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1 Issued April, 2002 Table of Contents Table of Contents Table of Contents Table of Contents Table of Contents Acknowledgments Acknowledgments Acknowledgments Acknowledgments Acknowledgments Acknowledgments Acknowledgments Acknowledgments Acknowledgments Acknowledgments ................................................................................................... ................................................................................................... ................................................................................................... ................................................................................................... ................................................................................................... 5 Overview of Diabetes Overview of Diabetes Overview of Diabetes Overview of Diabetes Overview of Diabetes Overview of Diabetes in Illinois Overview of Diabetes in Illinois Overview of Diabetes in Illinois Overview of Diabetes in Illinois Overview of Diabetes in Illinois .......................................................................... .......................................................................... .......................................................................... .......................................................................... .......................................................................... 9 Diabetes - General Information Diabetes - General Information Diabetes - General Information Diabetes - General Information Diabetes - General Information ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... 10 10 10 10 10 Type 1 Diabetes Type 1 Diabetes Type 1 Diabetes Type 1 Diabetes Type 1 Diabetes .................................................................................................. .................................................................................................. .................................................................................................. .................................................................................................. .................................................................................................. 11 11 11 11 11 Type 2 Diabetes Type 2 Diabetes Type 2 Diabetes Type 2 Diabetes Type 2 Diabetes .................................................................................................. .................................................................................................. .................................................................................................. .................................................................................................. .................................................................................................. 12 12 12 12 12 Nutrition Nutrition Nutrition Nutrition Nutrition ................................................................................................................ ................................................................................................................ ................................................................................................................ ................................................................................................................ ................................................................................................................ 14 14 14 14 14 Physical Activity Physical Activity Physical Activity Physical Activity Physical Activity .................................................................................................. .................................................................................................. .................................................................................................. .................................................................................................. .................................................................................................. 17 17 17 17 17 Student Physical Activity Schedule Student Physical Activity Schedule Student Physical Activity Schedule Student Physical Activity Schedule Student Physical Activity Schedule .................................................................. .................................................................. .................................................................. .................................................................. .................................................................. 18 18 18 18 18 Student Activity Pyramid Student Activity Pyramid Student Activity Pyramid Student Activity Pyramid Student Activity Pyramid ................................................................................... ................................................................................... ................................................................................... ................................................................................... ................................................................................... 19 19 19 19 19 Blood Sugar Monitoring Blood Sugar Monitoring Blood Sugar Monitoring Blood Sugar Monitoring Blood Sugar Monitoring ....................................................................................... ....................................................................................... ....................................................................................... ....................................................................................... ....................................................................................... 21 21 21 21 21 Hypoglycemia Hypoglycemia Hypoglycemia Hypoglycemia Hypoglycemia ........................................................................................................ ........................................................................................................ ........................................................................................................ ........................................................................................................ ........................................................................................................ 23 23 23 23 23 Hyperglycemia and Monitoring for Presence of Ketones Hyperglycemia and Monitoring for Presence of Ketones Hyperglycemia and Monitoring for Presence of Ketones Hyperglycemia and Monitoring for Presence of Ketones Hyperglycemia and Monitoring for Presence of Ketones ............................. ............................. ............................. ............................. ............................. 27 27 27 27 27 Insulin and Insulin Delivery Systems Insulin and Insulin Delivery Systems Insulin and Insulin Delivery Systems Insulin and Insulin Delivery Systems Insulin and Insulin Delivery Systems ............................................................... ............................................................... ............................................................... ............................................................... ............................................................... 29 29 29 29 29 Oral Medications Used in Diabetes Treatment Oral Medications Used in Diabetes Treatment Oral Medications Used in Diabetes Treatment Oral Medications Used in Diabetes Treatment Oral Medications Used in Diabetes Treatment .............................................. .............................................. .............................................. .............................................. .............................................. 30 30 30 30 30 Giving Insulin Giving Insulin Giving Insulin Giving Insulin Giving Insulin ......................................................................................................... ......................................................................................................... ......................................................................................................... ......................................................................................................... ......................................................................................................... 33 33 33 33 33 Age Related Responsibilities of Students Age Related Responsibilities of Students Age Related Responsibilities of Students Age Related Responsibilities of Students Age Related Responsibilities of Students ........................................................ ........................................................ ........................................................ ........................................................ ........................................................ 35 35 35 35 35 Psychosocial Aspects of the Student with Diabetes Psychosocial Aspects of the Student with Diabetes Psychosocial Aspects of the Student with Diabetes Psychosocial Aspects of the Student with Diabetes Psychosocial Aspects of the Student with Diabetes .................................... .................................... .................................... .................................... .................................... 37 37 37 37 37 Tools and Information for School Health Personnel Tools and Information for School Health Personnel Tools and Information for School Health Personnel Tools and Information for School Health Personnel Tools and Information for School Health Personnel Care Planning Care Planning Care Planning Care Planning Care Planning ........................................................................................................ ........................................................................................................ ........................................................................................................ ........................................................................................................ ........................................................................................................ 41 41 41 41 41 Appropriate Accommodations Under Illinois Law Appropriate Accommodations Under Illinois Law Appropriate Accommodations Under Illinois Law Appropriate Accommodations Under Illinois Law Appropriate Accommodations Under Illinois Law ............................................ ............................................ ............................................ ............................................ ............................................ 44 44 44 44 44 Tools for Staff Education Tools for Staff Education Tools for Staff Education Tools for Staff Education Tools for Staff Education Handling the Student with Diabetes at School Handling the Student with Diabetes at School Handling the Student with Diabetes at School Handling the Student with Diabetes at School Handling the Student with Diabetes at School .............................................. .............................................. .............................................. .............................................. .............................................. 53 53 53 53 53 Illness at School Illness at School Illness at School Illness at School Illness at School .................................................................................................. .................................................................................................. .................................................................................................. .................................................................................................. .................................................................................................. 55 55 55 55 55 Travel, Vacations or Camp Travel, Vacations or Camp Travel, Vacations or Camp Travel, Vacations or Camp Travel, Vacations or Camp ................................................................................. ................................................................................. ................................................................................. ................................................................................. ................................................................................. 56 56 56 56 56 Actions for the Principal Actions for the Principal Actions for the Principal Actions for the Principal Actions for the Principal .................................................................................... .................................................................................... .................................................................................... .................................................................................... .................................................................................... 57 57 57 57 57 Actions for the Teacher Actions for the Teacher Actions for the Teacher Actions for the Teacher Actions for the Teacher .................................................................................... .................................................................................... .................................................................................... .................................................................................... .................................................................................... 58 58 58 58 58 Diabetes in Children Diabetes in Children Diabetes in Children Diabetes in Children Diabetes in Children A Resource Guide for School Health Personnel A Resource Guide for School Health Personnel A Resource Guide for School Health Personnel A Resource Guide for School Health Personnel A Resource Guide for School Health Personnel

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Diabetes in Children: a Resource Guide for school Health Personnel

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  • 11111Issued Apri l , 2002

    Table of ContentsTable of ContentsTable of ContentsTable of ContentsTable of Contents

    AcknowledgmentsAcknowledgmentsAcknowledgmentsAcknowledgmentsAcknowledgmentsAcknowledgmentsAcknowledgmentsAcknowledgmentsAcknowledgmentsAcknowledgments ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... 55555

    Overview of DiabetesOverview of DiabetesOverview of DiabetesOverview of DiabetesOverview of DiabetesOverview of Diabetes in IllinoisOverview of Diabetes in IllinoisOverview of Diabetes in IllinoisOverview of Diabetes in IllinoisOverview of Diabetes in Illinois .................................................................................................................................................................................................................................................................................................................................................................................. 99999Diabetes - General InformationDiabetes - General InformationDiabetes - General InformationDiabetes - General InformationDiabetes - General Information ................................................................................................................................................................................................................................................................................................................................................................... 1 01 01 01 01 0Type 1 DiabetesType 1 DiabetesType 1 DiabetesType 1 DiabetesType 1 Diabetes .......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... 1 11 11 11 11 1Type 2 DiabetesType 2 DiabetesType 2 DiabetesType 2 DiabetesType 2 Diabetes .......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... 1 21 21 21 21 2NutritionNutritionNutritionNutritionNutrition ................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................ 1 41 41 41 41 4Physical ActivityPhysical ActivityPhysical ActivityPhysical ActivityPhysical Activity .......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... 1 71 71 71 71 7Student Physical Activity ScheduleStudent Physical Activity ScheduleStudent Physical Activity ScheduleStudent Physical Activity ScheduleStudent Physical Activity Schedule.......................................................................................................................................................................................................................................................................................................................................... 1 81 81 81 81 8Student Activity PyramidStudent Activity PyramidStudent Activity PyramidStudent Activity PyramidStudent Activity Pyramid ............................................................................................................................................................................................................................................................................................................................................................................................................................... 1 91 91 91 91 9Blood Sugar MonitoringBlood Sugar MonitoringBlood Sugar MonitoringBlood Sugar MonitoringBlood Sugar Monitoring ................................................................................................................................................................................................................................................................................................................................................................................................................................................... 2 12 12 12 12 1HypoglycemiaHypoglycemiaHypoglycemiaHypoglycemiaHypoglycemia ........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................ 2 32 32 32 32 3Hyperglycemia and Monitoring for Presence of KetonesHyperglycemia and Monitoring for Presence of KetonesHyperglycemia and Monitoring for Presence of KetonesHyperglycemia and Monitoring for Presence of KetonesHyperglycemia and Monitoring for Presence of Ketones ................................................................................................................................................. 2 72 72 72 72 7Insulin and Insulin Delivery SystemsInsulin and Insulin Delivery SystemsInsulin and Insulin Delivery SystemsInsulin and Insulin Delivery SystemsInsulin and Insulin Delivery Systems ........................................................................................................................................................................................................................................................................................................................... 2 92 92 92 92 9Oral Medications Used in Diabetes TreatmentOral Medications Used in Diabetes TreatmentOral Medications Used in Diabetes TreatmentOral Medications Used in Diabetes TreatmentOral Medications Used in Diabetes Treatment...................................................................................................................................................................................................................................... 3 03 03 03 03 0Giving InsulinGiving InsulinGiving InsulinGiving InsulinGiving Insulin ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................. 3 33 33 33 33 3Age Related Responsibilities of StudentsAge Related Responsibilities of StudentsAge Related Responsibilities of StudentsAge Related Responsibilities of StudentsAge Related Responsibilities of Students........................................................................................................................................................................................................................................................................................ 3 53 53 53 53 5Psychosocial Aspects of the Student with DiabetesPsychosocial Aspects of the Student with DiabetesPsychosocial Aspects of the Student with DiabetesPsychosocial Aspects of the Student with DiabetesPsychosocial Aspects of the Student with Diabetes .................................................................................................................................................................................... 3 73 73 73 73 7

