Diabetes in School

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					Diabetes in School

Diane Spokus Doctoral Candidate Health Educator Southcentral PA Area Health Education Center (AHEC)

The mission of the Pennsylvania AHEC Program is to help communities meet their primary health care needs

by creating a statewide infrastructure bridging community and academic resources to:


underserved community & individual has a different set of needs that must be identified and addressed.



retain primary care providers in underserved communities.

AHEC Housed in 45 States

Southcentral PA AHEC Region

Current statistics on childhood overweight Contributing factors and behaviors Health Impact Prevention strategies Resources

Thought Provoking Quote

―Today’s children’s lives may be shorter than their parents.‖

(Food Fight, Brownell and Horgen, 2003)

Overweight Chronic condition that develops when energy intake exceeds energy expenditure, resulting in excessive body weight

An estimated 9 million young people are overweight The percentage of children/adolescents that are overweight has doubled since the 1970’s Obesity is now the most prevalent nutritional disease of children and adolescents in the United States

1 in 3 children born in the year 2000 will develop Type II Diabetes (based on current trends) 27% of children age 5-10 have 1 or more heart disease risk factors

Why Worry About Pediatric Overweight?
Probability of overweight children being obese as an adults.
– 20% at 4 years of age – 50% at 6 years of age – 80% as an adolescent

Pediatric overweight impacts on adult health
– 2 fold increase in mortality as an adult in obese vs. non-obese adolescents

Percentage of US Children and Adolescents Who Were Overweight

Percentage of Overweight Children & Youth Who Become Obese Adults
Percentage of Overweight Children & Youth Who Become Obese Adults
80 70 60 50 40 30 20 10 0 Percentage
National Institute for Health Care Management, Nov 2003

Preschool School-age Adolescent

Contributing Factors
Physical Activity Diet Genetics Environmental (time, convenience, technology & community design) Socioeconomic Behavioral Complex interacting forces OBESITY

Contributing FactorsPhysical Activity
Children spend approximately 75% of their waking hours being inactive 31% do not achieve recommended levels of physical activity Girls are less likely than boys to engage in vigorous activity
YRBS 2001, CDC

Contributing Factors- Diet
2% of children (2 to 19 years) meet the five main recommendations for a healthy diet- Food Guide Pyramid 75% if children consume more saturated fat than is recommended- Dietary
Guidelines for Americans National Alliance for Nutrition and Activity, 2003

45 % of children eat no fruit. 20% eat less than one serving of vegetables.
(7 servings a day are recommended for this age group)

Contributing Factors- Diet
Children’s calorie intake increased by approximately 80 to 230 extra calories per day ( between 1989 and 1996, depending on the child’s age and activity level)

The number of calories children consume from snacks increased by 30% between 1977 and 1996 A child’s chance of becoming overweight increased by 60% with each additional can of soda or juice drink
National Alliance for Nutrition and Activity, 2003

Number of People with Diabetes
United States Pennsylvania 13 Million 660,000

People with diabetes that do not know it: United States 5.2 Million

Learning Objectives
Diabetes Basics Develop a Plan of Treatment Effective Diabetes Management Hypoglycemia Hyperglycemia Blood Glucose Monitoring Emergency Action Plan

The Child with Diabetes is a Shared Responsibility in School

Schools/Teachers Responsibility and Liability
―A school district must provide a child with a handicapping condition, including children with diabetes, all services necessary to assist the student to benefit from his/her school program.‖
(Act 15, Section 504, Rehabilitation Act of 1973)

Individual Education Plan (IEP) or Individual Health Plan (IHP)
Written plan of the child’s specific health needs Every child with diabetes should have one Implemented collaboratively with the school nurse, student, parents, and school personnel Emergency treatment and contact information

What is Diabetes?
It is a serious, chronic disease in which you have a high blood sugar level due to a lack of insulin Insulin is needed to take the glucose(sugar) out of the bloodstream and move it into the body’s cells to use for energy

Diabetes Basics
Diabetes is a metabolic disorder that impairs the body’s ability to use food properly
When we eat food it breaks down into sugar Sugar is needed for energy Sugar gets into the body’s cells with the help of insulin Insulin is a hormone released by the pancreas When sugar can’t get into the cells it builds up in the bloodstream causing a high blood sugar level This is Diabetes

Blood Glucose Levels
The amount of glucose in the blood. The recommended blood glucose levels for most people with diabetes are from about 80 to 120 before a meal, 180 or less after a meal, and between 100 and 140 at bedtime.

Types of Diabetes
Type 1
– No Insulin produced

Type 2
Not enough insulin produced Body unable to use insulin produced

Risk Factors
Type 1
Causes: Heredity Autoimmune disorder Environmental
Population: People under age 30 10% population

Type 2
Causes: Heredity (Family) Obesity Physically inactive Dietary Intake Advancing Age Ethnicity (Race)
Population: Adults Children 90% population

Risk Factors
Certain racial or ethnic groups, such as African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Pacific Islander Americans.

