Diabetes OverviewIn this section Show
Diabetes is a disorder of metabolism — the way in which the body converts food into energy. The body breaks food down by digestive juices into the fuel components needed to survive, including a sugar called glucose. Glucose is the body’s main source of energy. After digestion, glucose passes into the bloodstream, where it is available for cells to take in and use or store for later use (Kinder, 2012). In order for cells to take in glucose, a hormone called insulin must be present in the blood. Insulin acts as a “key” that unlocks “doors” on cell surfaces to allow glucose to enter the cells. Special cells (islet cells) produce insulin in an organ called the pancreas, which is about six inches long and lies behind your stomach. For people without diabetes, the pancreas automatically produces the right amount of insulin to enable glucose to enter cells. For people with diabetes, the body does not make or properly use insulin. If glucose cannot get inside cells, it builds up in the bloodstream. The buildup of glucose in the blood - sometimes referred to as high blood sugar or hyperglycemia (which means “too much glucose in the blood”) - is the hallmark of diabetes. When blood glucose goes above a certain level, the excess glucose flows out from the kidneys (the organs that filter wastes from the bloodstream) into the urine. The glucose takes water with it, which causes frequent urination and great thirst. These two conditions - frequent urination and unusual thirst - are usually the first noticeable signs of diabetes. Weight loss often follows, resulting from the loss of calories and water in urine. When the body no longer make insulin is no longer made, it must be obtained from another source – insulin injections or an insulin pump. When the body does not use insulin properly, oral medications may be taken instead of, or in addition to, insulin injections. However, neither insulin nor other medications are cures for diabetes; they only help control the disease. Diabetes management balances careful control of diet, exercise, and medication. Careful monitoring and prompt intervention are necessary to prevent life threatening hypoglycemic episodes and long-term complications such as heart disease, kidney failure, retinopathy, and serious impairment of circulation that may require amputations (Connecticut Department of Public Health, 2012) I. Types of DiabetesDiabetes occurs in several different forms. This manual focuses primarily on issues related to type 1 diabetes in children.
A. Type 1 DiabetesType 1 diabetes usually has a very rapid onset. It was previously called Juvenile Diabetes because most people develop it as children or teenagers. The immune system is the body’s system for fighting infection. In people with type 1 diabetes, the immune system attacks the beta cells (the insulin-producing cells of the pancreas) and destroys them. Since the pancreas can no longer produce insulin, people with type 1 diabetes need to take insulin daily to live. Type 1 diabetes can occur at any age, but it occurs most often in children and young adults. There is no single way to treat type 1 diabetes. Because each child’s life events vary, experienced diabetes teams are necessary to set up individualized treatment plans. For treatment plans to be most successful, an insulin regimen will be tailored to the needs of the child, as will a meal plan and recommendations for physical activity. New information on diabetes management allows people with diabetes to be more liberal with food planning. Type 1 Diabetes
Symptoms
Blood glucose monitoring is essential to help assess how well the treatment plan is working. Most children can perform blood glucose checks by themselves but may need a private place to do so. Some children may need supervision from the school nurse to see that the procedure is done properly and results are recorded accurately. How often the child checks or whether he/she checks at school at all are decisions made by the child’s parents/guardians and physician and supported by school personnel. It is the board of education’s responsibility to ensure that staff, including nursing staff, has adequate training and the updated skills necessary to best assist children with diabetes. The school nurse can then recognize when additional training is needed to perform a particular procedure and to help determine where appropriate training can be obtained.