    Tools and Information for School Health PersonnelTools and Information for School Health PersonnelTools and Information for School Health PersonnelTools and Information for School Health PersonnelTools and Information for School Health PersonnelCare PlanningCare PlanningCare PlanningCare PlanningCare Planning ........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................ 4 14 14 14 14 1Appropriate Accommodations Under Illinois LawAppropriate Accommodations Under Illinois LawAppropriate Accommodations Under Illinois LawAppropriate Accommodations Under Illinois LawAppropriate Accommodations Under Illinois Law............................................................................................................................................................................................................................ 4 44 44 44 44 4

    Tools for Staff EducationTools for Staff EducationTools for Staff EducationTools for Staff EducationTools for Staff EducationHandling the Student with Diabetes at SchoolHandling the Student with Diabetes at SchoolHandling the Student with Diabetes at SchoolHandling the Student with Diabetes at SchoolHandling the Student with Diabetes at School...................................................................................................................................................................................................................................... 5 35 35 35 35 3Illness at SchoolIllness at SchoolIllness at SchoolIllness at SchoolIllness at School .......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... 5 55 55 55 55 5Travel, Vacations or CampTravel, Vacations or CampTravel, Vacations or CampTravel, Vacations or CampTravel, Vacations or Camp..................................................................................................................................................................................................................................................................................................................................................................................................................... 5 65 65 65 65 6Actions for the PrincipalActions for the PrincipalActions for the PrincipalActions for the PrincipalActions for the Principal .................................................................................................................................................................................................................................................................................................................................................................................................................................... 5 75 75 75 75 7Actions for the TeacherActions for the TeacherActions for the TeacherActions for the TeacherActions for the Teacher .................................................................................................................................................................................................................................................................................................................................................................................................................................... 5 85 85 85 85 8

    Diabetes in ChildrenDiabetes in ChildrenDiabetes in ChildrenDiabetes in ChildrenDiabetes in ChildrenA Resource Guide for School Health PersonnelA Resource Guide for School Health PersonnelA Resource Guide for School Health PersonnelA Resource Guide for School Health PersonnelA Resource Guide for School Health Personnel

  • 22222Issued Apri l , 2002

    Actions for Health PersonnelActions for Health PersonnelActions for Health PersonnelActions for Health PersonnelActions for Health Personnel ............................................................................................................................................................................................................................................................................................................................................................................................ 5 95 95 95 95 9Actions for the CounselorActions for the CounselorActions for the CounselorActions for the CounselorActions for the Counselor .......................................................................................................................................................................................................................................................................................................................................................................................................................... 6 06 06 06 06 0Actions for Coaches and Physical Education TeachersActions for Coaches and Physical Education TeachersActions for Coaches and Physical Education TeachersActions for Coaches and Physical Education TeachersActions for Coaches and Physical Education Teachers ................................................................................................................................................................ 6 16 16 16 16 1Actions for Bus DriversActions for Bus DriversActions for Bus DriversActions for Bus DriversActions for Bus Drivers .............................................................................................................................................................................................................................................................................................................................................................................................................................................. 6 26 26 26 26 2Actions for Food Service Personnel,Actions for Food Service Personnel,Actions for Food Service Personnel,Actions for Food Service Personnel,Actions for Food Service Personnel,

    Parents, Teachers, and Others Providing FoodParents, Teachers, and Others Providing FoodParents, Teachers, and Others Providing FoodParents, Teachers, and Others Providing FoodParents, Teachers, and Others Providing Food ............................................................................................................................................................................................................. 6 36 36 36 36 3

    Sample FormsSample FormsSample FormsSample FormsSample FormsLetter From Doctor to School PersonnelLetter From Doctor to School PersonnelLetter From Doctor to School PersonnelLetter From Doctor to School PersonnelLetter From Doctor to School Personnel ........................................................................................................................................................................................................................................................................................ 6 76 76 76 76 7Authorization for the Mutual Exchange of Medical InformationAuthorization for the Mutual Exchange of Medical InformationAuthorization for the Mutual Exchange of Medical InformationAuthorization for the Mutual Exchange of Medical InformationAuthorization for the Mutual Exchange of Medical Information ........................................................................... 6 86 86 86 86 8Authorization and Permission for Administration of MedicationAuthorization and Permission for Administration of MedicationAuthorization and Permission for Administration of MedicationAuthorization and Permission for Administration of MedicationAuthorization and Permission for Administration of Medication ..................................................................................... 6 96 96 96 96 9Medical Statement for Children Requiring Modification in School MealsMedical Statement for Children Requiring Modification in School MealsMedical Statement for Children Requiring Modification in School MealsMedical Statement for Children Requiring Modification in School MealsMedical Statement for Children Requiring Modification in School Meals ..... 7 37 37 37 37 3

    AppendixAppendixAppendixAppendixAppendixDiabetes DefinitionsDiabetes DefinitionsDiabetes DefinitionsDiabetes DefinitionsDiabetes Definitions ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................ 7 77 77 77 77 7Diabetes ResourcesDiabetes ResourcesDiabetes ResourcesDiabetes ResourcesDiabetes Resources ................................................................................................................................................................................................................................................................................................................................................................................................................................................................................. 8 38 38 38 38 3Other PublicationsOther PublicationsOther PublicationsOther PublicationsOther Publications ........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... 9 19 19 19 19 1Diabetes WebsitesDiabetes WebsitesDiabetes WebsitesDiabetes WebsitesDiabetes Websites ...................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... 9 39 39 39 39 3Care of Children with Diabetes in the School and Day Care SettingCare of Children with Diabetes in the School and Day Care SettingCare of Children with Diabetes in the School and Day Care SettingCare of Children with Diabetes in the School and Day Care SettingCare of Children with Diabetes in the School and Day Care Setting ................................... 9 59 59 59 59 5Type 2 Diabetes in Children and AdolescentsType 2 Diabetes in Children and AdolescentsType 2 Diabetes in Children and AdolescentsType 2 Diabetes in Children and AdolescentsType 2 Diabetes in Children and Adolescents ................................................................................................................................................................................................................................................ 9 59 59 59 59 5

    Table of ContentsTable of ContentsTable of ContentsTable of ContentsTable of Contents

  • 33333Issued Apri l , 2002

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  • 44444Issued Apri l , 2002

  • 55555Issued Apri l , 2002

    AcknowledgmentsAcknowledgmentsAcknowledgmentsAcknowledgmentsAcknowledgmentsThe Illinois Department of Human Services acknowledges and greatly appreciates theThe Illinois Department of Human Services acknowledges and greatly appreciates theThe Illinois Department of Human Services acknowledges and greatly appreciates theThe Illinois Department of Human Services acknowledges and greatly appreciates theThe Illinois Department of Human Services acknowledges and greatly appreciates thethe cooperation and assistance of the following organizations and individuals in providingthe cooperation and assistance of the following organizations and individuals in providingthe cooperation and assistance of the following organizations and individuals in providingthe cooperation and assistance of the following organizations and individuals in providingthe cooperation and assistance of the following organizations and individuals in providingand reviewing the information contained in this document. A special thank you to theand reviewing the information contained in this document. A special thank you to theand reviewing the information contained in this document. A special thank you to theand reviewing the information contained in this document. A special thank you to theand reviewing the information contained in this document. A special thank you to theNew York State Department of Health for their generosity in sharing information fromNew York State Department of Health for their generosity in sharing information fromNew York State Department of Health for their generosity in sharing information fromNew York State Department of Health for their generosity in sharing information fromNew York State Department of Health for their generosity in sharing information fromChildren With Diabetes: A Resource Guide For Schools.Children With Diabetes: A Resource Guide For Schools.Children With Diabetes: A Resource Guide For Schools.Children With Diabetes: A Resource Guide For Schools.Children With Diabetes: A Resource Guide For Schools.

