TEACHERS & SCHOOLS GUIDE TO KIDS DIABETES

PROVIDED FREE FROM

http://www.kidsdiabetes.co.uk

The information contained here will provides the school teacher and administrator with a better understanding of a diabetic child’s needs.

The guide will give you basic understanding of what diabetes is and how it should be dealt with by a teacher or school as well as providing more insight into what a diabetic child has to cope with.

Each school will have its own policy’s on how to handle diabetic children. This guide will help you to make the necessary decisions in order to achieve the best support for a diabetic child. It includes some details about what is expected of a school and what its responsibilities are and some sensible suggestions on how to ensure a diabetic child enjoys a normal school life.

Diabetes is a life long disease. If managed correctly a diabetic child will lead a healthy life with little or few complications.

With the advent of modern technology and better education we can make a difference to improve the quality of life of a diabetic child.

Thank you for taking the time to read this document. This website is funded and run by a teenager with 14 years of experience of diabetes and aims to raise awareness of this escalating condition and educate people, schools and employers that diabetes can be lived with and controlled.

If you require further assistance, other documents are available free to download from the website on the schools page and include such useful information as what to do in an emergency, food values , taking a diabetic child on a school trip , school holidays , recipes and a list of very useful contact details for other diabetes organisations in the UK amongst other info.

Best Regards Emma Bonds

WHAT IS DIABETES?

Diabetes Mellitus is a common disorder that affects 2-3 people in every 100 of the population.  There are two types of diabetes:

·        Type 1 diabetes ( requires insulin injections termed as “insulin dependant” )

·        Type 2 diabetes ( can be controlled with tablets and or diet )

WHAT HAPPENS IN DIABETES?

·        Normally, a chemical (or hormone) called Insulin controls the levels of sugar (Glucose) in the blood. 

·        Glucose comes in fast and slow-acting forms from the food we eat

·        Fast acting or ‘Sugary’ foods include sweets, cakes and non-diet drinks.

·        Slow acting or ‘Starchy’ (carbohydrate) foods include bread, pasta or potatoes.  These are digested by the body and converted into glucose.

·        Insulin is produced in the Pancreas, a gland that lies behind the stomach.  Insulin allows glucose to move into muscles and the liver where it can be used to provide energy. 

·        Normally the body can produce enough insulin to keep the amount of glucose in the blood under control.

·        Diabetes develops when there is a lack of (or no) insulin (Type 1) or when the body does not respond properly to the insulin that is produced (Type 2).  This causes blood glucose levels to become too high

·        Once the amount of glucose in the blood reaches a certain level, it then spills over into the urine. 

The Tricky bit

The idea then, is to manage food intake with insulin injections and achieve a good balance. In a non diabetic person their sugar level goes up and down as food comes in and subsequently gets used, the difference is that they produce their own insulin to cope with all the food accordingly. This means that blood sugar levels stay at a fairly constant average all the time. A normal blood sugar level is between 4.5 to 6.0 as a reading on blood sugar level meters. ( no need to explain what this reading is or how it gets that just yet )

This reading will stay constant at these sort of levels at all times, before, during and after meals , drinks, alcohol, exercise, the lot.

 If we could show a pattern of the sugar level of a normal healthy person it would look like this graph below over the course of a day.

Normal person with normal sugar levels

6.0

4.0

morning                                                midday                                                 bedtime

If we could look at the graph of the sugar level of a diabetic child with poor control it would look like the graph below

Insulin dependant person with poor sugar level control

   30.0

   24.0

   18.0

   12.0

   6.0

   2.0

morning                                                midday                                                             bedtime                       

So you can see know that diabetes is a roller coaster of a ride for blood sugar levels. This is the problem. To maintain good health we must avoid these large peaks of high blood sugar levels and low blood sugar levels. We have to manage the amount of food we eat and make an educated guess about the sugar and carbohydrate content of each piece of food and figure out how long the sugar in the food we have just eaten is going to last us.

So, once we eat some food its sugar content is extracted into the diabetic child’s blood stream. This is the energy of the body, muscles and the brain. The insulin allows and helps the sugar in the blood to be absorbed into the body keeping up the body’s fuel supply. That’s why when blood sugar levels are very high we know that not enough sugar has got into the body out of the blood, its still there, captured in the blood. The results of having large amounts of sugar in your blood are not good for several reasons.

When blood sugar levels are running very low it means that all the sugar in the blood has been used and needs to be replaced, this would mean that too much insulin has been injected or not enough food eaten.