Symptoms of Type 1 DiabetesSymptoms usually develop over a short period of time. They include increased thirst and urination, constant hunger, weight loss and blurred vision. Affected children may also feel very tired all the time. If not diagnosed and controlled with insulin, the child with type 1 diabetes can lapse into a life-threatening condition known as diabetic ketoacidosis (DKA). Risk FactorsAlthough scientists have made much progress in predicting who is at risk for type 1 diabetes, they do not yet know what triggers the immune system’s attack on beta cells. They believe that type 1 diabetes is due to a combination of genetic and environmental factors. Researchers are working to identify these factors and stop the autoimmune process that leads to type 1 diabetes. B. Type 2 diabetesType 2 diabetes is the most common form of the disease, representing 90-95 percent of people with diabetes. It was previously known as adult-onset or non-insulin dependent diabetes because it most often occurs in overweight adults ages 40 or older. Now, as more children and adolescents in the United States become overweight and inactive, type 2 diabetes occurs more often in young people. To control their diabetes, children with type 2 diabetes may need to take oral medication, insulin or both. The first step in the development of type 2 diabetes is often a problem with the body’s response to insulin, called insulin resistance. For reasons scientists do not completely understand, the body cannot use insulin very well. This means that the body needs increasing amounts of insulin to control blood glucose. The pancreas tries to make more insulin, but after several years, insulin production may drop off. Symptoms of Type 2 DiabetesSymptoms may develop slowly or quickly, and may be similar to those of type 1 diabetes. A child or teen may feel tired, thirsty or nauseated and urinate often. Other symptoms include rapid weight loss, blurred vision, frequent infections, yeast infections and slow healing of wounds or sores. High blood pressure may be a sign of insulin resistance. In addition, physical signs of insulin resistance include acanthosis nigricans, where skin around the neck, armpits or groin appears dark, thick and velvety. On the other hand, some children or adolescents with type 2 diabetes show no symptoms at all when they are diagnosed. For that reason, it is important for parents and caregivers to talk to their health care providers about screening children or teens at high risk for diabetes. Risk factorsBeing overweight and having a family member who has type 2 diabetes are the key risk factors. In addition, type 2 diabetes is more common in certain racial or ethnic groups, such as African Americans, Hispanic/Latino Americans, American Indians, Asian Americans and Pacific Islander Americans. For children and teens at risk, health care providers can encourage, support and educate the entire family to make lifestyle changes that may delay or prevent the onset of type 2 diabetes. Such changes include reaching and maintaining a healthy weight and engaging in regular physical activity. Taking care of diabetes is important. If not treated, diabetes can lead to serious health problems. The disease can affect the blood vessels, eyes, kidneys, nerves, gums and teeth, and is the leading cause of adult blindness, lower limb amputations and kidney failure. People with diabetes also have a higher risk of heart disease and stroke. Some of these problems can occur in teens and young adults who develop diabetes during childhood. However, research shows that these problems can be greatly reduced or delayed by keeping blood glucose levels near normal. II. Effective Diabetes Management in SchoolsA. Effective Diabetes ManagementThe goal of effective diabetes management is to control blood glucose levels by keeping them within a target range that is determined for each child. Optimal blood glucose control helps to promote normal growth and development and allows for optimal learning. Effective diabetes management is needed to prevent the immediate dangers of blood glucose levels that are too high or too low. The key to optimal blood glucose control is to carefully balance food, exercise and insulin or medication. As a general rule, food makes blood glucose levels go up, and exercise and insulin make blood glucose levels go down. Several other factors, such as growth and puberty, mental stress, illness or injury also can affect blood glucose levels.
