Diabetes Training for

School Employees
Albemarle County Public
Schools

Purpose of this Presentation

The purpose of this presentation is to
provide information for use in the
training of school personnel in the
management of diabetes including
the administration of insulin and
glucagon as required by the Code of
Virginia.

Diabetes in Schools:
Legislation
Virginia Senate Bill 889

requires public schools with at

least one student diagnosed with
diabetes to ensure that at least
two employees have been trained
in the administration of insulin
and glucagon.
http://leg1.state.va.us/cgi-bin/l
egp504.exe?000+cod+22.1-274

Section 504 of the

Rehabilitation Act of 1973

Requires all public schools to

afford children with disabilities
(including diabetes) an equal
opportunity to participate in all
academic as well as nonacademic
and extracurricular services and
activities regardless of disability.

Diabetes Medical Management

Plan
A medical management plan must be
provided for each student with diabetes
(Individualized Health Care Plan IHCP)
completed by the students medical
management team and signed by both
the health care provider and the
students parent.

Components of the Plan

Contact Information parent and provider

Blood glucose monitoring: when, where,
and how independent the student is
Insulin: when, type, amount, how (pen,
syringe, pump), by whom (student, nurse)
Diet: Meals and snacks: time, amount
Treatment/management of low blood
sugar.
Treatment/management of high blood
sugar.

BASICS of DIABETES MANAGMENT

Blood glucose testing
Insulin administration
Diet carb counting
Exercise
Recognizing and treating high
blood sugar and low blood sugar
Emergency treatment of severe
low blood sugar

Blood Glucose
Monitoring

Different kinds of meters

Must be calibrated to match test
strips

Examples of Glucometers

Freestyle
Ascenia

One Touch

When to Check Blood Glucose

Students may check their blood
glucose:
Before eating snacks or meals

Before physical activity

When they have symptoms of low or

high blood glucose

Other times per plan

Blood Glucose Monitoring Skills

Wash & dry hands.

Insert test strip in glucose meter
Select appropriate site on the fingertip
(top or sides).
Puncture fingertip accurately and
obtain optimal amount of blood to
perform accurate measurement.
Place drop of blood on test strip.
Obtain accurate reading.
Record blood glucose results.

INSULIN
All people with Type 1 Diabetes manage
their diabetes with insulin.
Old method: Long-acting (basal) insulin and
2 doses of intermediate acting insulin.
New method: Long acting (Lantus, Levemir,
Ultralente) and 3 shorter acting doses
(Humalog/Novalog) at mealtimes based
on amount of carbohydrates in meal.

Carbohydrate Counting

Used in conjunction with a combination of long

acting (eg. Lantus) once a day with short acting
(Humalog or Novalog) with each meal.
Easier to learn than Exchanges or the Point System.
Food and insulin match better.
Increased variety of food choices.
More flexibility in meal/snack times.
Better blood sugar control.
Carbohydrate information on food labels makes meal
planning easier.
Focus is on carbohydrates, but protein and fat are
still important.
Count total carbohydrates.

Food Label
Nutrition Facts
Serving Size: 1 cup (253 g) Servings per container: 2
Amount per serving
260 calories

% Daily Values

Total fat 8 g
Sat. fat 3 g

13%
17%

Cholesterol 130 mg
Sodium 1010mg

44%
42%

Total Carbohydrate 22 g
Dietary Fiber 9 g

7%
36 %

Sugars 4 g
Protein 25 g

Tools for Carbohydrate Counting

Albemarle County Child Nutrition

Services:
http://schoolcenter.k12albemarle.org/educ
ation/sctemp/a93ebbb902ffa8b10a8102e55bd8
4ddf/1194888543/carb_cts_.xls
USDA:
http://www.nal.usda.gov/fnic/foodcomp/search
/
Fast food:
http://www.bddiabetes.com/resource.aspx?IDX=4253

Types of Insulin, Dosages & Times

Sample Plan
Pre-Breakfast Pre-Lunch
Pre-Dinner
Insulin
Humalog

Humalog

Humalog

Lantus: 10 units
before
breakfast
Daily

Carb Ratio:
_1__ units for
every15_ grams
carbs eaten

Carb Ratio:
_1__ units for
every 15 grams
carbs eaten

Carb Ratio: 1
units for every
15 grams carbs
eaten

Adjust for
blood
glucose
reading

Correction
Factor:

Correction
Factor:

Correction
Factor:

Add 1 unit for

every 50 mg/dl
above 150
Subtract: 1 units
for every 20 mg/dl
below 100 mg/dl

Add 1 unit for

every 50 mg/dl
above 150
Subtract: 1 units
for every 20 mg/dl
below 100 mg/dl

Add 1 unit for

every 50 mg/dl
above 150
Subtract: 1 units
for every 20 mg/dl
below 100 mg/dl

If dose is half
unit, round up.
For Carb count

If dose is half
unit, round up.
For Carb count

If dose is half
unit, round up.
For Carb count

Calculating Insulin Dose:

Pens and Pumps

Determine amount based on plan:

Step 1: Calculate number of carbs in
meal then determine the prescribed
ratio (eg. 1 unit for each 15 grams
carbs).
Step 2: Correction factor for blood
glucose reading (add insulin for higher
blood sugar reading and subtract for
lower reading).