    Agency/OrganizationAgency/OrganizationAgency/OrganizationAgency/OrganizationAgency/OrganizationNew York State Department of HealthAmerican Diabetes AssociationJuvenile Diabetes Research Foundation

    Workgroup MembersWorkgroup MembersWorkgroup MembersWorkgroup MembersWorkgroup MembersKathryn CoxDivision Administrator, Special EducationIllinois State Board of Education

    Ramesh Khardori, M.D.Professor/Vice ChairDepartment of MedicineDirector of Division of EndocrinologySouthern Illinois University School of Medicine

    Rodney A. Lorenz, M.D.William H. Albers Professor and ChairUniversity of IllinoisCollege of Medicine at Peoria

    William Maurer, M.D.Department of PediatricsUniversity of IllinoisCollege of Medicine at Peoria

    Marcella J. McIntyre, R.N., M.S.N., C.D.E.Director Diabetes ServicesCentral DuPage Health Systems

    Jacque McKernan, Ph.D., R.N., M.S., C.D.E.Diabetes Case Manager, Co-Chair (SS)Edward Center For Diabetes Education

    Cynthia Mears, D.O.Associate Medicine SpecialistDivision of General Academic PediatricsChildrens Memorial Hospital

    Thomas L. Pitts, M.D.Assistant ProfessorNorthwestern University Medical SchoolPast President Great Lakes RegionAmerican Diabetes Association

    Margaret Winters, R.N., B.A.Executive SecretaryIllinois Association of School Nurses

    W. Patrick Zeller, M.D.DirectorEdward Center for Diabetes Education

    Office of Family Health StaffOffice of Family Health StaffOffice of Family Health StaffOffice of Family Health StaffOffice of Family Health StaffStephen E. Saunders, M.D., M.P.H.Associate Director, Office of Family Health

    StaffStaffStaffStaffStaffMarie IrwinOffice Coordinator, School Health Program

    Victoria Jackson, R.N., M.S., N.C.S.N.School Nurse Consultant

    Cheryl Metheny, M.S., R.D., C.D.E.Diabetes Control Program

    Mary L. MillerAdministrator, Special Projects

    Chandana Nandi, R.D., M.S.Coordinator, Diabetes Control Program

    Judith Redick, B.A., M.S.Administrator, School Health Program

    Jill Sproat, B.A.Public Administration Intern

    For more information contact:For more information contact:For more information contact:For more information contact:For more information contact:Illinois Department of Human ServicesIllinois Department of Human ServicesIllinois Department of Human ServicesIllinois Department of Human ServicesIllinois Department of Human Services

    Division of Community Health and PreventionDivision of Community Health and PreventionDivision of Community Health and PreventionDivision of Community Health and PreventionDivision of Community Health and PreventionOffice of Family HealthOffice of Family HealthOffice of Family HealthOffice of Family HealthOffice of Family Health

    535 W. Jefferson535 W. Jefferson535 W. Jefferson535 W. Jefferson535 W. JeffersonSpringfield, Illinois 62702Springfield, Illinois 62702Springfield, Illinois 62702Springfield, Illinois 62702Springfield, Illinois 62702

    School Health Program Diabetes Control ProgramSchool Health Program Diabetes Control ProgramSchool Health Program Diabetes Control ProgramSchool Health Program Diabetes Control ProgramSchool Health Program Diabetes Control Program 217-785-4525 217-785-4525 217-785-4525 217-785-4525 217-785-4525 217-782-2166 217-782-2166 217-782-2166 217-782-2166 217-782-2166

  • 66666Issued Apri l , 2002

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    Overview of Diabetes in IllinoisOverview of Diabetes in IllinoisOverview of Diabetes in IllinoisOverview of Diabetes in IllinoisOverview of Diabetes in IllinoisDiabetes - General InformationDiabetes - General InformationDiabetes - General InformationDiabetes - General InformationDiabetes - General InformationNutritionNutritionNutritionNutritionNutritionPhysical ActivityPhysical ActivityPhysical ActivityPhysical ActivityPhysical ActivityBlood Sugar MonitoringBlood Sugar MonitoringBlood Sugar MonitoringBlood Sugar MonitoringBlood Sugar MonitoringHypoglycemiaHypoglycemiaHypoglycemiaHypoglycemiaHypoglycemiaHyperglycemiaHyperglycemiaHyperglycemiaHyperglycemiaHyperglycemiaInsulinInsulinInsulinInsulinInsulinAge Related Responsibilities of StudentsAge Related Responsibilities of StudentsAge Related Responsibilities of StudentsAge Related Responsibilities of StudentsAge Related Responsibilities of StudentsPsychosocial Aspects of the StudentPsychosocial Aspects of the StudentPsychosocial Aspects of the StudentPsychosocial Aspects of the StudentPsychosocial Aspects of the Student

    with Diabeteswith Diabeteswith Diabeteswith Diabeteswith Diabetes

  • 88888Issued Apri l , 2002

  • 99999Issued Apri l , 2002

    Diabetes Background:Diabetes Background:Diabetes Background:Diabetes Background:Diabetes Background: Diabetes requires a unique, complex and inseparable blend of self and medical care. Controlling blood glucose levels has been shown to reduce the likelihood of unwanted compli-

    cations. Early diagnosis of diabetes and control of glucose levels are proven elements in the preven-

    tion of complications related to diabetes.

    Diabetes in IllinoisDiabetes in IllinoisDiabetes in IllinoisDiabetes in IllinoisDiabetes in Illinois: Approximately 5.6% (513,735) of adults in Illinois have been diagnosed with diabetes.1

    Direct and indirect costs of diabetes exceed $7.6 billion annually.2

    More than 4,176 school-age children were estimated to have a diagnosis of type 1 diabe-tes.2

    Hospitalization charges for 1,911 children (age 0-19) were $16,230,550 in 2000, averaging$7,606 per child.3

    In 2000, the most common causes of diabetes-related hospitalizations of children (age 6-19) were ketoacidosis (929), diabetes without complication (477), and diabetes withoutother specific manifestations (67).3

    Diabetes in Children:Diabetes in Children:Diabetes in Children:Diabetes in Children:Diabetes in Children: The majority of children with diabetes are diagnosed with type 1 diabetes. Literature reports an alarming growth in the diagnosis of type 2 diabetes in adolescents,

    attributed in part to the high number of obese and overweight school-age children andsedentary life-styles.

    The Centers for Disease Control and Prevention (CDC) reports that one of every threenewly diagnosed adolescents has type 2 diabetes, once thought to impact only adults overage 40. According to CDC, young people affected tend to be 10-19 years old, with astrong family history of type 2 diabetes. They are slightly more likely to be girls than boys;to be African American, Hispanic or American Indian rather than other racial or ethnicgroups; and obese rather than normal weight.

    This manual is a compilation of resources designed to provide a reference for Illinois school healthpersonnel to utilize in the school setting for the management of the student with diabetes. Thecomplete needs of each individual student with diabetes must be evaluated by a health care providerwho should develop an Individual Diabetes Management PlanIndividual Diabetes Management PlanIndividual Diabetes Management PlanIndividual Diabetes Management PlanIndividual Diabetes Management Plan to address those needs. Thetools provided in this manual can assist school personnel in affecting positive health outcomes andhelping students with diabetes improve self-management skills and fully participate in mainstreamactivities.

    Overview of Diabetes in IllinoisOverview of Diabetes in IllinoisOverview of Diabetes in IllinoisOverview of Diabetes in IllinoisOverview of Diabetes in Illinois

    1Illinois Department of Public Health. Behavioral Risk Factor Surveillance System (BRFSS). Aggregate years 1998-2000.2Burden of Diabetes in Illinois. Centers for Disease Control and Prevention, 1997.3Illinois Health Care Cost Containment Council, 2000.

  • 1010101010Issued Apri l , 2002

    Diabetes is a disorder of metabolism -- the wayin which your body converts the food you eatinto energy. Most of the food you eat is bro-ken down by digestive juices into the fuel you need tosurvive. One such fuel is a sugar called glucose. Glu-cose is the bodys main source of energy and the brainsonly source of energy. After digestion, glucose passesinto your bloodstream, where it is available for cells totake in and use or store for later use.

    In order for your cells to take in glucose, a hormonecalled insulin must be present in your blood. Insulinacts as a key that unlocks doors on cell surfaces toallow glucose to enter the cells. Insulin is produced byspecial cells (islet cells) in an organ called the pancreas,which is about 6 inches long and lies behind your stom-ach.