Students with diabetes must monitor their blood glucose levels throughout the day by using a blood glucose meter. The meter gives a reading of the level of glucose in the blood at the time it is being checked. If blood glucose levels are too low (hypoglycemia) or too high (hyperglycemia), students can then take corrective action such as eating, modifying their activity level or administering insulin. Low blood glucose levels, which in rare cases, can be life-threatening, present the greatest immediate danger to people with diabetes (see hypoglycemia). Many students can handle all or almost all of their diabetes care by themselves. Others, because of age, developmental level or inexperience, will need help from school staff. The school nurse is the most appropriate person in the school setting to provide care for a student with diabetes. However, diabetes management is needed 24 hours a day, 7 days a week and diabetes emergencies can happen at any time. More importantly, the school nurse may not always be available. Therefore, the board of education should identify appropriate school personnel to be prepared to respond to emergencies at school and at all school-sponsored activities in which a student with diabetes participates. In this case, the school nurse should ensure proper training of qualified school employees and provide professional supervision and consultation regarding routine and emergency care of the student. B. Planning and Implementing Effective Diabetes ManagementCollaboration, cooperation and planning are key elements in developing and implementing successful diabetes management at school. As is true for children with other chronic diseases, students with diabetes are more likely to succeed in school when students, parents, school nurses, principals, teachers, other school personnel and the student’s health care providers (or personal health care team) work together to ensure effective diabetes management.Local school districts probably have similar plans and systems in place for children with other health considerations. To work collaboratively, the school district should assemble a school team that includes people who are knowledgeable about diabetes, the school environment and federal and state education and nursing laws. Team members may include the student, parents/guardian, the school nurse, school food service and other health personnel, administrators, the principal, the student’s teacher(s), guidance counselor and other relevant staff. This team works together to implement the recommendations developed by the student’s personal health care team and family. The team decides who needs to receive appropriate medical information about the child, and who will be trained by the nurse to assist with monitoring and performing certain tasks. In addition, the school team should be part of the group that develops and implements the student’s Individual Health Care Plan, Emergency Care Plan, Section 504 Plan (if needed), Individualized Education Program (IEP) or other education plan that addresses the student’s developmental and educational needs so that diabetes can be managed safely and effectively in school. The plan is based in part on the student’s medical recommendations, sometimes called a Diabetic Medical Management Plan (DMMP), as well as recommendations from the team. C. Federal and State LawsA number of laws address the school district’s responsibilities to help students with diabetes on a case-by-case basis. Under certain federal laws, any school that receives federal funding must reasonably accommodate the special needs of children with diabetes. If found eligible for services, federal law requires an individualized assessment and reasonable accommodation within the child’s usual school setting with as little disruption as possible to the school’s and child’s routines, in a way that allows the child to fully participate in all school activities. Schools have a responsibility to be knowledgeable about all relevant state and federal laws, and about how they impact policies in this area. Brief descriptions of the most relevant state and federal laws follow. CGS 10-212a Administration of Medications in Schools. This statute pertains to the administration of medications in the school setting. This statute addresses who may prescribe medications and who may administer medications in the school setting. The Regulations of Connecticut State Agencies Section 10-212a-1 through 10-212a-10 Administration of Medications by School Personnel and Administration of Medication During Before- and After-School Programs and School Readiness Programs.These regulations provide the procedural aspects of medication administration in the school setting. The regulations include definitions within the regulations; the components of a district policy on medication administration; the training of school personnel; self-administration of medications; handling, storage and disposal of medications; supervision of medication administration; administration of medications by coaches and licensed athletic trainers during intramural and interscholastic events; administration of medications by paraprofessionals and administration of medication in school readiness programs and before- and after-school programs.