This is where the tricky bit comes in trying to predict how much insulin to inject and at what times. Insulin injections and doses are planned and based upon just how much food a child is going to eat through the day. Physical exercise also has a large baring on how much food intake is required V’s how much insulin is needed.

So to avoid the pattern of the graph going way too high & way too low we can spread out the intake of food through the day. Instead of having breakfast , lunch & dinner we can take in additional food , fuel, in between meals. These are generally referred to as snacks in diabetes terms. These snacks are very important as they keep the intake of fuel and blood sugar from dropping too low through the day and sets up the blood sugar level roughly right for the next meal and next insulin injection.

Insulin comes in different types. Slow acting , fast acting and a mix of both together.

The slow acting insulin has a longer working time , it may last 10 – 12 hours and takes anything upto an hour to start working after you inject  it.

Fast acting insulin does just that and will start working within 30 minutes but generally has a shorter working time , maybe upto 6 hours.

There are several insulin manufacturers and several different types but that is the basic working principal. The longer lasting insulin looks generally cloudy and the fast acting insulin looks clear. Insulin is kept in a refrigerator while in storage but is fine kept at room temperature while it is being used over the course of 3 – 4 weeks.

Why Injections?

Insulin is not able to be taken in tablet form yet. The chemicals and process’s of the stomach destroy the insulin before it can work. Scientist’s are working on other applications such as nasal sprays and inhalers amongst other things to make the application of insulin more bearable. And there are now machines that can measure blood sugar levels without taking blood but they are not accurate or small enough for everyday use. We live in hope.

WHAT ARE THE SYMPTOMS OF DIABETES?

The symptoms of diabetes can vary in severity and may develop quickly or over a longer period of time.  The main ones are:

·        Thirst and a dry mouth

·        Passing a large amount of urine , constant visits to the toilet

·        Weight loss

·        Tiredness

·        Thrush

·        Blurring of vision

·        Mood swings or changes

·        Irritability as sugar levels get very low or very high

Most of the symptoms improve quickly after treatment to lower the blood glucose has been started. 

Blurring of vision may take several weeks or months to clear completely. Blurred vision usually only happens as a result of poorly managed blood sugar levels over a long period of time, usually from having excessively high sugar level readings.

In some rare cases, people can suffer eye and other complications with diabetes even though their sugar levels are well controlled.

Learning hindrance

When a diabetic experiences a very low blood sugar condition, this is called being hypoglycemic or having a “HYPO” for short. This situation can be very dangerous and must be dealt with immediately. More on this later……

Regular low levels of blood sugar can & will affect learning capabilities and concentration as well as mood swings, dizziness or light headedness. Younger diabetic children will find it difficult to explain this feeling and for newly diagnosed diabetics the event of a HYPO can be extraordinarily terrifying and may lead to a child convulsing , fitting , vomiting or possibly a seizure if not treated quickly……..more on this later.

Healing Hindrance

High blood sugar levels will slow down the healing process. So for children in schools that experience every day cuts and bruises as part of school playground life such as grazed knees etc may take longer to heal if sugar levels are not managed well

SOME USEFUL INFORMATION FOR TEACHERS AND SCHOOLS

Special ‘diabetic’ foods

·        These are not generally advised.  Often they are expensive and may cause diarrhea due to the type of sweeteners and flavorings used in these products.

Some “treats” are acceptable from time to time since we can’t emphasize enough that diabetic children are “kids” first and diabetics second, although we do not advocate the use of reduced sugar or low sugar foods as part of a healthy diet in the same way that your morning cream cake is not part of a balanced healthy diet. Any foods given to diabetic children other than packed lunches or school dinners should be double checked with the child’s parents first.

Identification cards are available from diabetes centre’s. not all children will have these but parents are encouraged to use these as identification to other organisations. They are not a legal requirement but may serve other identification purposes in some schools.

Equipment

·        Blood glucose meters and finger-pricking devices are available from the Diabetes Clinic and you will find that most children will have at least one blood testing meter with them. It is advisable to have a spare meter at school for each particular child in case of failures or damages. This is not always possible but is good practice it can be done

·         

·         The following items are available on prescription in the UK and diabetic children will be familiar with all these items.

