By April Roberts Aleman RN MS School Nurse

MUHSD Health Services Supervisor

Based on the program developed by

School Nurse Mary Zombeck RN MS CPNP

Diabetes Basics: A Training Program

for School Personnel

WHY IS IT IMPORTANT TO LEARN ABOUT THIS ILLNESS?

.• People with this illness cannot utilize the

food they eat because they are not producing insulin.

• The illness can have deadly complications, both short term and long term.

• The illness requires constant monitoring every day of their life, it becomes oppressive.

Different Types of Diabetes

• Type I diabetes, also known as Juvenile Onset Diabetes, begins in childhood up until about age 20.

• It is believed to be an autoimmune illness, but not genetic.

• Patient is completely dependent on injected insulin for survival.

Diabetes Type 2

• In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin.

• Very genetic

• High incidence in certain ethnic groups

Prevention: Diet and Exercise

Acanthosis Nigricans 

•TREATMENT•Diet and exercise

•The next step, if necessary, is treatment with oral anti-diabetic drugs. Anti-diabetic drugs include:

Sulfonylureas metformin phenforminrosiglitazone , pioglitazone, troglitazone. acarbose miglitol. nateglinide, repaglinide exenatide liraglutide (not FDA approved) sitagliptin pramlintide

•If necessary some type 2 diabetics need to use insulin.

•The long term effects are the same for diabetes type one: Heart disease

•Heart attacks

•High Blood Pressure

Blindness (retinopathy),

Nerve damage (neuropathy)

Kidney damage

Gestational Diabetes

• Gestational diabetes affects about 4% of all pregnant women.

• We don't know what causes gestational diabetes, but we have some clues.

– The placenta supports the baby as it grows. Hormones from the placenta help the baby develop.

– But these hormones also block the action of the mother's insulin in her body. This problem is called insulin resistance.

– Insulin resistance makes it hard for the mother's body to use insulin. She may need up to three times as much insulin.

DiagnosisThe Classic Symptoms

They are all due to high blood sugar which because the illness is not diagnosed goes untreated until a

crisis.

Polyphagia (frequently hungry) Blurred vision Polyuria (frequently urinating) Fatigue Polydipsia (frequently thirsty) Weight loss Poor wound healing (cuts, scrapes, etc.) Dry mouth Dry or itchy skin Recurrent infections such as vaginal yeast infections,

groin rash, or external ear infections (swimmers ear)

Why is it important to take care of diabetes???

The long term effects for diabetes type I:

• Heart disease • Heart attacks• High Blood Pressure

• Blindness (retinopathy),

• Nerve damage (neuropathy)

• Kidney damage

BALANCING ACT ALL THE TIME

INSULIN

• Insulin is a naturally occurring hormone that moves the glucose from the blood stream to the cells, so the

body can use the glucose to work.

• The pancreas makes insulin as the body needs it, depending what a person eats and how much they exercise.

TOO MUCH INSULINTakes too much sugar out of the bloodNot enough sugar in the blood for the brain to work.Brain will die, life will cease.

• TOO LITTLE INSULIN• Results in too much sugar in the blood• Thirst as body tires to dilute blood• Increased urination• Sleepiness

FOOD

• Food provides the body with glucose.

• The brain can only use a sugar called glucose to work. Without glucose the brain will DIE in a matter of minutes!

Too much or too little FOOD

TOO MUCH FOODToo much food causes the diabetic to gain weightThe diabetic will need more insulin the more he eatsIf he does not take enough insulin, the blood sugar will be high If the blood sugar gets too high this causes hyperglycemia and this causes long term effects

TOO LITTLE FOOD• Too little food causes low blood sugar• The blood sugar will be even lower if insulin is taken.

• Starch 15 CARBS Breads, Pastas, Beans, Chips, Potatoes

• Vegetable 5

• Fruit 15

• Fat 0

• Meat 0

• Milk 12

Is good for every student body!!!

Decreasing Exercise Does not use glucose/sugar

If the diabetic does not eat less the sugar will get too high in the blood.