Public Act No. 12-198 (HB 5348) An Act Concerning the Administration of Medicine to Students with Diabetes, the Duties of School Medical Advisors, the Availability of CPR and AED Training Materials for Boards of Education and Physical Exercise During the School Day.This Act allows a qualified school employee selected by the school nurse or principal to administer an emergency glucagon injection to a student with diabetes, under certain conditions and with a written authorization from the student's parents and a written order from the student's Connecticut-licensed physician. The Act also bars a school district from restricting the time or place on school grounds where a student with diabetes may test his or her blood-glucose levels, if the student has written permission from his parents or guardian and a written order from a physician. The Act extends required educational guidelines for school districts in how to manage students with life-threatening allergies to cover students with glycogen storage disease. It requires the State Department of Education and the Department of Public Health to issue the new guidelines by July 1, 2012, and school districts to develop individualized health care and glycogen storage disease action plans for their students with the disease by August 15, 2012. The plans must allow parents or guardians of students with the disease, or those they designate, to administer food or dietary supplements to their children with the disease on school grounds during the school day. The Act bars claims against towns, school districts, and school employees for damages resulting from these actions. The Americans with Disabilities Act (ADA) prohibits discrimination against any individual with a disability. Section 504 of the Rehabilitation Act of 1973 further protects the rights of children with disabilities, requiring reasonable accommodations that allow for the provision of a “free and appropriate public education” (FAPE). This legislation applies to all programs and activities receiving federal financial assistance, including public schools. Children are eligible for accommodations through Section 504 if they have a physical or mental impairment that substantially limits a major life activity. Major activities may include walking, seeing, hearing, speaking, breathing, learning, working, caring for oneself, and performing manual tasks. Children with diabetes are often considered eligible because of their special metabolic and dietary requirements. It is not required that the student receive special education services to be eligible for other services. The Individuals with Disabilities Education Act of 1976 (IDEA) provides financial assistance to state and local agencies for educating students with disabilities. Children are eligible if they fit one or more of the 13 categories of disability and if, because of the disability, they require special education and related services. The category that most often applies to children with diabetes is Other Health Impaired (OHI). This is defined as “having a limited strength, vitality or alertness, including heightened alertness to environmental stimuli, that results in limited alertness with respect to the education environment, that 1) is due to a chronic or acute health problem; and 2) adversely affects a child’s educational performance.” The Family Education Rights and Privacy Act of 1974 (FERPA) protects the privacy of students and their parents by restricting access to school records in which individual student information is kept. This act sets the standard for the confidentiality of student information. FERPA also sets the standards for notification of parents and eligible students of their rights with regards to access to records, and stipulates what may or may not be released outside the school without specific parental consent. Within schools, FERPA requires that information be shared among school personnel only when there is a legitimate educational interest. Public schools in Connecticut are required to meet standards set by the Occupational Safety and Health Administration (OSHA), a regulatory agency within the United States Department of Labor. These standards include the need for procedures to address possible exposure to blood-borne pathogens. Under OSHA regulations, schools are required to maintain a clean and healthy school environment. Schools must adhere to Universal Precautions designed to reduce the risk of transmission of blood-borne pathogens, which include the use of barriers such as surgical gloves and other protective measures when dealing with blood and other body fluids or tissues. These federal laws provide a framework for planning and implementing effective diabetes management in the school setting. School administrators and nursing personnel also should determine whether there are applicable state and local laws that should be factored into helping the student with diabetes. D. School Plans
The CSDE recommends that schools develop a plan for accommodating the health needs of children with diabetes. These plans should be based in part on the student’s health care provider’s medical management plan, sometimes called Diabetic Medical Management Plan (DMMP). The DMMP is completed by the student’s parents/guardians and the health care provider. It generally includes how to recognize and treat hypoglycemia and hyperglycemia as well as specific orders for blood glucose monitoring, administration of insulin and the steps to take in an emergency. A written school plan for each student’s diabetes management helps the student, their families, school staff and the student’s health care providers know what is expected of them. These expectations should be specified in writing in the documents below as determined by the team.
This information should be reviewed, along with the student’s IHCP and/or 504 Plan and updated each school year or upon a change in the student’s prescribed regimen, level of self-management, school circumstances (e.g., a change in schedule) or at the request of the student or parents/guardian. The Individual Health Care Plan (IHCP) |
Type of Activity: | If Blood Glucose Prior to Activity is: | Then Eat the Following Carbohydrate Before Activity: |
---|---|---|
Short Duration Less than 30 minutes | Less than 100 Greater than 100 | 15 grams carbohydrate No carbohydrate necessary |
Moderate Duration 1 hour | Less than 100 180-240 | 25-50 grams carbohydrate plus protein source 15 grams carbohydrate No carbohydrate necessary |
Strenuous 1-2 hours | 100-180 | 25-50 grams carbohydrate plus protein source 15 grams carbohydrate |
Note: If Blood glucose is above 240, physical activity should be restricted according to students’ DMMP, IHCP or ECP. |
4. Planning Beyond the School Day
Meeting the needs of students with diabetes requires advance planning for special events such as classroom parties, field trips, and school-sponsored extracurricular activities held before- or after- school. With proper planning students with diabetes can participate fully in all school-related activities.
