulin.
•    Insulin helps the body utilize food by converting sugar (glucose) into energy.
•    Without insulin, sugar accumulates in the blood stream and will cause symptoms.

Treatment
•    Taking multiple injections of insulin or treating the insulin resistance.
•    Testing blood sugar several times during the day.
•    Eating a balanced diet including all food groups.
•    Following a regular exercise program.

The goals of treatment are to: 

•   promote normal childhood/adolescent growth and development.
•   promote healthy emotional well-being.
•   maintain a balance between insulin, food, and exercise.

The challenges of living with diabetes:
•    Physical – how the body deals with the manifestations of high and low blood glucose
•    Emotional – Frustration and struggles imposed on them by the illness
•    Practical – Scheduling everything
•    Systemic – Impact of illness on family, schools, etc.

Blood Sugar Testing is required:
•    Research has shown that maintaining good control of blood sugar levels can prevent long-term complications of diabetes.
•    Procedure involves pricking a finger and placing a drop of blood on a test strip.
•    Strip placed in monitor and gives a digital readout of current blood sugar level.
•    Testing is often performed 3-4 times daily.

What is a “Low Blood Sugar?” (Hypoglycemia)
•    Defined as a blood sugar level tested less than 80 mg/dl.
•    Student may feel “low” and as a result exhibit behavior changes.
•    A low blood sugar episode does not feel good and may be frightening to the student.

Emergency action may be needed for a diabetic student:
•    Low blood sugar can develop within minutes and requires immediate attention!
•    Never send a child with suspected “low blood sugar” anywhere alone.

What are the causes of a “Low Blood Sugar?”
•    Late food or too little food
•    Too much exercise
•    Too much insulin
•    A planned or unplanned activity without additional food
•    A viral or bacterial illness

Signs/symptoms of “Mild Low Blood Sugar” may include on or many of the following symptoms:
•    Hungry
•    Shaky
•    Dizzy
•    Sweaty
•    Pale
•    Increased heart rate
•    Anxiousness
•    Irritability
•    Weakness, tiredness
•    Inability to concentrate
•    Personality change

Treatment of “Mild Low Blood Sugar”
•    Student treats self, depending on the age of the student and parent/physician/school nurse agreement.
•    Ingests quick sugar source such as 2-3 glucose tabs, 4-8 oz. Juice, glucose gel, 4-8 oz. Regular (not diet) soda, or 3-8 Lifesavers.
•    Continue to treat until blood sugar is above 80.

What are the Signs/symptoms of “Moderate Low Blood Sugar?”
•    Headache
•    Behavior changes
•    Poor coordination
•    Confusion
•    Blurry vision
•    Weakness
•    Slurred speech
•    Inability to make decisions

The Treatment of “Moderate Low Blood Sugar” includes:
•     Staff assistance typically.•    Insist on child swallowing a quick sugar source such as 2-3 glucose tabs, 4-8 oz. Juice, glucose gel, 4-8 oz. Regular (not diet) soda, or 3-8 Lifesavers.•   
Continue to treat until blood sugar above 80.

What are the Signs/symptoms of “Severe Low Blood Sugar?”
•    Loss of consciousness
•    Seizure

Treatment of “Severe Low Blood Sugar” requires:
•    Calling 911, immediately.
•    Position on side, if possible.
•    Don’t attempt to give anything by mouth.
•    Glucagon (an injection) may be given by nurse if prescribed and available or the parents if he/she arrives on campus before 911.

What is the follow-up management for mild and moderate “Low blood sugars?”
•    Wait 10-15 minutes
•    Repeat food if symptoms persists or blood sugar remains less than 80 (if known).
•    Follow with snack of complex carbohydrate and protein (e.g., crackers and cheese) according to licensed health care providers orders.
•   Follow individual health care plan for diabetics that are specific to student and developed by the school nurse, parent and licensed health care provider.
Typically, the school nurse will be paged to direct staf in the treatment follow-up as this treatment requires nursing licensure, self care if orders indicate student is independent or given by PDA or parent.

What is the definition of a “High Blood Sugar?” (Hyperglycemia)
•    Defined as a blood sugar level greater than 240 mg/dl.
•    May occur quickly with viral or bacterial illness.
•    Pattern of high blood sugar indicates the need for evaluation of management.

What are the causes of “High Blood Sugars?”
•    Too much food
•    Too little insulin
•    Decrease activity
•    Bacterial or viral illness

What are the Signs/symptoms “Mild High Blood Sugar?”
•    Thirst
•    Frequent urination
•    Fatigue/sleepiness
•    Increased hunger
•    Loss of concentration
•    Blurred vision
•    Sweet breath
•    Urine Ketones (varies from 0 to small)
•    Note undiagnosed children may exhibit some or all of these signs, plus weight loss.

Treatment for a “Mild High Blood Sugar” involves:
•    Drinking zero-calorie fluids (i.e., water.)
•    Check urine ketones, if test strips available (many students will not test for ketones at school.)
•    Increase activity level briefly (i.e., walk around) if ketones are not present.
•    Decrease activity if ketones are present.

What are the signs/symptoms of a “Moderate High Blood Sugar?”
•    Mild symptoms plus
•    Dry mouth
•    Nausea
•    Stomach cramps
•    Vomiting
•    Urine ketones (moderate to large)

What is the treatment for a “Moderate High Blood Sugar?”
•    Drink zero-calorie fluids, as tolerated.
•    Check urine ketones, if test strips available.
•    Decrease activity.
•    Call parent.
•    Anti-nausea suppository, if prescribed (only licensed school staff can administer).