    Diabetes - General InformationDiabetes - General InformationDiabetes - General InformationDiabetes - General InformationDiabetes - General Information

    American Diabetes Association Recommendations forAmerican Diabetes Association Recommendations forAmerican Diabetes Association Recommendations forAmerican Diabetes Association Recommendations forAmerican Diabetes Association Recommendations forDiabetes Classification,Testing and Diagnosis (revised 1997)Diabetes Classification,Testing and Diagnosis (revised 1997)Diabetes Classification,Testing and Diagnosis (revised 1997)Diabetes Classification,Testing and Diagnosis (revised 1997)Diabetes Classification,Testing and Diagnosis (revised 1997)

    Name ChangesName ChangesName ChangesName ChangesName Changes

    Type 1 - Formerly (IDDM) - insulin dependent diabetes mellitusType 1 - Formerly (IDDM) - insulin dependent diabetes mellitusType 1 - Formerly (IDDM) - insulin dependent diabetes mellitusType 1 - Formerly (IDDM) - insulin dependent diabetes mellitusType 1 - Formerly (IDDM) - insulin dependent diabetes mellitus

    Type 2 - Formerly (NIDDM) - non-insulin dependent diabetes mellitusType 2 - Formerly (NIDDM) - non-insulin dependent diabetes mellitusType 2 - Formerly (NIDDM) - non-insulin dependent diabetes mellitusType 2 - Formerly (NIDDM) - non-insulin dependent diabetes mellitusType 2 - Formerly (NIDDM) - non-insulin dependent diabetes mellitus

    In people who do not have diabetes, the pancreasautomatically produces the right amount of insulin toenable glucose to enter cells. Type 1 diabetes occurswhen the pancreas stops making any insulin. In peoplewho have type 2 diabetes, cells do not respond to theeffects of the insulin that the pancreas produces. Ifglucose cannot get inside cells, it builds up in the blood-stream. The buildup of glucose in the blood--sometimesreferred to as high blood sugarhigh blood sugarhigh blood sugarhigh blood sugarhigh blood sugar or hyperglycemia--isthe hallmark of diabetes.

    When the glucose level in your blood goes above acertain level, the kidneys (two organs that filter wastefrom the bloodstream) work to get rid of the glucose inthe urine. The glucose takes water with it, which causesfrequent urination and extreme thirst. These twosymptoms--frequent urination and unusual thirst-- maybe the first noticeable signs of diabetes. Weight loss,the result of loss of calories and water, may also benoticed.

    Simplified Testing and DiagnosisSimplified Testing and DiagnosisSimplified Testing and DiagnosisSimplified Testing and DiagnosisSimplified Testing and Diagnosis

    Diabetes can be diagnosed using any one of these 3 methods,Diabetes can be diagnosed using any one of these 3 methods,Diabetes can be diagnosed using any one of these 3 methods,Diabetes can be diagnosed using any one of these 3 methods,Diabetes can be diagnosed using any one of these 3 methods,

    and must be confirmed on a different day, again using one of these methods:and must be confirmed on a different day, again using one of these methods:and must be confirmed on a different day, again using one of these methods:and must be confirmed on a different day, again using one of these methods:and must be confirmed on a different day, again using one of these methods:

    1. A Fasting Plasma Glucose (FPG) of > 126 mg/dl (after no caloric intake for at least eight hours.)*1. A Fasting Plasma Glucose (FPG) of > 126 mg/dl (after no caloric intake for at least eight hours.)*1. A Fasting Plasma Glucose (FPG) of > 126 mg/dl (after no caloric intake for at least eight hours.)*1. A Fasting Plasma Glucose (FPG) of > 126 mg/dl (after no caloric intake for at least eight hours.)*1. A Fasting Plasma Glucose (FPG) of > 126 mg/dl (after no caloric intake for at least eight hours.)*

    2. A casual plasma glucose (taken at any time of day without regard to time of last meal)>200 mg/dl2. A casual plasma glucose (taken at any time of day without regard to time of last meal)>200 mg/dl2. A casual plasma glucose (taken at any time of day without regard to time of last meal)>200 mg/dl2. A casual plasma glucose (taken at any time of day without regard to time of last meal)>200 mg/dl2. A casual plasma glucose (taken at any time of day without regard to time of last meal)>200 mg/dl

    with the classic diabetes symptoms of increased urination, increased thirst and unexplained weightwith the classic diabetes symptoms of increased urination, increased thirst and unexplained weightwith the classic diabetes symptoms of increased urination, increased thirst and unexplained weightwith the classic diabetes symptoms of increased urination, increased thirst and unexplained weightwith the classic diabetes symptoms of increased urination, increased thirst and unexplained weight

    loss.loss.loss.loss.loss.

    3. An oral glucose tolerance test (OGTT) value of >200 mg/dl in the two hour sample.3. An oral glucose tolerance test (OGTT) value of >200 mg/dl in the two hour sample.3. An oral glucose tolerance test (OGTT) value of >200 mg/dl in the two hour sample.3. An oral glucose tolerance test (OGTT) value of >200 mg/dl in the two hour sample.3. An oral glucose tolerance test (OGTT) value of >200 mg/dl in the two hour sample.

    * Pr * Pr * Pr * Pr * Prefefefefeferererererrrrrred test:ed test:ed test:ed test:ed test: ease of administr ease of administr ease of administr ease of administr ease of administraaaaation,tion,tion,tion,tion, con con con con convvvvvenienceenienceenienceenienceenience,,,,, acce acce acce acce acceptaptaptaptaptability to student,bility to student,bility to student,bility to student,bility to student, and lo and lo and lo and lo and lowwwwwer cost.er cost.er cost.er cost.er cost.

  • 1111111111Issued Apri l , 2002

    Symptoms of High Blood Sugar thatSymptoms of High Blood Sugar thatSymptoms of High Blood Sugar thatSymptoms of High Blood Sugar thatSymptoms of High Blood Sugar thatCharacterize Type 1 DiabetesCharacterize Type 1 DiabetesCharacterize Type 1 DiabetesCharacterize Type 1 DiabetesCharacterize Type 1 Diabetes

    -frequent urination (including during-frequent urination (including during-frequent urination (including during-frequent urination (including during-frequent urination (including duringthe night)the night)the night)the night)the night)

    -unusual thirst-unusual thirst-unusual thirst-unusual thirst-unusual thirst-extreme hunger/weakness-extreme hunger/weakness-extreme hunger/weakness-extreme hunger/weakness-extreme hunger/weakness-unexplained weight loss-unexplained weight loss-unexplained weight loss-unexplained weight loss-unexplained weight loss-extreme fatigue-extreme fatigue-extreme fatigue-extreme fatigue-extreme fatigue-blurred vision-blurred vision-blurred vision-blurred vision-blurred vision-slow healing of cuts and bruises-slow healing of cuts and bruises-slow healing of cuts and bruises-slow healing of cuts and bruises-slow healing of cuts and bruises-frequent infections of skin/gums/-frequent infections of skin/gums/-frequent infections of skin/gums/-frequent infections of skin/gums/-frequent infections of skin/gums/

    vagina/bladdervagina/bladdervagina/bladdervagina/bladdervagina/bladder-tingling/numbing in legs, feet, hands-tingling/numbing in legs, feet, hands-tingling/numbing in legs, feet, hands-tingling/numbing in legs, feet, hands-tingling/numbing in legs, feet, hands

    Type 1 diabetes usually has a very rapid onset.It was previously called Juvenile Diabetesbecause most people develop it as children orteenagers. This type of diabetes occurs when thepancreas stops making insulin. The underlying causefor this damage has not been identified yet, althoughresearch is currently underway. Approximately five toten percent of all people with diabetes have type 1diabetes, and the majority of students with diabeteshave type 1.

    There is no single way to treat type 1 diabetes. Todate, insulin injection is necessary for survival. Eachstudents life events vary and experienced diabetesteams are necessary to set up individualized treatmentplans. For treatment plans to be most successful, aninsulin regimen must be tailored to the needs of thestudent, as well as a meal plan and recommendationsfor physical activity. New information on diabetes man-agement allows people with diabetes to be more liberalwith food intake as well as meal and exercise times.

    Students with diabetes must be allowed to participatefully in all school activities. Students need the coopera-tion and support of school staff members to help withthe treatment plan.

    Type 1 DiabetesType 1 DiabetesType 1 DiabetesType 1 DiabetesType 1 Diabetes

    Blood sugar monitoring may be ordered by the childshealth care provider to help assess how well thetreatment plan is working. Most students can performblood sugar checks by themselves but may need aprivate place to do so. Some students may needsupervision to see that the procedure is done properlyand results are recorded accurately. It is helpful for thestudent to have a meter at school so the blood can bechecked when needed. The student should use thesame brand and model meter at home and school.Use of the same meter will enable the student toaccurately interpret results and make appropriatedecisions regarding medication, food and/or exercise.Whether or not the student checks blood sugar levelsat school, and how often, are decisions made by thestudents diabetes team in conjunction with the student,family, and school personnel.

    It is the local board of educations responsibility toensure that staff, including school health personnel, haveadequate training and current knowledge in order toassist students with diabetes. School health personnelare responsible for recognizing when additional stafftraining is needed to perform a particular procedureand determining where the appropriate training can beobtained.

  • 1212121212Issued Apri l , 2002

    Type 2 DiabetesType 2 DiabetesType 2 DiabetesType 2 DiabetesType 2 Diabetes

    Type 2 diabetes is the most common form ofthe disease, representing ninety to ninety-fivepercent of adults with diabetes. It was previ-ously known as adult-onset or non-insulin dependentdiabetes because it was most often diagnosed afterage 40. A recent trend has emerged in which type 2diabetes is being diagnosed in children, adolescents andyoung adults. Studies are currently underway to betterdefine the populations at highest risk for this form ofdiabetes, so that preventive measures may be takenand appropriate behavioral and medical therapies canbe developed.