Contributing FactorsSocioeconomic
National Growth and Health Study
– Concluded parental socioeconomic status is associated inversely with childhood overweight in white children but not African American and Hispanic

Contributing FactorsBehavioral
Family meal patterns and food choices Food availability Portion sizes School food service and vending

Health Impact
Cardiovascular Endocrine system Pulmonary Orthopedic Gastrointestinal/Hepatic Mental Health

Health Impact
– High blood pressure – Elevated cholesterol levels – Elevated triglyceride level

– Type 2 diabetes – Menstrual irregularity – Early onset of menstruation – Insulin problems

Signs and Symptoms of Diabetes
Type 2 Type 1
– – – – – Frequent urination Very thirsty/hunger Feeling very tired Blurred vision Unexplained weight loss – – – – – – – Frequent urination Very hungry/thirsty Feeling very tired Blurred vision Slow healing cuts Frequent infections No symptoms at all

Type 1
Absolute insulin deficiency

Type 2
Produce insulin Insulin Resistance

Insulin Shots Meal Planning/Health Diet Monitoring Glucose Exercise

Meal Planning/Health Diet Exercise Weight Loss Monitoring Glucose Medication (pills, insulin, or both, if necessary)

What Happens When You Eat
Cells in your body need sugars and starches for energy to do their job Food you eat is turned into sugar and starches by the stomach Sugars and starches are carried in the bloodstream to the cells The pancreas makes more insulin – the key- that opens the doors of the cells so the sugar goes into the cell

What Happens When You Eat

= Sugar = Insulin

Not Having Diabetes
If you have Insulin, you have the Key

= Sugar = Insulin

Having Diabetes
Not having Insulin - you lack the Key to open the door to cell wall

Complications of Diabetes
Eye Damage
– blindness

Increased risk for heart attack and strokes Kidney damage Nerve damage Foot ulcers/impaired wound healing
– amputations

Lifestyle Changes
Healthy Diet Physical Activity Stop Smoking Reduce Stress

Type 1 Effective Diabetes Management
Insulin (1-4 injections daily) Blood glucose monitoring (3-4 times daily) Meal Planning (carbohydrate counting) Exercise Ketone Testing (BS>240 or illness) Lab work- keep within target range

Type 2 Effective Diabetes Management
Meal Planning (decrease fat/cholesterol) Increase activity (physical exercise) Glucose monitoring Medication (oral or insulin) Lab work- keep within target range

Hypoglycemia (Low Blood Sugar)
Teachers Must Know
– Know the symptoms common to your student – Times most likely to occur
(before lunch, during and after exercise)

– How to treat – Response time after treatment
(15 minutes)

– When do parents wish to be notified?

Causes of Hypoglycemia
(Low Blood Sugar level)

Causes: Skipped meals/snacks Extra Exercise (burns more sugar) Incorrect dose of insulin

Hypoglycemia (Low Blood Sugar)
– Shakiness Sweating – Anxious Irritable/crying – Headache Fast Heartbeat – Hunger Dizziness – Impaired vision (Blurry) – Decreased concentration – Difficulty following directions – Weak and tired

Treatment of Hypoglycemia
Follow your facility’s protocols 15 grams Carbohydrate= 1 serving (Fruit, milk, starches)
4 Glucose tablets 4 ounces of Juice (1/2 cup) 4-5 ounces regular soda 1 cup milk 4-6 lifesavers/hard candy 2 Tablespoons raisins (Use parent preference when possible)

Treatment of Hypoglycemia
Once symptoms go away give light snack or meal in the next 30 minutes.
– Example:
½ peanut butter or meat sandwich and ½ glass milk

Treatment of Hypoglycemia What to Do
Intervene promptly. Follow IHP Check blood sugar Treat with 1 carbohydrate= 15 grams Wait 15 minutes Recheck blood sugar Retreat if blood sugar is < 60 or as specified in IHP Follow with substantial snack or lunch if needed

Points to Remember
Never leave student unattended Have a sugar source available Buddy system can be helpful School attendance may be affected

What is Hyperglycemia?
High blood sugar level Causes
– – – – Too little medicine Too much food Too little exercise Illness,infection, stress

Hyperglycemia (High Blood Sugar)
– – – – – – – – – Extreme Thirst Frequent Urination Dry Skin Increased Hunger Drowsiness Visual Disturbances /Blurred Vision Weight Loss Slow healing cuts Classroom performance may drop

Causes of Hyperglycemia
(High Blood Sugar)

Missed insulin injection Not enough insulin Eating too much food Impending or acute illness Infection Too little exercise Emotional or physical stress

Treatment of Hyperglycemia
Unless the child is sick they can stay in school
Follow IHP and facility’s protocol Increase fluids (water, without sugar)
– Diet drinks, broth, ice chips, water

