DIABETES MELLITUSDIABETES MELLITUSType 1Type 1

By Dana Beaver, RNBy Dana Beaver, RN

Diabetes MellitusDiabetes Mellitus

Is one of the oldest conditions Is one of the oldest conditions known to man, having been known to man, having been identified in 1500 B.C.identified in 1500 B.C.

(Selekman, J., 2006)(Selekman, J., 2006)

What is Diabetes?What is Diabetes?

Diabetes is a disease in which the Diabetes is a disease in which the body does not produce or properly body does not produce or properly use insulinuse insulin

Insulin is a hormone that is needed Insulin is a hormone that is needed to convert sugar, starches and other to convert sugar, starches and other food into energy for daily lifefood into energy for daily life

(American Diabetes Association [ADA], 2009)(American Diabetes Association [ADA], 2009)

Diabetes MellitusDiabetes Mellitus

There are a number of different types There are a number of different types of Diabetesof Diabetes

Type 1 and Type 2 are the most Type 1 and Type 2 are the most common type in children and common type in children and adolescentsadolescents

This presentation will focus on Type This presentation will focus on Type 1 Diabetes1 Diabetes(Selekman, J., 2006)(Selekman, J., 2006)

Diabetes Mellitus Type 1Diabetes Mellitus Type 1

Approximately 1 in 400-600 children and Approximately 1 in 400-600 children and adolescents have Type 1 Diabetesadolescents have Type 1 Diabetes

Type 1 Diabetes develops when the body’s Type 1 Diabetes develops when the body’s immune system destroys pancreatic beta cells, immune system destroys pancreatic beta cells, the only cells in the body that make the hormone the only cells in the body that make the hormone insulin that regulates blood glucoseinsulin that regulates blood glucose

To survive, people with Type 1 Diabetes must To survive, people with Type 1 Diabetes must have insulin delivered by injection or by pump have insulin delivered by injection or by pump

(ADA, 2009)(ADA, 2009)

Causes of Diabetes Type ICauses of Diabetes Type I

The body produces insufficient insulin, or The body produces insufficient insulin, or the insulin is ineffectivethe insulin is ineffective

Causes include: predetermined genetic Causes include: predetermined genetic susceptibility, and environmental factorssusceptibility, and environmental factors

Other causes are particular viruses Other causes are particular viruses and toxinsand toxins

(Lewis, K., and Bear, B., 2009)(Lewis, K., and Bear, B., 2009)

Management of a Student with Management of a Student with Diabetes Type 1Diabetes Type 1

Management of a child with diabetes is a vital Management of a child with diabetes is a vital part of a student’s academic experiencepart of a student’s academic experience

The school nurse will develop the Individualized The school nurse will develop the Individualized Healthcare Plan (IHP) and the Emergency Care Healthcare Plan (IHP) and the Emergency Care Plan (ECP), in accordance with the medical planPlan (ECP), in accordance with the medical plan

These plans will be available to treat the These plans will be available to treat the student’s diabetic needs while at schoolstudent’s diabetic needs while at school

Some students will require an Individualized Some students will require an Individualized Educational Plan (IEP) or a 504 PlanEducational Plan (IEP) or a 504 Plan

(Silkworth, C., Arnold, M., Harringan, J., & Zaiger, D., 2005) (Silkworth, C., Arnold, M., Harringan, J., & Zaiger, D., 2005)

Medical Treatment of Diabetes Medical Treatment of Diabetes Type 1Type 1

Individuals with Diabetes Type 1 require Individuals with Diabetes Type 1 require insulin injections to sustain life insulin injections to sustain life

The student will need to check their blood The student will need to check their blood glucose level during the day, using a blood glucose level during the day, using a blood glucose monitoring deviceglucose monitoring device

Supplies will be kept in health officeSupplies will be kept in health office(insulin, syringes, test strips, insulin pump (insulin, syringes, test strips, insulin pump equipment)equipment)

(Lewis, K., and Bear, B., 2009)(Lewis, K., and Bear, B., 2009)

Blood glucose monitoringBlood glucose monitoring

Medical Treatment Medical Treatment (continued)(continued)

A student with Type 1 Diabetes will need A student with Type 1 Diabetes will need to give self injections of insulin, after to give self injections of insulin, after testing their blood glucose level in the testing their blood glucose level in the health office ,several times during the day health office ,several times during the day (according to their medical plan)(according to their medical plan)

(Lewis, K., and Bear, B., 2009)(Lewis, K., and Bear, B., 2009)

Medical Treatment Medical Treatment (continued)(continued)

A student with Type I Diabetes may wear an A student with Type I Diabetes may wear an insulin pumpinsulin pump

A student will still require to test their blood A student will still require to test their blood glucose during the school dayglucose during the school day