§         Blood monitoring lancets and strips

§         insulin pen devices

§         Pen needles

§         Safe-clip ( for removing the sharp end of syringes or needles )

§         Urine testing strips

§         Possibly syringes and glass vials (these are almost entirely phased out )

Blood sugar meters are sensitive pieces of equipment and are susceptible to go wrong in very hot and very cold temperatures. They are battery operated with long life batteries. These meters use a special “stick” which is inserted into the meter and becomes the blood collection device or blood pick up point. The meter then analyses the amount of blood on the end of the stick and produces a blood sugar level reading.

Climate & Temperature problems for meters

They can give false readings at extreme temperatures, which can lead to problematic events. This should be taken into account on school trips and journeys out of class. Provision should be made to ensure that meters can be kept within their operational working temperatures as far as possible.

Hot Days

In general they must be kept out of direct sunlight and in the shade on a hot day. For very hot climates a cooler bag or vacuum bag is advisable. Small icepacks inserted into an insulated pocket in a cooler bag provide protection on the hottest days.

Cold Days

On the coldest days out of school, meters should be kept wrapped in warm clothing. A child’s coat pocket may not offer enough warmth to avoid  slowing the meter down to a non-working temperature. Likewise a female teachers handbag may not also offer enough protection. Once again it is the responsibility of the child’s parent to ensure that they provide protection for these such situations but the school should make the parents aware that the child may be in this type of environment for longer periods of time as & when necessary

Meters, like mobile phones come in all different shapes and sizes. In general you cannot use one child’s blood glucose meter to measure another diabetic child’s sugar level. This is important , and here is why……….

There are many different types of blood sugar level meters on the market. They all work on the same basic principal. Some give results in 5 seconds others take 60 seconds. They all produce a wide variation of readings from the same blood sample. So if a child’s diet and insulin dose is based on using a particular type of meter then they will have become used to eating, drinking, exercising and injecting according to the sugar level readings from that one type of meter.

This regime will not necessarily work for another child. You must not make this assumption as it could lead to unwanted sugar level readings.

Older blood sugar level meters required more quantity of blood than newer sugar level meters and also generally take longer to produce a result. Newer sugar level meters also tend to be smaller in size and are ideal for students to carry on their person.

Very young children will need supervision to carry out a blood test after initial diagnoses of diabetes but will surprisingly be very capable, very soon, to manage their own blood test. It is important that diabetic students are allowed to carry a blood sugar level meter with them as there are & will be times when a student will need to do unexpected blood sugar test’s. Here’s why………..

Unexpected Blood test’s

Diabetes is a disease where the basic principals and understandings apply to each person but individual people are affected in different ways by different foodstuffs.

 What do we mean?……………

As well as being diabetic it is naturally essential that children , of all ages, have a healthy and well balanced diet. Fruit plays a big part in a diabetics diet since it contains natural sugars ( fructose ) and a healthy amount of fibre. An example of the use of fruit is to provide an amount of carbohydrate, longer lasting food and bananas can be good for this. However the effect of a banana on one child’s sugar levels can &  will differ from another diabetic child.

Its important that you liaise with the parent or carer of the diabetic child if you are supervising food or food intake. What my be fine for one child may not be for another. A food substance that you think will be long lasting may not last as long as you think. An experienced parent of a diabetic child will be able to tell you about particular foods reactions.

In addition to this other things will affect how often a child needs to do a blood test. Common colds, and other child hood afflictions have an affect on sugar levels. A common cold may make one diabetic child have unusually higher sugar levels while it may make another have unusually lower sugar levels. The treatment for both cases being very different.

Stress and worrying also affect sugar levels. Although a child may appear outwardly confident the stress and worry of everyday school, let alone dealing and handling diabetes will from time to time affect sugar levels

The lesson here is please allow your student to carry a blood sugar level testing meter with them rather than keep in a central office or at school reception. Please bare in  mind that modern meters can give very accurate results in as little as 5 seconds. If a child feels that they are about to go into a hypo and it takes 5 minutes to get to a central office and do a test , this may be too late.

Blood Samples

Blood is extracted from fingers using a finger-pricking device. These are usually in the shape and form of a large pen. They are spring operated and are primed by either pulling back a lever, turning a dial or moving a slider.

Again, they all work on the same principal. They all use a very sharp disposable lancet, which is replaced after each blood test is done.

They usually have a depth setting as well. This allows the user to gauge how deep into the skin a lancet is pierced. The idea is that younger children have softer skin and a less deep penetration of the skin is less painful and heals slightly quicker.  Also - See important notes…………..

