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What School Nurses Need to Know About Diabetes Management in Schools

What School Nurses Need to Know About Diabetes Management in Schools . Diabetes. Diabetes. Incidence of Diabetes Age 20 and under. Rate of new cases of Type 1 among youth are 19.0 per 100,000 each year Rate of new cases of Type 2 among youth 5.3 per 100,000

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What School Nurses Need to Know About Diabetes Management in Schools

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  1. What School Nurses Need to Know About Diabetes Management in Schools Diabetes Diabetes

  2. Incidence of Diabetes Age 20 and under • Rate of new cases of Type 1 among youth are 19.0 per 100,000 each year • Rate of new cases of Type 2 among youth 5.3 per 100,000 • KY rates- for those 20 years and younger approximately • Type 1 is 4,000 • Type 2 1,140 • SEARCH for Diabetes in Youth Study by CDC 2000-2005

  3. If you don’t have diabetes . . .

  4. Understanding Diabetes • Complex disease • Digestion breaks down carbohydrates  sugar (glucose) • Sugar bloodstream • Insulin moves sugar into cells for energy

  5. Type 1 vs. Type 2 Diabetes No insulin (key) means that sugar cannot enter the cell. Insulin (key) cannot unlock the cell door. Insulin resistance or inability of body to use insulin.

  6. Type 1 Diabetes • Autoimmune disorder • Insulin-producing cells are destroyed • Daily insulin replacement necessary • Age at onset: usually childhood, young adulthood • Most common type of diabetes in children and adolescents

  7. Type 1 Diabetes Onset- relatively quick Symptoms : increased urination, tiredness, weight loss, increased thirst, hunger, dry skin, blurred vision Cause: uncertain, both genetic and environmental factors

  8. Hypoglycemia Unawareness • Immature counterregulatory mechanisms • Cognitive Capacity

  9. Honeymoon Phenomenon • Not all newly diagnosed experience this phenomenon • Can last for weeks up to 2 years • We can not let our guard down

  10. Target Ranges Type 1 • Toddlers 0-6 years of age • Before meal 100-180 • Bedtime/overnight 110-180 • A1c <8.5 % (but >7.5%) • The Art and Science of Diabetes Self-Management Education Desk Reference, 2011

  11. Target Range Type 1 • School Age (6-12) • Before meals 90-180 • Bedtime/overnight 100-180 • A1C <6%

  12. Target Range Type 1 • Adolescents and young adults (13-19) • Before meals 90-130 • Bedtime/overnight 90-150 • A1C <7.5 % • The Art and Science of Diabetes Self-Management Education Desk Reference, 2011

  13. Type 2 Diabetes • Has increased in in children and adolescences • At diagnosis 85% of children are overweight or obese • Nearly all have first/second relative with Type 2 • Many are African American, Hispanic, Native American

  14. Type 2 Diabetes • Insulin resistance-first step • Age at onset : • Most common in adults • Increasingly common in youth • Overweight • Inactivity • Genes • ethnicity

  15. Type 2 Diabetes • Onset: variable timeframe for children • Symptoms: tired, thirsty, hungry, increased urination • Some children show not symptoms at diagnosis • Others are symptomatic with very high blood glucose levels

  16. Acanthosis Nigricans Hyperinsulinemia, a consequence of insulin resistance that occurs associated with obesity, stimulates the formation of these characteristic plaques • Acanthosis nigricans is traditionally characterized by hyperpigmented, velvety plaques in body folds, though involvement of other areas occurs as well.

  17. Treatment • The most effective treatment is weight loss and exercise to correct the underlying cause abnormality. • The cutaneous changes of acanthosis nigricans are a result of reductions in blood insulin levels.

  18. Public Health Alert….. • Onset in younger populations leads to earlier onset of complications • Macrovascular • Microvascular • Early diagnosed and intervention may help with preventing or delaying costly complications

  19. Gestational Diabetes • Occurs in late stages of pregnancy • Usually goes away after birth • More likely to develop type 2 • Caused by hormones of pregnancy or shortage of insulin • Treatment: similar to Type 2 except insulin is the usual if medication is required

  20. Pre-Diabetes • Prevalence of diabetes increased 19% between 1980 and 1996 • March, 1996 government announced some 16 million have “pre-diabetes” • Most did not know they have it • Total number of people could rise to 33 million – costing an extra $100 billion in health care costs