Follow meal plan Monitor blood sugar more frequently Take medication according to IHP Deal with stress If blood sugar is >240 or as indicated in IHP, check for ketones Call parent/doctor when ketones present or as indicated in IHP

Foot Care
– Look at feet daily – Wash feet daily Use lukewarm water Keep skin soft Dry feet well – Check shoes before putting on – Always wear socks – Keep feet warm and dry

– Walk barefoot – Use heating pads/hot water bottles – Wear tight socks or knee highs – Wear socks with holes – Wear torn or tight shoes

How To Treat High Blood Sugar
Follow your facility’s protocol Follow directions provided by doctor Give fluids without sugar if able to swallow
– Such as:
Diet drinks Broth Ice Chips Water

Blood Glucose Monitoring
Role of the School
– Facilitate blood glucose monitoring per IHP – Act on blood glucose test result per IHP – Provide monitoring data to parents

Blood Glucose Monitoring
– Safety – Manage Illness – Improve Blood Sugar Control – Adjust Insulin – Sense of Control – Know effects of foods, exercise, and stress

Factors That Change Blood Sugar Levels
Diet Exercise Medication Emotions Hormones Rapid growth Illness Menstrual periods

Blood Glucose Monitoring in School
Who is responsible? Teacher/Nurse/ Student When: Before lunch Before and after GYM Symptomatic Where: Designated area Document Blood Sugar in log book

Emergency Management
– – – – <70 mg/dl Treat with carbohydrate If unresponsive call 911 Administer Glucagon(hormone that raises blood glucose levels by causing the release of stored carbohydrate from the liver))

– Check for ketonescall parent/MD or as indicated in IHP – Increase fluids (non-sugared)

Medication taken by injection through a syringe/pump Types of Insulin
Rapid acting Short acting Intermediate Long Mixtures of fast/long acting
Sliding scale may be utilized

Meal planning
Snacks Lunches School parties Field trips After school activities
– Meals and snacks must be scheduled – Consistency is the key

– Better control of blood sugar – Feel good – Maintain normal body weight – Improved endurance – Precaution: Can cause Hypoglycemia

Frequent monitoring Ketone testing:
– Urinate on a reagent strip then compare color – Positive for ketones- follow IHP – Increase fluids- water- to prevent dehydration

Psychological Issues
At each stage of development there will be different issues to deal with relating to food, insulin, blood glucose testing, diabetes

Referral to psychologist/counselor
Becoming independent with their care can be a problem Self esteem is important for each student

They do not wish to feel different than their peers

Children with diabetes can do every thing other children can do

Remember they were a child before the diabetes Do not assume your student completely understands his/her condition Developing an individual care plan will help them gain control with managing their diabetes and will help all those involved with their care

Key Terms
Autoimmune disease – A disorder in which the immune system mistakenly attacks an destroys body tissue that it believes to be foreign. In type 1 diabetes, an autoimmune disease, the immune system attacks and destroys the insulinproducing beta cells.

Key Terms
Insulin Resistance – A condition in which the body does not respond normally to the action of insulin. Many people with type 2 diabetes have insulin resistance.

Key Terms
Ketones – Chemicals that the body makes when there is not enough insulin in the blood and the body must break down fat for its energy. Ketones can poison and even kill body cells. When the body does not have the help of insulin, ketones build up in the blood and ―spill‖ over into the urine so that the body can get rid of them. Ketones that build up in the body for a long time lead to serious illness and coma.

American Diabetes Association (ADA)
– 1-800—DIABETES – www.diabetes.org

American School Health Association
– 1-330-678-1601 – www.ashaweb.org

Centers for Disease Control and Prevention (CDC)
– 1-800-311-3435 – www.cdc.gov

Juvenile Diabetes Research Foundation International
– 1-800-533-CURE – www.jdrf.org

Emergency Kit
Blood glucose meter, testing strips, lancets, and batteries for the meter Urine ketone strips Insulin and supplies Insulin pump and supplies, including syringes Other medications Antiseptic wipes or wet wipes Fast-acting source of glucose Carbohydrate-containing snacks Hypoglycemia food supplies (enough for 3 episodes): quick-acting sugar and carbohydrate/protein snacks Glucagon emergency kit

Food Guide Pyramid for Children
– www.usda.gov/cnpp/KidsPyra/LittlePyr.pdf – 5 a Day – www.5aday.com

Dole-5-A-Day education materials
– Free to elementary teachers – www.dole5aday.com

American Dietetic Association American Academy of Pediatrics American Academy of Family Physicians American Medical Association Centers for Disease Control Activate Weight Control Information Center Department of Agriculture
– Team Nutrition – Food & Nutrition Information Center
www.eatright.org www.aap.org www.aafp.org

www.ama-assn.org www.cdc.gov www.kidnetic.com www.niddk.nih.gov/health/nutrit/wi n.htm
www.fns.usda.gov/tn www.nal.usda.gov/fnic

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