 Blood Testing - Important Note:

Please ensure that children do not share or cross-use finger-pricking devices if you have more than one diabetic child at your school. It is common for lancets that pierce the skin only to be changed once a day or less. This is not the best practice but is what actually happens.

If you invite or authorize one child to use another child’s finger pricking pen then there is a chance of the passing of other unknown infections between children via the blood droplets on the end of the lancet tips. Please try to avoid this, as it will also make most parents of diabetic children very annoyed as they may have planned the number of blood testing strips that their child has in the blood testing kit. Like one battery from a mobile phone may not fit another, so too will the lancet tips in finger pricking devices not necessarily fit a different type of finger pricking device.

It is the responsibility of parents or carer’s of the child  to ensure that diabetic children have adequate blood testing strips and that their meters are functioning correctly. It is not the responsibility of the school. Your responsibility is to ensure that the diabetic child is not restricted from managing its own diabetes properly as & when required. You also need to know basic information on how to deal with “hypo conditions”.

Blood sugar levels

“Hypo” ( hypoglycemic ) Low Blood Sugar – ( run out of petrol )

This is the condition where the diabetic child is basically out of fuel. The reserved sugar that was in the blood stream has been depleted and needs topping up. Most diabetic kids will have an emergency pack with them that many schools allow them to keep with them in a school bag. Often this small pack will contain some glucose ( dextrose ) tablets, small chocy bar and maybe 2-3 plain biscuits. This is often enough to just top up a sugar level to stop it falling too low to get bay upto the next regular meal.

We discussed earlier the highs and lows on the simple graph, you may remember that we need to avoid sugar levels going too high or too low. From the pattern of the graph, you can see that sugar levels go up after meals and fall down again leading up to the next meal time.

You can see that if no food is taken that sugar levels would continue to drop and drop. Once low enough this is when the “hypo” condition happens. Diabetics hypo at different readings. One child may have a reading of 1.0 on their meter and be coherent and plausible and healthy enough to deal with the situation. Find sugary food and carry on with no problem.

Another child may “hypo” at a reading of 4.0 and be convulsing and fitting on the floor and be in no fit state to see to their own medication or sugar intake requirements.

The point we are trying to make here is that you must not make assumptions that you know and understand each individual diabetics dietary and food needs. You must liaise with the child’s parents if you are involved in making dietary decisions for the child.

Other things that affect when a child hypo’s are the amount of physical exercise that a child gets. This will affect the rate at which a childs sugar level drops or falls. To indicate this effect lets look at two more graphs.

The first graph, as before shows an exaggerated view of poor diabetes control and the pattern would be as below.

Insulin dependant person with poor sugar level control

   30.0

   24.0

   18.0

   12.0

   6.0

   2.0

morning                                                midday                                                             bedtime

This next graph shows what happens if a child takes physical exercise before midday. See how much more quickly the sugar level drops. It drops in a shorter time and so if this child were planning to eat at lunch time the may not have made it. They would have needed to eat sooner than the next planned meal.

   30.0

   18.0

   12.0

   6.0

   2.0

morning                                                midday                                                             bedtime

So in this situation the child had an unexpected hypo because of an unexpected period of physical exercise.

The child’s sugar levels came down very quickly because they were  simply playing or involved in a Gym Class. The result is as before, the blood sugar level is yo yo-ing up and down and not under control. If this condition is maintained it will lead to further health complications.

We would also expect mood swings as well and the child would generally feel pretty lousy and probably grumpy with it.

If on the other hand the child had taken evasive action to avoid this before the exercise they would have not gone into a hypo condition and their sugar level would be more balanced. The action of simply eating some carbohydrate before the exercise would combat this large , quick fall in sugar levels, something as simple as a  biscuit / cookie would make all the difference in this situation.

Once again we must not make the assumption that a simple biscuit will work for all diabetics. The basic principal can be applied but each person may need very different amounts of food to eat in each case.

This situation has been highlighted since it is very common in schools to see this situation occur at particular times. The most noticeable is when insulin levels have been reduced through periods of wet weather. This may seem obvious but is often missed. If a period of wet weather suddenly dries up & the sun shines, what do school children do at break times. They go play outside and run around doing kids stuff. This is one of the most obvious cases of this type of situation arising.

You can use the understanding and principals here and apply them to any form of physical exercise that may be unexpected. Older children will be able to manage this. Younger diabetics will need help in this area.

Smoking

It should go without saying, however, for older students smoking is even more of a problem than normal since smoking significantly increases the risk of developing problems associated with diabetes.