They will need to make adjustments on their They will need to make adjustments on their insulin pumpinsulin pump

(Lewis, K., and Bear, B., 2009)(Lewis, K., and Bear, B., 2009)

INSULIN PUMP

Reactions while in schoolReactions while in school

Two reactions a student may have Two reactions a student may have while in school related to using while in school related to using insulininsulin

HYPERGLYCEMIA- blood glucose too highHYPERGLYCEMIA- blood glucose too highHYPOGLYCEMIA- blood glucose too lowHYPOGLYCEMIA- blood glucose too low

(Lewis, K., and Bear, B., 2009)(Lewis, K., and Bear, B., 2009)

HYPERGLCEMIAHYPERGLCEMIABlood glucose too highBlood glucose too high

Hyperglycemia is when a blood glucose Hyperglycemia is when a blood glucose level is greater than 240 mg/dllevel is greater than 240 mg/dl

Onset of hyperglycemia is slowOnset of hyperglycemia is slow Causes of hyperglycemia: Causes of hyperglycemia:

missed insulin dosesmissed insulin doseseating more food than plannedeating more food than plannedillness illness certain medicationscertain medications

(Selekman, J., 2006)(Selekman, J., 2006)

Signs or student complaintsSigns or student complaintsthat may indicatethat may indicatehigh blood glucose high blood glucose (HYPERGLYCEMIA)(HYPERGLYCEMIA)

Increased thirst and urinationIncreased thirst and urination Flushed skinFlushed skin Nausea, vomitingNausea, vomiting Weakness and drowsinessWeakness and drowsiness Fruity breathFruity breath If untreated, can cause unconsciousnessIf untreated, can cause unconsciousness

(Lewis, K., and Bear, B., 2009)(Lewis, K., and Bear, B., 2009)

Serious condition related to Serious condition related to HYPERGLYCEMIAHYPERGLYCEMIA

Diabetic Ketoacidosis (DKA) is a Diabetic Ketoacidosis (DKA) is a serious and complicated condition, serious and complicated condition, when there is too much glucose in the when there is too much glucose in the bloodstream and cannot be properly bloodstream and cannot be properly utilized by the body. It occurs from utilized by the body. It occurs from profound insulin deficiencyprofound insulin deficiency

If DKA is untreated it can progress to If DKA is untreated it can progress to coma coma (Silkworth et al., 2005) (Silkworth et al., 2005)

DIABETIC EMERGENCYDIABETIC EMERGENCY

ALL students who take insulin are at risk ALL students who take insulin are at risk for low blood sugar (HYPOGLYCEMIA)for low blood sugar (HYPOGLYCEMIA)

Children with Diabetes are taught by their Children with Diabetes are taught by their diabetes educator and doctors if they diabetes educator and doctors if they experience symptoms of hypoglycemia, to experience symptoms of hypoglycemia, to treat with/without a blood glucose treat with/without a blood glucose measurementmeasurement

(Silkworth et al., 2005) (Silkworth et al., 2005)

HYPOGLYCEMIAHYPOGLYCEMIABlood glucose too lowBlood glucose too low

Hypoglycemia is defined as a blood Hypoglycemia is defined as a blood glucose level that is less than 70 mg/dlglucose level that is less than 70 mg/dl

Hypoglycemia can have a rapid onsetHypoglycemia can have a rapid onset Hypoglycemia is a medical emergencyHypoglycemia is a medical emergency Causes of hypoglycemia:Causes of hypoglycemia:

too much insulintoo much insulinmeals and snacks delayed or missedmeals and snacks delayed or missedextra exercise or activityextra exercise or activity

(Lewis, K., and Bear, B., 2009)(Lewis, K., and Bear, B., 2009)

Signs or student complaintsSigns or student complaintsthat may indicatethat may indicatelow blood glucose low blood glucose (HYPOGLYCEMIA)(HYPOGLYCEMIA)

Mild SignsMild Signshungerhungerirritabilityirritabilityshakiness shakiness weakness, anxietyweakness, anxietyinability to inability to

concentrateconcentratenot feeling wellnot feeling well““feel funny” feel funny” (Lewis, K., and Bear, B., 2009)(Lewis, K., and Bear, B., 2009)

Moderate to Moderate to severesevere confusionconfusionslurred speechslurred speechslow thinkingslow thinkingsleepinesssleepinesserratic behaviorerratic behaviorunconsciousnessunconsciousnessseizuresseizures

Diabetic EmergencyDiabetic Emergency

DIABETIC STUDENTS WITH SIGNS OR DIABETIC STUDENTS WITH SIGNS OR COMPLAINTS OF HYPOGLYCEMIA NEED TO GO COMPLAINTS OF HYPOGLYCEMIA NEED TO GO IMMEDIATELY TO NURSE ACCOMPANIED WITH A IMMEDIATELY TO NURSE ACCOMPANIED WITH A BUDDY OR STAFF MEMBERBUDDY OR STAFF MEMBER