    The latest findings from the Centers for DiseaseControl and Preventions (CDC) National Health andNutrition Examination Survey (NHANES) show thatincreasing numbers of children and teens are overweight.The initial results for 1999 show 13 percent of childrenages 6-11 are overweight, which is an 11 percentincrease from the previous NHANES survey. Thenumber of overweight teens ages 12-19 years increasedfrom 11 percent to 14 percent in the same time period.In Illinois, there are an estimated 145,420 children inthe 6-11 years age group and 199,833 teens in the12-19 years age group who are overweight. Overweightstudents are at increased risk for cardiovascular disease,diabetes, and other serious health problems.

    TTTTThe Path Toward Type 2 Diabeteshe Path Toward Type 2 Diabeteshe Path Toward Type 2 Diabeteshe Path Toward Type 2 Diabeteshe Path Toward Type 2 Diabetes

    One of the greatest risk factors for type 2 diabetesis excess weight. As an individual gains weight, theextra weight causes the cells of the body to becomeresistant to the effects of insulin. The pancreasresponds by producing more and more insulin, whicheventually begins to build up in the blood.

    Acanthosis nigricans (AN) is a skin problem often foundon the neck, axilla, groin, and other flexural areas. Lit-erally, AN means thick, coarse, and dark.

    In students of color who are also overweight andhave a family history of type 2 diabetes, AN may be anearly warning sign of insulin resistance.

    Acanthosis Nigricans is not a screening tool for type 2diabetes.

    Acanthosis NigricansAcanthosis NigricansAcanthosis NigricansAcanthosis NigricansAcanthosis Nigricans

    Impaired glucose tolerance (IGT) may be anotherprecursor of type 2 diabetes. Impaired glucose toleranceoccurs when the pancreas becomes exhausted andcan no longer produce enough insulin to move glucoseout of the bloodstream into cells. Glucose begins tobuild up in the blood. If it is not diagnosed and treated,this gradual rise in glucose may lead to type 2 diabetes,high blood pressure, and heart disease--in any orderand in any combination.

    While all of these harmful activities are going on insidethe body, the affected individual may feel perfectly fine.Type 2 diabetes is considered a silent disease becauseit works its destruction over many years without causingany noticeable symptoms. One-third of the people whohave type 2 diabetes do not know it.

    Type 2 diabetes is treated by controlling food intakeand activity level. Oral medication may be added to thetreatment to help maintain glucose levels. If these man-agement tools do not achieve normalization of bloodsugar levels, the addition of insulin may be indicated.

    Source: Centers for Disease Control. National Health and Nutrition Examination Survey. 1999. http://www.cdc.gov/nchs/nhanes.htmSource: More American children and teens are overweight. News Releases, March 12, 2001. National Center for Health Statisitcs.

  • 1313131313Issued Apri l , 2002

    Preventing and Managing Type 2 DiabetesPreventing and Managing Type 2 DiabetesPreventing and Managing Type 2 DiabetesPreventing and Managing Type 2 DiabetesPreventing and Managing Type 2 Diabetes

    The best way to help prevent and manage type 2diabetes is to adopt and follow a healthy life-style.Healthy life-style recommendations are important foreveryone.

    Components of Healthy Living for PreventionComponents of Healthy Living for PreventionComponents of Healthy Living for PreventionComponents of Healthy Living for PreventionComponents of Healthy Living for Preventionand/or Management of Type 2 Diabetesand/or Management of Type 2 Diabetesand/or Management of Type 2 Diabetesand/or Management of Type 2 Diabetesand/or Management of Type 2 Diabetes

    Well-balanced diet Weight management Regular physical activity Blood glucose monitoring and management Medication, if prescribed Avoidance of tobacco use Stress management Avoidance of alcohol consumption Maintenance of normal blood pressure Maintenance of normal lipid levels

    Gestational Diabetes MellitusGestational Diabetes MellitusGestational Diabetes MellitusGestational Diabetes MellitusGestational Diabetes Mellitus

    Gestational Diabetes Mellitus (GDM) is a type of dia-betes mellitus that can occur when a woman is preg-nant. In the second half of pregnancy, the womanmay have glucose (sugar) in the blood at a higher thannormal level. However, when the pregnancy ends, theblood glucose levels return to normal in about 95 per-cent of all cases. Women who have gestational diabe-tes should work closely with their health care team tolearn how to monitor their blood sugars, plan their meals,and adjust their activity levels in order to control bloodsugar levels. Women who have had GDM are morelikely to develop type 2 diabetes later in life.

    Testing for Type 2 Diabetes in ChildrenTesting for Type 2 Diabetes in ChildrenTesting for Type 2 Diabetes in ChildrenTesting for Type 2 Diabetes in ChildrenTesting for Type 2 Diabetes in Children Criteria:Criteria:Criteria:Criteria:Criteria:Overweight:Overweight:Overweight:Overweight:Overweight: BMI > 85th percentile for age and sex; weight for height > 85th percentile; or weight>120th percentile of ideal weight for height

    Plus any two of the following risk factors:Plus any two of the following risk factors:Plus any two of the following risk factors:Plus any two of the following risk factors:Plus any two of the following risk factors: Family history of type 2 diabetes in first or second degree relative Race/ethnicity (American Indian, African-American, Hispanic, Asian/Pacific Islander) Signs of insulin resistance or conditions associated with insulin resistance (acanthosis

    nigricans, hypertension, dyslipidemia, polycystic ovary syndrome)

    Age of initiation: Age of initiation: Age of initiation: Age of initiation: Age of initiation:Age 10 years or at onset of puberty, if puberty occurs at a younger age

    Frequency: Frequency: Frequency: Frequency: Frequency:Test is recommended every two years

    Test: Test: Test: Test: Test:Fasting plasma glucose preferred

    Note: Clinical judgement should be used to test for diabetes in high-risk children who do notmeet these criteria.

    Reprinted with permission from: American Diabetes Association. Type 2 diabetes in children and adolescents.Diabetes Care. Vol. 23: 81-389. March, 2000.

  • 1414141414Issued Apri l , 2002

    NutritionNutritionNutritionNutritionNutrition

    Medical nutrition therapy is one of the cor-nerstone treatments of diabetes.Thegoals of nutrition therapy include: an ad-equate caloric and nutritional intake for optimal growthand development, and the proper balance of food,insulin and activity to achieve appropriate blood glu-cose levels.

    A meal plan is developed by the health care pro-vider to meet the individual needs of the studentwith diabetes, taking into consideration food prefer-ences, cultural influences, family eating patterns andschedules, weight, activity level, and insulin actionpeaks. The students health care provider will specifywhether the students nutritional plan affords themthe means of eating with flexibility and then calcu-late an insulin dose that is appropriate for their ap-petite or a plan which requires a controlled amountof carbohydrate at each meal. The meals andsnacks should be timed appropriately to coincidewith the peak effect of the students insulin. It isrecommended that students with diabetes see aRegistered Dietitian, who is also a Certified DiabetesEducator, once a year to discuss their meal plan.

    The Food Guide Pyramid The Food Guide Pyramid The Food Guide Pyramid The Food Guide Pyramid The Food Guide Pyramid is a guide for choos-ing healthy foods.

    There are 3 major nutrients found in the food groupsidentified on the Food Guide Pyramid: protein, fat, andcarbohydrate.

    Protein builds and repairs body tissues. Protein isimportant for normal growth and development.

    Over the years, many popular body building and weightloss regimens have overemphasized the role proteinplays in a healthy, well-balanced meal plan. It is notuncommon for individuals to turn to protein supple-ments in the forms of powders, shakes, and bars toboost their protein intake. It is important to note thatprotein needs for even vigorous athletes can be easilymet with everyday food sources. It is especially im-portant for students with diabetes to communicate withtheir health care provider if they are considering a pro-tein supplement or any other nutritional supplement,due to the potential impact supplements may have onblood sugar levels.

    Fats carry the flavor of our foods, and are a veryconcentrated source of energy for the body. Theyalso slow the time it takes for the stomach to emptyafter a meal.

    Food Group Sources of Fats:Food Group Sources of Fats:Food Group Sources of Fats:Food Group Sources of Fats:Food Group Sources of Fats: Meat and OthersMeat and OthersMeat and OthersMeat and OthersMeat and Others Fats and OilsFats and OilsFats and OilsFats and OilsFats and Oils Sugary FoodsSugary FoodsSugary FoodsSugary FoodsSugary Foods

    Food Group Sources of Protein:Food Group Sources of Protein:Food Group Sources of Protein:Food Group Sources of Protein:Food Group Sources of Protein: Meat and OthersMeat and OthersMeat and OthersMeat and OthersMeat and Others Milk and YogurtMilk and YogurtMilk and YogurtMilk and YogurtMilk and Yogurt

  • 1515151515Issued Apri l , 2002

    Carbohydrates provide most of the energy weneed to move, work and live. As such, the majority ofcalories consumed should come from carbohydratesources, spaced appropriately throughout the day. Ofall the food components, carbohydrates have the great-est effect on blood sugar. The total amount of carbo-hydrates consumed has more of an effect on bloodsugar than the type of carbohydrate.

