DIABETES MELLITUS

Type 1

By Dana Beaver, RN
 Diabetes Mellitus

 Is one of the oldest conditions known

to man, having been identified in
1500 B.C.

(Selekman, J., 2006)

 What is Diabetes?

 Diabetes is a disease in which the body

does not produce or properly use insulin
 Insulin is a hormone that is needed to
convert sugar, starches and other food
into energy for daily life

(American Diabetes Association [ADA], 2009)

 Diabetes Mellitus

 There are a number of different types of

Diabetes
 Type 1 and Type 2 are the most common
type in children and adolescents
 This presentation will focus on Type 1
Diabetes
(Selekman, J., 2006)
 Diabetes Mellitus Type 1

 Approximately 1 in 400-600 children and adolescents

have Type 1 Diabetes
 Type 1 Diabetes develops when the body’s immune
system destroys pancreatic beta cells, the only cells in the
body that make the hormone insulin that regulates blood
glucose
 To survive, people with Type 1 Diabetes must have
insulin delivered by injection or by pump

(ADA, 2009)
 Causes of Diabetes Type I

 The body produces insufficient insulin, or the

insulin is ineffective
 Causes include: predetermined genetic
susceptibility, and environmental factors
 Other causes are particular viruses
and toxins

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

 Management of a Student with
Diabetes Type 1
 Management of a child with diabetes is a vital part of a
student’s academic experience
 The school nurse will develop the Individualized
Healthcare Plan (IHP) and the Emergency Care Plan
(ECP), in accordance with the medical plan
 These plans will be available to treat the student’s
diabetic needs while at school
 Some students will require an Individualized
Educational Plan (IEP) or a 504 Plan

(Silkworth, C., Arnold, M., Harringan, J., & Zaiger, D., 2005)
 Medical Treatment of Diabetes
Type 1
 Individuals with Diabetes Type 1 require insulin
injections to sustain life
 The student will need to check their blood
glucose level during the day, using a blood
glucose monitoring device
 Supplies will be kept in health office
(insulin, syringes, test strips, insulin pump
equipment)

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

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

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

 Medical Treatment (continued)
 A student with Type I Diabetes may wear an insulin
pump

 A student will still require to test their blood glucose

during the school day

 They will need to make adjustments on their insulin

pump

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

INSULIN PUMP
 Reactions while in school
 Two reactions a student may have while
in school related to using insulin

HYPERGLYCEMIA- blood glucose too high

HYPOGLYCEMIA- blood glucose too low

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

 HYPERGLCEMIA
Blood glucose too high
 Hyperglycemia is when a blood glucose level is
greater than 240 mg/dl
 Onset of hyperglycemia is slow
 Causes of hyperglycemia:
missed insulin doses
eating more food than planned
illness
certain medications
(Selekman, J., 2006)
 Signs or student complaints
that may indicate
high blood glucose
(HYPERGLYCEMIA)
 Increased thirst and urination
 Flushed skin
 Nausea, vomiting
 Weakness and drowsiness
 Fruity breath
 If untreated, can cause unconsciousness

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

 Serious condition related to
HYPERGLYCEMIA
 Diabetic Ketoacidosis (DKA) is a serious
and complicated condition, when there is
too much glucose in the bloodstream and
cannot be properly utilized by the body. It
occurs from profound insulin deficiency
 If DKA is untreated it can progress to
coma
(Silkworth et al., 2005)
 DIABETIC EMERGENCY
 ALL students who take insulin are at risk for
low blood sugar (HYPOGLYCEMIA)

 Children with Diabetes are taught by their

diabetes educator and doctors if they experience
symptoms of hypoglycemia, to treat
with/without a blood glucose measurement

(Silkworth et al., 2005)

 HYPOGLYCEMIA
Blood glucose too low
 Hypoglycemia is defined as a blood glucose
level that is less than 70 mg/dl
 Hypoglycemia can have a rapid onset
 Hypoglycemia is a medical emergency
 Causes of hypoglycemia:
too much insulin
meals and snacks delayed or missed
extra exercise or activity
(Lewis, K., and Bear, B., 2009)
 Signs or student complaints
that may indicate
low blood glucose (HYPOGLYCEMIA)
Mild Signs Moderate to severe
hunger confusion
irritability slurred speech
shakiness slow thinking
weakness, anxiety sleepiness
inability to concentrate erratic behavior
not feeling well unconsciousness
“feel funny” seizures
(Lewis, K., and Bear, B., 2009)
 Diabetic Emergency
 DIABETIC STUDENTS WITH SIGNS OR COMPLAINTS
OF HYPOGLYCEMIA NEED TO GO IMMEDIATELY
TO NURSE ACCOMPANIED WITH A BUDDY OR
STAFF MEMBER
 Symptoms can worsen quickly!
 NEVER leave a student unattended in case their blood
glucose level goes too low and they lose consciousness
 Treatment will be followed according to medical plan,
IHP and ECP
(Silkworth et al., 2005)
 Sample Treatment of
HYPOGLYCEMIA
 Give student fast acting carbohydrates (fruit
juice, glucose tabs, regular soda pop) if awake
and alert
 If unconscious, Glucagon intramuscular would
be given
 If uncertain whether a student is hyperglycemic
or hypoglycemic, always treat for hypoglycemic
(Silkworth et al., 2005)
 Possible Effects on Individual
Student
 Poor self-image as a result of being “different”
 Altered mood and mental alertness
 Risk for depression, doubles
 Parental relationships may be strained from having
parent who does too much or too little
 May feel insulin injections are form of punishment
 Unable to participate in certain sports, which may be
due primarily to parental concerns
 May not be able to eat “all foods” at a class party
(Lewis, K., and Bear, B., 2009)
 Long Term
Type 1 Diabetes Complications
 Heart disease- Diabetes carries an increased risk for heart attack, stroke,
and complications related to poor circulation
 Kidney disease- Diabetes can damage the kidneys which can cause them to
fail
 Eye complication- Diabetes can cause eye problems and may lead to
blindness
 Nerve damage- Diabetes can cause neuropathy (nerve damage), which is
one of the most common complications
 Foot complications- can happen when there is nerve damage or poor
circulation to the feet
 Skin complications- As many as one-third of people with Diabetes will have
a skin disorder
 Depression- Diabetes increases a persons risk for depression

(ADA, 2009)
 The Teacher’s Role in Diabetic
Management
Be Helpful-
Assist students as needed. Follow IEP or 504 plan accordingly

Be Observant-
Notice when students are showing signs that something isn’t
right

Be Supportive-
If a student is having difficulty, approach and support in a
reassuring manner and…….

Be Calm-
Call or send for the school nurse
 References
American Diabetes Association. (2009). Retrieved April 5, 2009, 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).

Individualized healthcare plans for the school nurse: concepts, framework, issues,
and applications for school nursing practice. Minnesota: Sunrise River Press.