Symptoms can worsen quickly!Symptoms can worsen quickly! NEVER leave a student unattended in case their NEVER leave a student unattended in case their

blood glucose level goes too low and they lose blood glucose level goes too low and they lose consciousnessconsciousness

Treatment will be followed according to medical Treatment will be followed according to medical plan, IHP and ECPplan, IHP and ECP(Silkworth et al., 2005) (Silkworth et al., 2005)

Sample Treatment of Sample Treatment of HYPOGLYCEMIAHYPOGLYCEMIA

Give student fast acting carbohydrates Give student fast acting carbohydrates (fruit juice, glucose tabs, regular soda pop) (fruit juice, glucose tabs, regular soda pop) if awake and alertif awake and alert

If unconscious, Glucagon intramuscular If unconscious, Glucagon intramuscular would be givenwould be given

If uncertain whether a student is If uncertain whether a student is hyperglycemic or hypoglycemic, always hyperglycemic or hypoglycemic, always treat for hypoglycemictreat for hypoglycemic(Silkworth et al., 2005) (Silkworth et al., 2005)

Possible Effects on Individual Possible Effects on Individual StudentStudent

Poor self-image as a result of being “different”Poor self-image as a result of being “different” Altered mood and mental alertnessAltered mood and mental alertness Risk for depression, doublesRisk for depression, doubles Parental relationships may be strained from Parental relationships may be strained from

having parent who does too much or too littlehaving parent who does too much or too little May feel insulin injections are form of punishmentMay feel insulin injections are form of punishment Unable to participate in certain sports, which may Unable to participate in certain sports, which may

be due primarily to parental concernsbe due primarily to parental concerns May not be able to eat “all foods” at a class partyMay not be able to eat “all foods” at a class party

(Lewis, K., and Bear, B., 2009)(Lewis, K., and Bear, B., 2009)

Long Term Long Term Type 1 Diabetes ComplicationsType 1 Diabetes Complications

Heart disease- Heart disease- Diabetes carries an increased risk for heart attack, Diabetes carries an increased risk for heart attack, stroke, and complications related to poor circulationstroke, and complications related to poor circulation

Kidney disease- Kidney disease- Diabetes can damage the kidneys which can Diabetes can damage the kidneys which can cause them to failcause them to fail

Eye complication- Eye complication- Diabetes can cause eye problems and may lead Diabetes can cause eye problems and may lead to blindnessto blindness

Nerve damage- Nerve damage- Diabetes can cause neuropathy (nerve damage), Diabetes can cause neuropathy (nerve damage), which is one of the most common complications which is one of the most common complications

Foot complications-Foot complications- can happen when there is nerve damage or can happen when there is nerve damage or poor circulation to the feetpoor circulation to the feet

Skin complications-Skin complications- As many as one-third of people with Diabetes As many as one-third of people with Diabetes will have a skin disorderwill have a skin disorder

Depression- Depression- Diabetes increases a persons risk for depressionDiabetes increases a persons risk for depression

(ADA, 2009)(ADA, 2009)

The Teacher’s Role in Diabetic The Teacher’s Role in Diabetic ManagementManagement

Be Helpful-Be Helpful-Assist students as needed. Follow IEP or 504 plan Assist students as needed. Follow IEP or 504 plan

accordingly accordingly

Be Observant-Be Observant-Notice when students are showing signs that Notice when students are showing signs that

something isn’t rightsomething isn’t right

Be Supportive-Be Supportive-If a student is having difficulty, approach and If a student is having difficulty, approach and

support in a support in a reassuring manner and…….reassuring manner and…….

Be Calm-Be Calm-Call or send for the school nurse Call or send for the school nurse

ReferencesReferences

American Diabetes Association. (2009). Retrieved April 5, 2009, American Diabetes Association. (2009). Retrieved April 5, 2009, from http://www.diabetes.org/from http://www.diabetes.org/

Lewis, K., & Bear, B. (2009). Manual of school health: a handbook for school nurses, educators, and health professionals. California: Saunders.

.Selekman, J. (2006). School nursing: a comprehensive text. F.A.

Philadelphia: Davis Company.

Silkworth, C., Arnold, M., Harringan, J., & Zaiger, D. (2005). Silkworth, C., Arnold, M., Harringan, J., & Zaiger, D. (2005). Individualized healthcare plans for the school nurse: concepts, Individualized healthcare plans for the school nurse: concepts, framework, issues, and applications for school nursing practice. framework, issues, and applications for school nursing practice. Minnesota: Sunrise River Press.Minnesota: Sunrise River Press.