While there are no forbidden foods for children or teens with diabetes, school parties often include foods high in carbohydrates and fats. Providing more nutritious snacks will be healthier for all students and encourage good eating habits. Parents/guardians should decide whether students with diabetes should be given the same food as other students or food the parents provide. Parents should be given advance notice of parties to incorporate special foods in the meal plan or to adjust the insulin regimen.
With proper planning students with diabetes can participate fully in all school-related activities
Students often view a field trip as one of the most interesting and exciting activities of the school year, and students with diabetes must be allowed to have these school-related experiences.
Students with diabetes often need support from an adult on school trips. Although it is not unusual to invite parents to chaperone field trips, parental attendance is not a prerequisite for participation by the student with diabetes. If parents do not accompany their child on field trips, the school nurse needs to determine the level of health care needed on this trip and whether or not it is necessary for a nurse to participate. Often a nurse is not needed on the trip; however, school personnel need to be properly trained to accompany the student with diabetes off-site and ensure that all the student’s supplies are brought along with the student as specified in their IHCP or ECP. This includes snacks and supplies to treat hypoglycemia.
The plan for coverage and care during extracurricular activities should be included in the student’s IHCP, 504 plan, IEP, or other education plan. As with field trips, qualified school employees must be trained to ensure student safety and trained in responding to routine and emergency care.
Transportation IssuesSimilar to other school activities away from the school building, advanced planning is necessary for meeting the needs of students with diabetes while being transported to and from school. School bus drivers need to be aware that they often may have students with health care needs riding the buses and should be educated on diabetes and, in particular, the signs of hypoglycemia. School bus drivers also need to understand how to handle an emergency. The IHCP and ECP should address how emergencies will be managed on school transportation. In most situations, this plan will allow for the student to have access to food, supplies and equipment on the bus, if needed.
5. Social and Emotional Aspects of Diabetes
The diagnosis of diabetes in a child can have a significant impact on the entire family. In many cases, the diagnosis of diabetes, like other chronic health diseases, is a major event for both the child and the family. Each individual in the family is affected and feelings experienced often follow a similar pattern although all reactions are unique and may occur at different times for different families. These feelings may linger if they are not recognized and expressed. Dealing with feelings openly can help the child and the family learn to face the daily challenges and facilitate acceptance of having diabetes. The feelings described below may be present in all families who have a child with diabetes.
Denial“This can’t really be happening.” “I don’t need to take my insulin today.”
“It’s not that serious.” “No one has to know I have diabetes.”
The child or family member may find it difficult to even talk about diabetes. It may be too painful to face. This can interfere with the medical team’s ability to educate and treat the child. At times, the child or the parent/guardian may try to hide their feelings to be “strong” or not to upset the others. This denial may make the child’s ability to adjust to the daily struggles much more difficult.
SadnessThe child or family member may cry, feel depressed, or hopeless. Feeling sad is normal, and brief periods of sadness can occur for years after diagnosis. It is important for the child or family member to express their sadness and to openly share their feelings. They should be encouraged to seek professional help if they feel depressed or hopeless for a long period of time.
Anger“Why me? or Why my child?”
“Why do I have to do it all?”
“It isn’t fair!”
Anger may be vented toward nurses, doctors, God, spouse, friends, siblings, teachers, the list is endless. Although this also is a normal feeling, it may interfere with the child or the family member’s ability to adjust to the daily pressures of managing diabetes. If it is having a major impact on the child or the family as a unit, individual counseling may be helpful.
Fear“What will this mean for my child’s life?”
“What’s going to happen?”
“How can we ever leave him alone?”