Example from Sample Plan

Students lunch contains 60 grams of
carbs and his blood sugar reading is
160mg/dl.
Step 1: 1 unit for each 15 grams = 4
units
Step 2: Correction factor: add 1 unit for
blood sugar reading of 160mg.
Insulin dose = 5units

More Examples from Sample Plan

Calculating Insulin Dose
Grams of
carbs
80 g (5.3 units
round down)

Blood
Sugar
80 mg/dl
(minus 1
unit)
75 g (5 units) 360 (plus 5
units)
65 g (4 units
90 (no
round down)
correction)
100 g (6 units 175 (plus 1
round down)
unit)

Amount of
Insulin (Dose)
4 units

10 units
4 units
7 units

Insulin Chart

Types of Insulin Injections

Types of Insulin Injections:
1.

Vials and syringes

2.

Insulin pens

3.

Insulin pumps

Insulin Vials and Syringes

Insulin Vial and Syringes

Insulin Pens

Insulin Pumps

For All Types of Insulin Skills

Determine appropriate storage &

security of insulin, syringes, & medical
supplies.
State where plan is located.
State 5 rights of medication
administration: student, medication,
dose, time and route.
Determine insulin dose per plan.
Document amount of insulin and time of
administration.

Insulin Types

Preparing for Insulin Injection: Steps

1 through 4

Step 1: Remove cap

Step 2: Wipe the top

with alcohol swab

Step 3: Draw air into

the syringe equal to the
dose

Step 4: Put the needle

through the rubber top
of the vial and push the
plunger to inject air into
the vial

Preparing for Insulin Injection:

Steps 5 through 7
Step 5: Draw up dose Leave
syringe in the vial and turn both
upside down. Hold the syringe and
fial firmly in one hand. Make sure
the tip of theneedle is in the insulin

Step 6: Check for bubbles

Before you take the needle out of

the vial, check the syringe for
bubbles

Step 7:

Tap to release If
bubbles are in the medicine, hold
the syringe straight up and tap the
side of the syringe until the bubbles
float to the top. Push the bubbles
out with the plunger and draw the
insulin back in until you have the
correct dose.

Injection Instructions

Gather together the insulin-loaded

syringe or pen, an alcohol swab and
a dry cotton swab or tissue.
Select the injection site (illustration).
Swab the site with an alcohol swab.
Gently pinch up the skin and fat with
the thumb and forefinger.
Hold the syringe like a pencil, close
to the needle for better control.
Push the needle in quickly and all the
way, at a 90-degree angle to the
pinched-up skin.
Push the plunger in to inject the
insulin.
Slowly let go of the pinched-up skin
and then remove the needle.
Using a dry swab, apply gentle
pressure to the injection site to
prevent bruising.
Discard the needle and syringe in the
sharps container.To avoid possible
injury, never leave used needles
lying around.

Insulin Pen Injection Skills

Determine amount of insulin to be

administered based on plan.
Prepare pen by applying needle appropriately.
Prime the pen with 2 units dial 2 and push
plunger to dispense the two into trashcan.
Dial the correct dose to be administered.
Demonstrate accurate injection technique.
Dispose of used needle correctly.
Document amount of insulin and time
administered.

Insulin Vials and Syringes Skills

Assemble supplies: vials, syringes,

alcohol pads.
Accurately measure insulin dose with
syringe.
Locate appropriate sites for injection.
Demonstrate accurate injection
technique.
Dispose of syringes in sharps container.
Record amount of insulin and time
administered.

Insulin Pumps

Pumps vary by manufacturer.

Calculate amount of bolus at meal
time per plan.
Enter the amount on pump per
instructions.
Record the amount of bolus.

Hyperglycemia (High Blood Sugar)

Causes of Hyperglycemia:
- Too much food
- Too little insulin
- Decreased activity
- Illness
- Infection
- Stress

Symptoms of Hyperglycemia
Mild

Thirst
Fatigue/sleepiness
Increased hunger
Blurred vision
Weight loss
Stomach pains
Flushing of skin
Lack of concentration
Sweet fruity breath

Moderate

Any of the mild symptoms

Dry mouth
Nausea
Stomach cramps
Vomiting

Severe

Any of the mild or

moderate symptoms plus:
Labored breathing
Very weak
Confused
Unconscious

Symptoms of Hyperglycemia
Symptoms of
Hyperglycemia

Mild
Thirst
Frequent urination
Fatigue
Increased hunger
Blurred vision
Stomach pains
Flushing skin
Inability to concentrate
Sweet, fruity breath

Moderate
Mild symptoms plus
Dry mouth
Nausea
Stomach cramps
Vomiting

Severe
Mild and moderate symptoms plus
Labored breathing
Very weak
Confused
Unconscious

Treatment for Hyperglycemia: High

Blood Sugar

Allow free use of the bathroom.