If the sugar is high in the blood and the diabetic uses insulin to lower it they will gain weight.

Encourage the diabetic to exercise and maintain correct blood sugars.

Increasing Exercise:

Uses glucose (sugar)

Causes the level of sugar in the blood to go down (low blood sugar)

Is good for diabetics, but they must plan ahead and have snacks handy in case their blood sugar gets too low.

May have to schedule PE at a time convenient for the diabetic in terms of blood sugar stability.

There are

3 variables

that influence

blood sugar

beyond the tri-angle.

BALANCING ACT ALL THE TIME

• Stress causes the blood sugar to go up. Tests, boyfriend issues, drama, girlfriend problems, home dysfunctions, bad grades, up-coming tests, no money, yelling teachers, out of control diabetes; it all can cause the diabetic student to have a high level of glucose in their blood.

• In general illness and injuries cause blood sugar to go up, unless the diabetic stops eating (or is vomiting).

Signs of low blood sugarMOST IMPORTANT PART OF THIS TRAINING

Mild hypoglycemia • Symptoms of mild low blood sugar usually

develop when blood sugar falls below 60 to 65 mg/dL

• Nausea. • Extreme hunger. • Feeling nervous or jittery. • Cold, clammy, wet skin; excessive sweating not

caused by exercise. • A rapid heartbeat (tachycardia). • Numbness or tingling of the fingertips or lips. • Trembling.

Moderate hypoglycemia • MOST IMPORTANT PART OF THIS TRAINING

• If blood sugar continues to fall, the nervous system will be affected.

• Mood changes, such as irritability, anxiety, restlessness, or anger.

• Confusion, difficulty in thinking, or inability to concentrate.

• Blurred vision, dizziness, or headache. • Weakness, lack of energy. • Poor coordination. • Difficulty walking or talking, such as staggering or

slurred speech. • Fatigue, lethargy, or drowsiness.

Severe hypoglycemia • The symptoms of severe low blood sugar

develop when blood sugar falls below 30 mg/dL and may include:

• Seizures or convulsions. • Loss of consciousness, coma. • Low body temperature (hypothermia). • Prolonged severe hypoglycemia can cause

irreversible brain damage and heart problems, • If emergency medical treatment is not provided,

severe hypoglycemia can be fatal.

Denial and Hypoglycemic Unawareness

• Tighter diabetic control is achieved through intensive insulin therapy; however, an unwanted consequence of this therapy is a threefold increase in severe episodes of hypoglycemia

• Developmentally, children may also lack the cognitive and emotional sophistication to develop adaptive coping strategies in the face of threatening experiences related to hypoglycemia.

Treatment for hypoglycemia

• Food-Carbohydrates, simple then complex

• Juice• Chips• Fruit• Bagels, etc

• Glucose Tabs• Gucose Gel• Glucagon

Glucagon Procedure

Essential Steps

• Verify signs of severe low blood glucose: Unable to swallow; Uncooperative; Combative; Unconscious.• Place student on side – or – in upright position if restless/uncooperative• Have someone call paramedics, parent, and school nurse• Place one of the following in cheek pouch closest to ground and massage: 15 gm. of Glucose Gel• If student becomes unconscious or starts to seize, give Glucagon • Perform first aid for seizure• When student is able to swallow give sips of regular soda pop (not diet) as

tolerated until paramedics arrive.• When paramedics arrive, student will be transported for medical care.• Document in aeries

HYPERGLYCEMIAHigh Blood Sugar

• Excessive thirst

• Fatigue, weakness

• Increase in number of trips to the bathroom

• Blurry vision

• Diabetic ketoacidosis

• Water, LOTS

• Exercise

• Insulin

• Re test after 20 to 30 minutes, if stable return to class

HYPERGLYCEMIATreatment

MUHSD Standard Accommodations

• Students can check their blood sugar anywhere on campus including in class

• Students can eat and drink in class• Students can go to the restroom as

needed• Students can use the health office as

needed.

CONCLUSION

Together we can help the diabetic student take good care of themselves,

attend school,

participate in student activities,

and enjoy life.