There are so many fears that are expressed by the family and the child. Parents/guardians fear the increase in responsibility and the expenses. They worry about the future, and doubt their ability to manage diabetes every day. Siblings fear they may “get” diabetes too. T he child with diabetes fears hospitals, injections, finger sticks, low blood sugars and even death. He/she may fear being different from friends. All these fears are certainly justified, but can be allayed if they are openly discussed and support is given as needed.
Guilt“What did I do to deserve this?”
“If I just hadn’t eaten so much sugar.”
“The diabetes may have come from my side of the family.”
Parents/guardians commonly feel that they “gave” their child diabetes. This idea often persists even though we know other factors also play a role in the onset of diabetes. The child may feel diabetes is a punishment for bad behavior. Such feelings are very common at the time of diagnosis. As time goes on, the child feels guilty if he/she “sneaks” extra candy, skips doing blood tests, lies about blood glucose results or does not “follow the rules.” Parents/guardians feel guilty whenever they have to enforce the “rules” of self-management or deny their child a “treat”. The opportunities to feel guilty are always there. Parents/guardians and children need to be supported in their efforts each day.
Acceptance“I don’t like having diabetes but I guess I can handle it.”
“The shots aren’t so bad, I just wish I could eat whatever I want.”
This stage may take a long time to reach and some may never come to accept diabetes as part of their life. A well-adjusted family learns to cope with the endless demands and struggles diabetes can add to their life. They feel more confident and hopeful. Sadness and anger may still occur but these periods are temporary. The family needs to seek out resources in the community and within their family to ease the burden of daily management. Dealing with all of these emotions can be a challenge for the family with diabetes. They must come to the understanding that diabetes should not prevent a child from living a full and active life. They are not alone. There are many resources available in the community and many other families traveling the same road.
Factors Causing Emotional Distress at Diagnosis of Diabetes in a Child
- Uncertainty about the outcome of the immediate situation.
- Feelings of intense guilt and anger about the occurrence of diabetes.
- Feelings of incompetence and helplessness about the responsibility for managing the illness.
- Loss of valued life goals and aspirations because of illness.
- Anxiety about planning for an uncertain future.
- Recognition of the necessity for a permanent change in living.
6. Promoting Student Independence
While it is very important to provide students with assistance and supervision of their diabetes care as needed, it is equally important to enable students to take on the responsibility of learning diabetes self-management and control. Age alone should not be the guideline used to assume that a child is ready to accept responsibility for managing components of diabetes care. It is important to realize that children develop at different rates.
Adults must recognize that responsibilities related to diabetes depend not just on age, but also on the development of the individual as well as the circumstances at individual schools.
Student ability to participate in self-care also depends upon their willingness to do so. As students are ready, they can assume more responsibility for their care. Children need to be encouraged and supported to gradually assume diabetes self care as they mature and demonstrate confidence. Adults must be sure that when the responsibility is given that children are willing to accept it. Keep in mind that children’s ability or desire to perform certain diabetes related tasks may vary. It is normal for them to regress and depend on an adult to handle the responsibility of their diabetes care. Parents, school nurses, relatives and other reliable adults must be sensitive to these needs and remain supportive to children with diabetes.
Health care providers must provide written orders stating the need and the capability of students to conduct self-testing. Such an order will permit a student to self-test their blood glucose on school grounds. The school nurse and/or other school personnel should collaborate with the student and family to ensure that the student’s ability to self-test will result in effective diabetes management and complies with OSHA’s Universal Precautions.
The CDSE’s Guidelines for Blood Glucose Self-Monitoring in School is located on the CSDE website.
Students’ competence and capability for performing diabetes-related tasks are determined by the health care provider and parents/guardians and supported by the school team. Diabetes care includes and depends on self-management. Ultimately, persons with diabetes, when appropriate, become responsible for all aspects of self-care, including blood glucose monitoring and insulin administration. Regardless of their level of self-management, students with diabetes may require assistance when blood glucose levels are out of the target range.