Encourage student to drink water.
Check urine for ketones per plan.
Follow instructions in plan.
Students who test positive for ketones should
not participate in p.e. or sports until ketones
are no longer present.
Call parent for high blood sugar per plan.
Some students plan will state that the
student needs to go home for blood sugar
above a certain number (300 or higher
depending on the plan).

Hypoglycemia: Low Blood Sugar

Causes of low blood sugar
Too much insulin
Missed food
Delayed food
Too much or too intense exercise

Symptoms of Hypoglycemia
Mild

Hunger
Shakiness
Weakness
Paleness
Anxiety
Dizziness
Sweating
Drowsiness
Personality change
Inability to concentrate

Moderate

Headache
Behavior change
Poor coordination
Blurry vision
Weakness
Slurred speech
Confusion

Severe

Loss of consciousness
Seizure
Inability to swallow

IMPORTANT!!!!

A student who complains of feeling low

or who you suspect may be low should
never be sent to check blood glucose,
to go the nurses office or anywhere
else alone. The student could lose
consciousness or become disoriented.

Treatment of Mild Hypoglycemia

Follow plan for parameters for

treatment.
Provide quick acting source of
carbohydrates such as juice or glucose
tablets per plan.
Wait 10 to 15 minutes and recheck
blood glucose.
Student may self treat if permitted by
plan.

Treatment of Moderate Hypoglycemia

Student will need assistance/supervision.

Give quick acting carbohydrate per plan.
Wait 10 to 15 minutes and check again.
Follow parameters of plan for how much
carbohydrate to give and when to repeat
if needed.
May administer glucose gel or icing if
student is low but conscious and able to
swallow.

Hypoglycemia Mild to Moderate (Skills)

State signs of hypoglycemia.

State treatment of mild to moderate
hypoglycemia.
Describe use of glucose gel or icing
for treatment of hypoglycemia.

What is GLUCAGON?

A hormone that is made naturally in the

pancreas. It releases stores of glucose from the
liver causing blood glucose levels to rise.
Because it is produced naturally it is a safe drug
-- it cannot be overdosed and it has no major side
effects.
Glucagon injection is used for severe
hypoglycemia when the diabetic is unable to
swallow.
When injected it causes blood sugar to rise and
the person to regain consciousness.
Glucagon is to be injected into the muscle of the
legs, arms or buttocks.

Treatment of Severe
Hypoglycemia: GLUCAGON
Glucagon Kit: Lilly
For video on glucagon administration see
http://web.diabetes.org/video/glucagon.wmv

Glucagon Instructions Steps 1 - 3

1.

2.

3.

Remove the flip off seal from

the bottle of glucagon. Wipe
rubber stopper on bottle with
alcohol swab.
Remove the needle protector
from the syringe and inject the
entire contents of the syringe
into the bottle of powdered
glucagon. Do not remove the
plastic clip from the.
Swirl bottle gently until the
glucagon dissolves completely.
Do not shake shaking may
cause bubbles to form.
Glucagon should not be used
unless the solution is clear and
of a water-like consistency.

Glucagon Instructions Steps 4 through

8
4.

5.

6.

Using the same syringe,

hold bottle upside down
and making sure the
needle tip remains in the
solution, gently withdraw
all of the solution from the
bottle. The plastic clip on
the syringe will prevent the
rubber stopper from being
pulled out of the syringe.
Clean the injection site on
buttock, arm, or thigh with
alcohol.
Insert the needle into the
loose tissue and inject the
amount (half or all per
plan). Apply light pressure
at the injection site and
withdraw the needle.

7.
8.

Turn person on side.

As soon as patient is able
to swallow give fast acting
sugar such as juice or soft
drink followed by a long
acting source of sugar such
as crackers and cheese or a
meat or peanut butter
sandwich. Sprite or ginger
ale work well if stomach is
upset.

Severe Hypoglycemia: Glucagon

Skills

Accurately state when Glucagon should be

administered.
Describe how to mix and withdraw Glucagon from vial.
Determine dose based on plan (0.5mg or 1.0mg).
Locate appropriate injection sites and injection
technique (intramuscular).
Precautions: turn child on side, call 9-1-1 & state it is a
diabetic emergency, call parents.
Give quick acting carbohydrate such as soft drink (NOT
DIET) when student is awake and can swallow.
Document time and amount of Glucagon administered.

Sample Log

Conclusion
As school personnel we want
to ensure that all of our
students learn and prosper in
school. By understanding the
basics of diabetes and
knowing how to care for a
student with diabetes, you will
be able to help your student
take advantage of all of the
learning and growing
opportunities your school has
to offer. Thank you for
interest and willingness to
help your student with
diabetes succeed and thrive
in school.