    Food Group Sources of Carbohydrates:Food Group Sources of Carbohydrates:Food Group Sources of Carbohydrates:Food Group Sources of Carbohydrates:Food Group Sources of Carbohydrates: StarchesStarchesStarchesStarchesStarches FruitFruitFruitFruitFruit Milk and YogurtMilk and YogurtMilk and YogurtMilk and YogurtMilk and Yogurt Sugary FoodsSugary FoodsSugary FoodsSugary FoodsSugary Foods

    Meal planning for diabetes includes all the principles ofgood nutrition that are recommended for good health.Students with diabetes are encouraged to choose awell-balanced diet with an appropriate amount of car-bohydrate at each meal and snack in order to helpmanage blood sugar levels.

    Healthy carbohydrates from starches, fruits and milkare encouraged as part of the daily meal plan. Sweets(foods high in sugar and low in other nutrients) can beworked into a meal plan occasionally, as long as thecarbohydrates they contain are taken into account.

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    xobeciuj)ecnuo4(1 ekacpucllams1

    tiurfhserfeceip1 seikoocllams2

    srekcarclamina8 gniddupkcapkcans1

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    Carbohydrate information can be obtained from manysources, including the Food Guide Pyramid, food labels,and any number of books that contain the nutrientinformation of specific foods.

    Knowing the carbohydrate content of given foodsallows for more flexibility in the meal plan. One servingfrom the starch/grain, fruit, milk or sweets group con-tains 15 grams of carbohydrates. The following chartillustrates examples of foods that contain approximately15 grams of carbohydrates.

  • 1616161616Issued Apri l , 2002

    Food LabelsFood LabelsFood LabelsFood LabelsFood Labels

    Another method of determining how a food may fitinto the students daily meal plan is through the nutri-tion information found on the Nutrition Facts label.This label can help determine the appropriate portionsize to provide the right amount of carbohydrate neededat any given meal or snack. The sample nutrition factlabel for macaroni and cheese lists the Serving Size,Servings Per Container and Total Carbohydrate. Usingthis information, you can determine that, if the studentneeds to eat 30 grams of carbohydrate, and macaroniand heese is available, the student should have 1 cupmacaroni and cheese. (One cup is the serving size, thecontainer has two servings, total carbohydrate in oneserving is 31 g.)

    Special Nutrition IssuesSpecial Nutrition IssuesSpecial Nutrition IssuesSpecial Nutrition IssuesSpecial Nutrition IssuesSchool Parties:School Parties:School Parties:School Parties:School Parties:

    Field Trips:Field Trips:Field Trips:Field Trips:Field Trips:Students should carry convenient snacks when

    traveling away from school, on the bus and at fieldtrips. Bus drivers and chaperones should be notifiedthat the student has diabetes and may need to eat asnack on the bus or during the trip.

    After Care:After Care:After Care:After Care:After Care:The student should have a convenient snack avail-

    able if staying after school or attending after schoolactivities or programs. Notify school personnel that thestudent may need to eat during the session.

    School Meal Programs:School Meal Programs:School Meal Programs:School Meal Programs:School Meal Programs:Students with diabetes may participate in school meal

    programs. Families can review the school menu aheadof time and make modifications as needed. Familiesshould be encouraged to contact the school food ser-vice director to discuss any modifications or additionalfoods they might send to compliment the meal pro-vided.

    Sweets can be eaten on a special occasion such as abirthday party or Halloween Party. The carbohydratesshould be included as part of the students meal plan.The class might also consider planning the party snacksfor a time when the student normally needs a snack orbefore a physical activity. Some students will need tocheck their blood glucose before the snack (or start ofthe party) to determine what treat is appropriate. Par-ents/guardians of all students in the classroom shouldbe notified of the need to send appropriate servingsize items to ensure that all students can participate.

    Label for Macaroni and CheeseLabel for Macaroni and CheeseLabel for Macaroni and CheeseLabel for Macaroni and CheeseLabel for Macaroni and Cheese

    Adapted from Children with Diabetes: A Resource Guide forSchools. New York State Department of Health.

    Total Fat 12g

    Sodium 470mg

    Dietary Fiber 0g 0%Sugars 5g

    Protein 5gVitamin A 4%Vitamin C 2%Calcium 20%Iron 4%

    Nutrition FactsServing Size 1 cup (228g)Servings Per Container 2

    Calories 2,000 2,500Total Fat Less than 65g 80g Sat Fat Less than 20g 25gCholesterol Less than 300mg 300mgSodium Less than 2,400mg 2,400mgTotal Carbohydrate 300g 375g Dietary Fiber 26g 30g

    Cholesterol 30mg

    *Percent Daily Values are based on a 2,000 calorie diet. Your Daily Values may be higher or lower depending onyour calorie needs.

    Saturated Fat 3g

    Total Carbohydrate 31g

  • 1717171717Issued Apri l , 2002

    Physical ActivityPhysical ActivityPhysical ActivityPhysical ActivityPhysical Activity

    Children and teenagers are naturally active andplay is their work. Physical activity is an impor-tant part of the overall management of diabe-tes. The benefits of physical activity include cardiovas-cular fitness, long term weight control, improved insulinsensitivity, social interaction and the promotion of self-esteem fostered by team play. Additionally, physicalactivity can help to lower blood sugar.

    Physical activity is a fundamental part of a healthylife-style for all students including those with diabetes.Students with diabetes can participate in physical edu-cation class and after school sports. The studentsThe studentsThe studentsThe studentsThe studentshealth care providerhealth care providerhealth care providerhealth care providerhealth care provider will determine adjustments inmedication and food for appropriate blood glucose con-trol during physical activity. Families should be encour-aged to include more physical activity at home. Thephysical activity pyramid is a guide for increasing activ-ity. (See pages 18 and 19.)

    General Physical ActivityGeneral Physical ActivityGeneral Physical ActivityGeneral Physical ActivityGeneral Physical ActivityGuidelines:Guidelines:Guidelines:Guidelines:Guidelines:

    The student participating in sports or physicalactivity should do the following:

    1. Drink lots of sugar free fluids, especially water.2. Keep rapid acting carbohydrate sources

    available.3. Test blood sugar before, during and after

    physical activity, as ordered by the health careprovider.

    4. Wear diabetes ID.5. If low blood sugar is a problem after exercise,

    eat more carbohydrates or talk with the healthcare provider about reducing the amount ofinsulin taken prior to physical activity.

    Carbohydrate ReplacementCarbohydrate ReplacementCarbohydrate ReplacementCarbohydrate ReplacementCarbohydrate Replacementfor Physical Activityfor Physical Activityfor Physical Activityfor Physical Activityfor Physical Activity

    The blood sugar should be checked according to thestudents individual health care plan and proper mea-sures taken to keep the level in the appropriate range.The following chart illustrates actions that mightmightmightmightmight berecommended by the students health care providerto maintain a safe blood sugar during physical activity.

    According to the most recent position statement from the According to the most recent position statement from the According to the most recent position statement from the According to the most recent position statement from the According to the most recent position statement from the American Diabetes American Diabetes American Diabetes American Diabetes American Diabetes Association (Diabetes Care, Association (Diabetes Care, Association (Diabetes Care, Association (Diabetes Care, Association (Diabetes Care, Volume 23,Volume 23,Volume 23,Volume 23,Volume 23,Supplement 1, January 2001) regarding exercise and control of blood sugars, the following guidelines should be adopted:Supplement 1, January 2001) regarding exercise and control of blood sugars, the following guidelines should be adopted:Supplement 1, January 2001) regarding exercise and control of blood sugars, the following guidelines should be adopted:Supplement 1, January 2001) regarding exercise and control of blood sugars, the following guidelines should be adopted:Supplement 1, January 2001) regarding exercise and control of blood sugars, the following guidelines should be adopted:

    Avoid exercise if fasting glucose levels are >250 mg/dl and ketones are present, and use caution ifglucose levels are >300 and no ketones are present.

    Eat additional carbohydrates if glucose levels are

  • 1818181818Issued Apri l , 2002

    Student Physical Activity ScheduleStudent Physical Activity ScheduleStudent Physical Activity ScheduleStudent Physical Activity ScheduleStudent Physical Activity Schedule

    SundaySundaySundaySundaySunday

    MondayMondayMondayMondayMonday

    TuesdayTuesdayTuesdayTuesdayTuesday

    WednesdayWednesdayWednesdayWednesdayWednesday

    ThursdayThursdayThursdayThursdayThursday

    FridayFridayFridayFridayFriday

    SaturdaySaturdaySaturdaySaturdaySaturday

  • 1919191919Issued Apri l , 2002

    Student Activity PyramidStudent Activity PyramidStudent Activity PyramidStudent Activity PyramidStudent Activity Pyramid

    CUT DOWN ON

    T.V. watchingVideo/computer gamesSitting more than 30 min. at a time

    Leisure & Playtime Strength & FlexibilitySwingingCanoeingTumblingMiniature

    Golf

    Push-ups/pull-upsMartial artsDancingRope climbing

    Aerobic Exercises(at least 20 minutes)

    Roller bladingBikingSkateboardingRope climbing

    SwimmingRunning

    Recreational activities(at least 20 minutes)

    VolleyballBasketballSoccerSkiing

    KickballRelay races

    Play outsideTake the stairs instead of the elevatorHelp around the house or yard

    Pick up your toysWalk to the storeGo for a walk

    EVERYDAY

    3-5 TIMES A WEEK

    2-3 TIMES A WEEK

    Source: 2000 University of Missouri. Published by University Extension, University of Missouri-Columbia.http:/muextension.missouri.edu/xplor

  • 2020202020Issued Apri l , 2002

    Physical Activity Special Issues:Physical Activity Special Issues:Physical Activity Special Issues:Physical Activity Special Issues:Physical Activity Special Issues:

    Treatment:Treatment:Treatment:Treatment:Treatment:

    1 Test blood sugar after physical activity, before bedtime and even during the night, as ordered by thehealth care provider.