What are the signs/symptoms of a “Severe High Blood Sugar?”
•    Labored breathing
•    Very weak
•    Confused
•    Unconscious
•    Urine ketones (moderate to large)

What is the treatment for “Severe High Blood Sugar?”
•    Call 911
•    Call parent

Special Considerations for the school setting
•    Diabetic students may need to use the bathroom frequently and should be allowed to do so.
•    High blood sugar is characterized by excessive thirst.  It is important to drink plenty of water and it may be helpful for the student to use a water bottle in the classroom.

What about Nutrition, Meal Planning, and Snacks at school?
•    Structured meals and snacks help promote optimal blood glucose control and help prevent the incidence of low blood sugar levels during the school day.
•    A meal plan is not a diet, but a guide to assist children/families with diabetes in choosing age-appropriate meals and snacks.
•    Children with diabetes are children first and their needs and favorite foods will mirror other children their age.

What is the role of Carbohydrate foods in the diet?
•    Most important aspect of the meal plan.
•    Consistency in amounts eaten at each meal and snack makes it easier to fine-tune insulin doses.
•    Main source of blood glucose – approx. 90-100% enters the blood stream as glucose 15 min.-2 hours after eating.
•    Includes bread and starches, fruit, and milk.

What is the purpose of Proteins in the diet?
•    Approx. 50-60% of dietary protein is converted to glucose and released into the blood stream 2-5 hours after meal.
•    Include meat, fish, poultry, eggs, peanut butter, cheese, and meat alternatives.
•    Adds ‘staying power’ to the meal.
•    Protein food at breakfast may reduce low blood sugar before lunch.
•    Protein food is recommended at lunch.

What about Fats in the diet?
•    They have negligible (less than 10%) effects on blood sugar levels.
•    Delays and slows the digestive process.

How does sugar effect the diet?
•    Sugar is ok and not a poison.
•    Sugar is acceptable in a diabetes meal plan.
•    Research has shown that sugar does not dramatically elevate blood sugar levels.  It acts similarly to other carbohydrates such as potato or bread.
•    Foods containing sugar should be treated as part of the carbohydrate foods allowed in the child’s meal plan.

Matching Food/Insulin Action
•    Children generally need 3 meals and 2-3 snacks each day.
•    Eating 4-5 hours apart with snacks 2-3 hours after the previous meal almost always matches the peak times of insulin action.
•    Almost all children receive a combination of a quick-acting insulin and an intermediate or long-acting insulin before breakfast.

What about Exercise and Sports?
•    A great way for a child to stay in shape, spend time with friends, build self-confidence, have fun, and help blood sugars stay within an acceptable range.

Suggestions for Exercising and sports:
•    Child should be allowed to check blood sugar before, during, or after exercising.
•    Eat before intensive exercising.
•    Have extra snacks available during exercise to prevent low blood sugar (i.e., Gatorade, cheese and crackers.)
•    Always have quick-acting sugared food/beverages available for managing low blood sugar.
•    Plan ahead for known increased exercise at an unusual time such as walk-a-jog-a-thon or mile run.

The Law and Diabetes
•    Diabetes is considered a disability under federal law.
•    Children with diabetes must have full access to all activities, services, or benefits provided by public schools.

Suggested accommodations for the school setting/classroom:
•    School nurse, parents and student should mutually determine the most appropriate location for blood sugar monitoring and insulin administration.
•    Student may have permission to do blood sugar testing in the classroom.
•    Student may also need to check sugar on field trips or during special events.
•    Parents are responsible to supply snacks for school.
•    Students should have at least one additional snack readily available for emergency consumption.
•    Student needs to be allowed to snack when and where necessary to maintain adequate blood sugar levels.
•    A student who does not respond to a snack and/or exhibits signs of low blood sugar needs to be accompanied to the health room, or a call for assistance should be made from the classroom.
•    A student must be allowed to drink water or other sugar-free fluids in the classroom, as needed, to dilute high blood sugars.
•    A student needs to be allowed extra bathroom privileges as high blood sugars result in increased urine output.
•    A student with high blood sugar will receive insulin according to orders from his/her health care provider.  The student may be allowed to self-inject in the classroom or health room, if appropriate and determined in advance with input from the school nurse.
•    When the student experiences either a high blood sugar reaction or a low blood sugar reaction, his/her thought processes are likely to be adversely affected.   Therefore, accommodations will need to be made with regards to performance expectations during the time immediately before and for at least one hour after the episode is treated.
•    Instructions may have to be repeated or student notes shared if the student is either out of the classroom for blood sugar treatment or has memory difficulties as a result of high or low blood sugar levels.
•    Parents should be given at least a one-day notice of extra events such as parties or “field days.”
 

Parent-Designated Adult
•    The law provides for parents to choose an unrelated adult to provide blood sugar testing and/or insulin administration.
•    School district employees may not be required to serve as the PDA but may volunteer to do so.
•    The PDA must sign a letter of intent stating that they are volunteering for the position.
•    PDA’s must complete equivalent training to that provided by the school district for all employees who work with the diabetic student.
•    PDA’s must also complete special training for the additional care they are providing.
•    This additional training will not be provided by the school district.
•    Parents must request from the school nurse the forms necessary to complete prior to any PDA assignments.

Typical Questions/Concerns of Parents
•    Who will monitor the health of my child during the school day?
•    How can I reach my child’s teacher?
•    Will my child be labeled as “that diabetes kid?”
•    Will my child’s new teacher know anything about diabetes?
•    What about the diabetes supplies?
•    What about snacks at school?
•    What will happen when there are special  occasions such as school parties, field trips, etc.?