  21. Criteria for Diagnosisof Pre-diabetes • Fasting plasma glucose 100 – 125 [Impaired fasting glucose (IFG)] or • 2-hr post 75g oral glucose challenge 140-199 mg/dl [Impaired glucose tolerance (IGT)] or • A1C 5.7% - 6.4%

  22. Pre-diabetes is . . . • Blood sugar higher than normal, but not high enough to be diabetes • At increased risk for developing: • Type 2 diabetes • Heart disease and stroke (1.5 increased risk) • A warning to take charge of your health Diabetes May Be Ahead

  23. Goal of Therapy • To achieve physical and psychological well-being while maintaining long-term glycemic control and to avoid microvascular and macrovascular complications The Art an Science of diabetes Self-Management Education, A Desk Reference for Healthcare Professionals

  24. Management Goal • Diabetes is managed but does not go away • Goal is the maintain a target glucose range

  25. A1C.. What is the buzz • Three month blood sugar average • Weighted result

  26. Parents Reaction to Diagnosis • Feelings of grief • Educators may need to help explore feelings • Need to understand • Loss of Healthy Child • Guilt-genetic component

  27. Diabetes Management Constant Juggling 24/7 • Insulin/Medication • Physical Activity • Food Intake

  28. School Nurses……….. • Are most appropriate to • Coordinate diabetes care in the school • Supervise diabetes care • Provide direct care (when available) • Communicate about health concerns to parents/guardian and health care team

  29. Hypoglycemiaor Hyperglycemia

  30. Numbers to aim for . . . Before meals Ages Levels 0-6: 100-180 6-12: 90-180 13-19: 90-150 Bedtime 0-6: 110-200 6-12: 100-180 13-19: 90-150

  31. HYPOGLYCEMIA

  32. Signs of Mild Hypoglycemia Fast Heartbeat Anxious Irritable Dizzy KDPCP (Kentucky Diabetes Prevention and Control Program) 2011

  33. Signs of Hypoglycemia Sweaty Headache Hungry NumbnessTired KDPCP (Kentucky Diabetes Prevention and Control Program) 2011

  34. Moderate Hypoglycemia Confusion Sleepiness Erratic Behavior KDPCP (Kentucky Diabetes Prevention and Control Program) 2011

  35. Treating a Low Blood Sugar • Test your blood sugar right away if you can. • If you can’t test, treat as if you are low. • Eat or drink one “emergency food”. • Test blood sugar in 15 minutes. If still low, eat or drink 15 grams carbohydrate. KDPCP (Kentucky Diabetes Prevention and Control Program) 2011

  36. Rule of 15 Eat15 grams of carbohydrate Example: 3 – 4 glucose tabs,15 grams glucose gel, ½ cup juice or regular soft drink, 1 Tbsp honey or sugar Wait15 minutes Retest blood sugar If blood sugar is still low, repeat Rule of 15

  37. Emergency Foods KDPCP (Kentucky Diabetes Prevention and Control Program) 2011

  38. Severe Hypoglycemia • Emergency treatment needed • Activate EMS • Administer Glucagon • Turn student on their side • Notify parents/guardian KDPCP (Kentucky Diabetes Prevention and Control Program) 2011

  39. Hyperglycemia KDPCP (Kentucky Diabetes Prevention and Control Program) 2011

  40. Signs of Hyperglycemia Go to the bathroom a lot Dry, Itchy Skin Very Thirsty Tired Blurry vision Very hungry KDPCP (Kentucky Diabetes Prevention and Control Program) 2011

  41. Characteristics ofDiabetic Ketoacidosis (DKA) • Hyperglycemia • Ketones in blood and urine • Dehydration • Electrolyte imbalance KDPCP (Kentucky Diabetes Prevention and Control Program) 2011

  42. Signs of DKA • Symptoms of high blood sugar • Deep, rapid breathing • Acetone Breath • Weakness • Headache • Confusion • Nausea, vomiting & abdominal pain KDPCP (Kentucky Diabetes Prevention and Control Program) 2011

  43. Treatment of DKA • Insulin replacement • Fluid replacement • Correct electrolyte imbalance KDPCP (Kentucky Diabetes Prevention and Control Program) 2011

  44. Management has come a long way……….

  45. Old way of determining blood sugar Early 80’s bed side assessment of blood sugars was based on color change

  46. Meters • Meters were introduced in the mid 80’s • Took two minutes for the test • Now take a speck • Only seconds

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