    2 Ensure that a snack, which includes carbohydrate and protein, is eaten before bedtime, as recom-mended by the health care provider.

    Snack Choices for Physical ActivitySnack Choices for Physical ActivitySnack Choices for Physical ActivitySnack Choices for Physical ActivitySnack Choices for Physical Activity15 grams carbohydrate:15 grams carbohydrate:15 grams carbohydrate:15 grams carbohydrate:15 grams carbohydrate:

    1 - 4 ounce juice box1 - 4 ounce juice box1 - 4 ounce juice box1 - 4 ounce juice box1 - 4 ounce juice box1 cup Gatorade1 cup Gatorade1 cup Gatorade1 cup Gatorade1 cup Gatorade

    1 sliced orange or apple1 sliced orange or apple1 sliced orange or apple1 sliced orange or apple1 sliced orange or apple1 small box raisins1 small box raisins1 small box raisins1 small box raisins1 small box raisins6 saltine crackers6 saltine crackers6 saltine crackers6 saltine crackers6 saltine crackers1 cup light yogurt1 cup light yogurt1 cup light yogurt1 cup light yogurt1 cup light yogurt

    3/4 cup dry unsweetened cereal3/4 cup dry unsweetened cereal3/4 cup dry unsweetened cereal3/4 cup dry unsweetened cereal3/4 cup dry unsweetened cereal

    30 grams carbohydrate:30 grams carbohydrate:30 grams carbohydrate:30 grams carbohydrate:30 grams carbohydrate:1 cereal bar1 cereal bar1 cereal bar1 cereal bar1 cereal bar

    1 - 8 ounce juice box1 - 8 ounce juice box1 - 8 ounce juice box1 - 8 ounce juice box1 - 8 ounce juice box2 slices bread2 slices bread2 slices bread2 slices bread2 slices bread1 small bagel1 small bagel1 small bagel1 small bagel1 small bagel

    45-50 grams carbohydrate45-50 grams carbohydrate45-50 grams carbohydrate45-50 grams carbohydrate45-50 grams carbohydrateplus protein:plus protein:plus protein:plus protein:plus protein:

    1 sports nutrition bar1 sports nutrition bar1 sports nutrition bar1 sports nutrition bar1 sports nutrition bar1 package (6) cheese or peanut butter sandwich crackers plus 4 oz. juice1 package (6) cheese or peanut butter sandwich crackers plus 4 oz. juice1 package (6) cheese or peanut butter sandwich crackers plus 4 oz. juice1 package (6) cheese or peanut butter sandwich crackers plus 4 oz. juice1 package (6) cheese or peanut butter sandwich crackers plus 4 oz. juice

    Protein Sources:Protein Sources:Protein Sources:Protein Sources:Protein Sources:Peanut ButterPeanut ButterPeanut ButterPeanut ButterPeanut Butter

    Sliced or String CheeseSliced or String CheeseSliced or String CheeseSliced or String CheeseSliced or String CheeseLunch MeatLunch MeatLunch MeatLunch MeatLunch Meat

    EggEggEggEggEggPeanuts, Walnuts or AlmondsPeanuts, Walnuts or AlmondsPeanuts, Walnuts or AlmondsPeanuts, Walnuts or AlmondsPeanuts, Walnuts or Almonds

    A low blood sugar can occur long afterA low blood sugar can occur long afterA low blood sugar can occur long afterA low blood sugar can occur long afterA low blood sugar can occur long aftera physical activity session.a physical activity session.a physical activity session.a physical activity session.a physical activity session.

  • 2121212121Issued Apri l , 2002

    Blood Sugar MonitoringBlood Sugar MonitoringBlood Sugar MonitoringBlood Sugar MonitoringBlood Sugar Monitoring

    Blood sugar (glucose) monitoring is a necessaryand useful tool in the management of diabetes.Monitoring helps detect patterns of blood sugarvalues as well as in identifying acute problems of highor low blood sugar. Students with an intensivemanagement plan monitor their blood sugar before allmeals to help them decide how much insulin to take.

    There are numerous brands of monitors available,each with specific features that a student may finduseful. School health personnel need to become familiarwith the various monitors being used. In Illinois, mostinsurance companies cover the costof monitors for persons with type 1,type 2 and gestational diabetes,regardless of whether or not they useinsulin.

    What is a normal blood sugar level?What is a normal blood sugar level?What is a normal blood sugar level?What is a normal blood sugar level?What is a normal blood sugar level?

    For a person who does not have diabetes, a normalblood sugar level is 70-120 mg/dl. Blood sugar levels ina student with diabetes will vary depending on insulinaction times, food consumed, and activity level.

    The diabetes health care professional will advise thestudents family of an appropriate target range forthe blood sugar level, and the necessary action to takewhen blood sugar levels are outside of this range. Theprofessional will also specify how often the blood sugarshould be checked.

    Points Points Points Points Points to Considerto Considerto Considerto Considerto Consider

    Allow the student to assist in the steps of themonitoring procedure. The amount ofinvolvement will depend upon the age of thestudent, their individual development andpersonality. Even small children can help withsome of the steps, such as choosing thefinger or getting the strip out of the container.

    Be positive when referring to blood sugarlevels. Values are either within range orout of range which can be called high orlow, rather than good or bad. Use anon-judgmental approach when a result isabnormal.

    If the blood sugar reading is unusually highor unusually low, repeat the test. Treat forhyperglycemia or hypoglycemia according tothe second test result.

    Criteria for DeterminingCriteria for DeterminingCriteria for DeterminingCriteria for DeterminingCriteria for DeterminingAppropriateness ofAppropriateness ofAppropriateness ofAppropriateness ofAppropriateness of

    Self-Testing Blood SugarSelf-Testing Blood SugarSelf-Testing Blood SugarSelf-Testing Blood SugarSelf-Testing Blood Sugarat Schoolat Schoolat Schoolat Schoolat School

    The student demonstrates accurate bloodsugar testing technique (as outlined onp 22.)

    The student consistently uses appropriateinfection control practices.

    The student appropriately disposes ofsharps.

    The student is able to interpret bloodsugar results and institute appropriatetreatment if necessary.

  • 2222222222Issued Apri l , 2002

    Blood Sugar TestingBlood Sugar TestingBlood Sugar TestingBlood Sugar TestingBlood Sugar Testing

    PreparationPreparationPreparationPreparationPreparation

    1. Gather supplies and prepare work surface.

    2. Ready the blood glucose meter and stripaccording to the manufacturers instructions.

    3. The student washes hands in warm, soapywater.

    4. If assisting in the procedure, wash your ownhands and put on gloves.

    5. Load the lancet into the lancet device.

    ProcedureProcedureProcedureProcedureProcedure

    6. Select a site on the side of any fingertip.

    7. The student stands with his/her arm belowthe level of the heart for 30 seconds.

    8. Puncture the site with the lancet.

    9. Gently massage from wrist to palm to fingerwith a downward motion to form an adequatedrop of blood. (Do not squeeze the fingertoo tightly.)

    10. Apply the drop of blood to the target site onthe strip, being sure the target site is cov-ered by blood and not smeared. Mostmeters begin testing when blood is detectedon the strip. Review and follow themanufacturers instruction book.

    Provided by parent/guardianProvided by parent/guardianProvided by parent/guardianProvided by parent/guardianProvided by parent/guardian Alcohol wipes Lancet device Ultrafine lancets Blood glucose meter Meter owners guide Blood glucose testing strips-use the kind

    specifically required for students meter Communication log

    11. Gently, but firmly, apply a tissue or cotton ballto the puncture site. Apply bandaid as needed.

    Clean UpClean UpClean UpClean UpClean Up

    12. Carefully remove the lancet from the lancetdevice and discard in a sharps container.

    Do not reuse lancets!Do not reuse lancets!Do not reuse lancets!Do not reuse lancets!Do not reuse lancets!

    13. Discard the tissues, cotton balls, and other pa-per products in plastic-lined covered trash can.

    14. Wash and sanitize the area. Use soapy waterfollowed by a 1:10 bleach/water solution.

    15. Remove gloves.

    DocumentationDocumentationDocumentationDocumentationDocumentation

    16. Record result in the daily procedure log and inthe students communication book.The result is recorded as ____mg/dl.(Example: 60 mg/dl)

    17. Refer to the students Care Plan Care Plan Care Plan Care Plan Care Plan to determineif action is needed, such as: Give snack or meal or fast acting glucose. Give dose of insulin. Call parent or guardian. Call emergency medical services (911).

    18. Return supplies to storage. Advise parent orguardian of supplies that need to be replenished.Allow at least one weeks notice.