To help determine how much responsibility students with diabetes can handle, it is helpful to understand the childhood development stages. Adults must recognize that responsibilities related to diabetes depend not just on age, but also on the development of the individual as well as the circumstances at individual schools. The charts below provide guidelines for determining the average age for assuming diabetes related skills. These are general recommendations, but children must be evaluated individually. Independence takes time and requires support and supervision from adults. Children who have a network of adults to support and assist them with diabetes management may maintain better diabetes control.
General Guidelines: Age-Appropriate ResponsibilitiesAge | Developmental Characteristics | Diabetes-Related Responsibility |
---|---|---|
3-7 years | Imaginative/concrete thinkers Cannot think abstractly Self-centered | Parent supervision for all tasks Is generally cooperative for blood glucose tests and insulin shots Inconsistent with food choices Gradually learns to recognize hypoglycemia Not much concept of time |
7-12 years | Concrete thinkers Capable of more logic and understanding More curious More social More responsible | Can learn to test blood glucoses At age 10 or 11, can draw up and give shots on occasion Can make own food choices Can recognize and treat hypoglycemia By 11 or 12 years, can be responsible for remembering snack, but may still need reminders. Alarm watches may promote independence. |
12-18 years | More independent Behavior varies Body image important Away from home more More responsible Capable of abstract thinking | Capable of doing the majority of shots and blood tests but may still needs some parental supervision and review at times to make decisions about dosage Knows which food to eat Gradually recognizes the importance of good sugar control to prevent later complications May be more willing to inject multiple shots per day |
F. Diabetes Management Training for Qualified School Employees
Diabetes management training provides information on the necessary care for students with diabetes during the school day and during before- and after-school activities. The CSDE recommends training of qualified school employees when a student is diagnosed with diabetes, when a student with diabetes is enrolled in the school, or when appropriate. Training should be ongoing and include regular refresher sessions.
Suggested Components- Introduction to the child’s IHCP, ECP and DMMP.
- Type 1 and 2 diabetes: what it is, how it is managed (if not covered at planning meeting.)
- Monitoring tools: blood glucose monitor, insulin pump, written records, etc.
- Signs and symptoms of hypoglycemia and hyperglycemia.
- Procedures for routine care of the individual student.
- Emergency procedures (such as, administration of glucose tabs, gel or glucagon injection).
- Overview of universal health and safety guidelines (OSHA) and disposal of supplies.
- Monitoring techniques (for those who may do finger sticks or arm sticks.)
Following the initial training, school nurses often provide the ongoing training needs of qualified school employees and students (see Appendix A for staff training record).
References
Appendix C
American Nurses Association and National Council of State Boards of Nursing. Joint Statement on Delegation
American Diabetes Association. (2011). Diabetes Statistics.
American Diabetes Association. (2012). Estimated Average Glucose (eAG).
American Diabetes Association. (2012). Children with Diabetes: Information for School and Child Care Providers
American Diabetes Association. (2012). Living With Diabetes.
Connecticut Board of Examiners for Nursing. Declaratory Ruling on Delegation by Licensed Nurses to Unlicensed Assistive Personnel
Connecticut Board of Examiners for Nursing. Declaratory Ruling on LPN Scope of Practice
Connecticut Department of Public Health. (2012). Chronic Disease: Diabetes Prevention and Control Program .
Connecticut Department of Labor, Division of Occupational Safety and Health (CONN-OSHA)
Connecticut State Department of Education. (2012). Guidelines for Blood Glucose Self-Monitoring.
.Connecticut State Department of Education. (1989). Connecticut Advisory School Health Council. Roles and qualifications of school health personnel.
Kinder, C.N. (2012). Yale-New Haven Teacher’s Institute. Biomedical Engineering and Diabetes.
Public Act No. 12-128 An Act Concerning the Administration of Medicine to Students with Diabetes, the Duties of School Medical Advisors, the Availability of CPR and AED Training Materials for Boards of Education and Physical Exercise During the School Day .
United States Department of Agriculture. (2012). Choose MyPlate
KidsHealth from Nemours. (2012). Type 1 Diabetes: What is it?