    EquipmentEquipmentEquipmentEquipmentEquipmentProvided by schoolProvided by schoolProvided by schoolProvided by schoolProvided by school Latex or vinyl gloves-do not have to be

    sterile Tissues or cotton balls Disposable container for lancet and strip Procedure log and pen 1:10 bleach/water solution

    (1 part bleach to 10 parts water) Bandaids

  • 2323232323Issued Apri l , 2002

    HypoglycemiaHypoglycemiaHypoglycemiaHypoglycemiaHypoglycemia

    Hypoglycemia: Low BloodHypoglycemia: Low BloodHypoglycemia: Low BloodHypoglycemia: Low BloodHypoglycemia: Low BloodSugar (Insulin Reaction)Sugar (Insulin Reaction)Sugar (Insulin Reaction)Sugar (Insulin Reaction)Sugar (Insulin Reaction)

    Warning signs and symptoms of low blood sugar (in-sulin reaction) happen suddenly. Signs and symptomscan easily be mistaken for misbehavior. The studentmay or may not be able to recognize symptoms devel-oping. The severity of a low blood sugar reaction mayrapidly progress from mild to severe if untreated.

    Severe reactions are often preventable by early de-tection and treatment of low blood sugars. Be familiarwith identification and treatment of low blood sugar toavert an emergency situation. Blood sugar can go toolow if the student with diabetes has:

    Taken too much insulin

    Not eaten enough food

    Had extra exercise without extra food or

    decrease in insulin

    If the student appears to be having signs or symp-toms, check blood sugar immediately. If the bloodsugar level cannot be determined, go ahead and treatthe symptoms.

    Never send a student suspected of having a lowNever send a student suspected of having a lowNever send a student suspected of having a lowNever send a student suspected of having a lowNever send a student suspected of having a lowblood sugar to the health service office alone!blood sugar to the health service office alone!blood sugar to the health service office alone!blood sugar to the health service office alone!blood sugar to the health service office alone!Send another student to get help if needed.Send another student to get help if needed.Send another student to get help if needed.Send another student to get help if needed.Send another student to get help if needed.

    Hypoglycemia-blood sugar between 50Hypoglycemia-blood sugar between 50Hypoglycemia-blood sugar between 50Hypoglycemia-blood sugar between 50Hypoglycemia-blood sugar between 50

    and 70 mg/dland 70 mg/dland 70 mg/dland 70 mg/dland 70 mg/dlSigns and Symptoms - A wide variety of symptoms

    and behaviors can occur Change in personality Acting quiet and withdrawn

    Being stubborn or restless

    Tantrums or sudden rage

    Confusion

    Inappropriate emotional responses (laughter,

    crying)

    Poor concentration or day dreaming

    Shakiness, dizziness, lightheadedness

    Lack of response to verbal communication

    Sweatiness

    Headache

    TreatmentTreatmentTreatmentTreatmentTreatment

    Optimally, check blood sugar before treating a stu-dent suspected of hypoglycemia. When in doubt -treat. To treat, give the student some quick-actingsugar (see chart on p.27 for age appropriate amounts)such as one of the following:

    cup (4 oz.) of fruit juice (grape juice) 3/4 cup (6 oz.) of REGULAR (not diet) soda 3-4 glucose tablets 1 cup (8 oz.) sports drink

    Check the blood sugar 15 minutes after treatment.If the blood sugar result is less than 70 mg/dl, or if thestudent still has symptoms, repeat the quick sugartreatment and blood sugar testing cycle until thestudent is symptom-free and the blood sugar result isabove 70 mg/dl.

    When the student feels better and the blood sugarresult is above 70 mg/dl, give one (1) of the followingfoods if the students next meal is more than 1 houraway and/or the student will be participating in activeplay/sports following this low blood sugar episode:

    4 graham cracker squares with 2 tablespoonspeanut butter or 1 ounce cheese,

    6 saltine crackers with 2 tablespoons peanutbutter or 1 ounce cheese,

    or or or or or the equivalent combination of carbohydrate(approximately 15 grams) and protein(approximately 1 oz.).

    The student may return to class after the blood sugaris above 70 mg/dl and he/she no longer has symp-toms.

  • 2424242424Issued Apri l , 2002

    Glucagon is a hormone which helps the liver releasesugar, thus increasing the level of sugar in the blood. Itmust be injected with a syringe into the skin, like insulin.

    When To Use Glucagon

    Glucagon is administered when the student has lowblood sugar and is unable to take liquid or food bymouth because of severe sleepiness, unconsciousness,or seizure activity. Check the students health care planfor orders from the health care provider about the useof glucagon.

    What is Glucagon?

    What You Need Glucagon Emergency Kit.

    The parent or guardian will need a prescriptionto purchase the kit at a pharmacy. It is recom-mended that the student have one kit for homeand a second kit for school.

    Use of glucagon should be part of a studentshealth care plan and be supplied to the schoolby the parent or guardian with accompanyingphysician order.

    Keep glucagon at room temperature in acentral location. Inform appropriate staff ofthe location of the kit.

    When possible, practice drawing up glucagon withan expired kit.

    Check the expiration date of the glucagon kit ona regular basis. Inform parents when it is closeto the expiration date and ask them to obtain areplacement kit for school prior to that date.Dispose of the expired kit appropriately.

    Hypoglycemia-blood sugarHypoglycemia-blood sugarHypoglycemia-blood sugarHypoglycemia-blood sugarHypoglycemia-blood sugar

    40 mg/dl or less40 mg/dl or less40 mg/dl or less40 mg/dl or less40 mg/dl or less

    Signs and Symptoms Staggering walk

    Pale appearance

    Uncontrollable crying episode

    Slurred speech

    Blank stare

    Inability or refusal to take anything by mouth

    TreatmentTreatmentTreatmentTreatmentTreatment

    Double the treatment amounts indicated in the treat-ment for hypoglycemia with blood glucose 50-70 mg/dl. If the student has difficulty drinking but is able toswallow (student may not be able to follow directions,)place cake gel or glucose gel in between the studentscheek and gums. Administer the entire tube. Rub thecheek gently to make sure sugar is being absorbed.Check the blood sugar every 15 minutes until normal.Follow with food if more than 30 minutes until nextmeal or snack.

    When Possible, Check a BloodSugar Before and/or

    After Giving Glucagon.

    If the student becomes:If the student becomes:If the student becomes:If the student becomes:If the student becomes:UUUUUNCONSCIOUSNCONSCIOUSNCONSCIOUSNCONSCIOUSNCONSCIOUSUUUUUNRESPONSIVENRESPONSIVENRESPONSIVENRESPONSIVENRESPONSIVE

    DDDDDISPLAYSISPLAYSISPLAYSISPLAYSISPLAYS CONVULSIONCONVULSIONCONVULSIONCONVULSIONCONVULSION-----LIKELIKELIKELIKELIKE MOVEMENTMOVEMENTMOVEMENTMOVEMENTMOVEMENT

    This is a MedicalThis is a MedicalThis is a MedicalThis is a MedicalThis is a MedicalEmergency!!!Emergency!!!Emergency!!!Emergency!!!Emergency!!!

    Treat Immediately:Treat Immediately:Treat Immediately:Treat Immediately:Treat Immediately: Be sure the student is lying down in a safe

    area protected from head and bodily injury. Position the student on his/her side. Inject glucagon per medical order. Call for emergency medical assistance. Do not attempt to put anything between the

    teeth. As the student regains consciousness, nau-

    sea and vomiting may occur. Notify parent/guardian, school administrator,

    and/or diabetes team as soon as possible.

  • 2525252525Issued Apri l , 2002

    CAUTIONCAUTIONCAUTIONCAUTIONCAUTION1. I1. I1. I1. I1. If the student does not awaken within about 15 minutes, give another dose off the student does not awaken within about 15 minutes, give another dose off the student does not awaken within about 15 minutes, give another dose off the student does not awaken within about 15 minutes, give another dose off the student does not awaken within about 15 minutes, give another dose of

    glucagon and CALL 911 IMMEDIATELY.glucagon and CALL 911 IMMEDIATELY.glucagon and CALL 911 IMMEDIATELY.glucagon and CALL 911 IMMEDIATELY.glucagon and CALL 911 IMMEDIATELY.

    2 .2 .2 .2 .2 . Low blood glucose may cause convulsions.Low blood glucose may cause convulsions.Low blood glucose may cause convulsions.Low blood glucose may cause convulsions.Low blood glucose may cause convulsions.

    3. When an unconscious student awakens, he/she may vomit. To prevent the student3. When an unconscious student awakens, he/she may vomit. To prevent the student3. When an unconscious student awakens, he/she may vomit. To prevent the student3. When an unconscious student awakens, he/she may vomit. To prevent the student3. When an unconscious student awakens, he/she may vomit. To prevent the student

    from choking on vomit, turn the student on their side.from choking on vomit, turn the student on their side.from choking on vomit, turn the student on their side.from choking on vomit, turn the student on their side.from choking on vomit, turn the student on their side.

    Notify parents/guardians and school administrator of the episode as soon as possible.Notify parents/guardians and school administrator of the episode as soon as possible.Notify parents/guardians and school administrator of the episode as soon as possible.Notify parents/guardians and school administrator of the episode as soon as possible.Notify parents/guardians and school administrator of the episode as soon as possible.

    TO ADMINISTER GLUCAGONTO ADMINISTER GLUCAGONTO ADMINISTER GLUCAGONTO ADMINISTER GLUCAGONTO ADMINISTER GLUCAGON1 .1 .1 .1 .1 . Using the same syringe that contained the glucagon dilutant, draw up an appropriateUsing the same syringe that contained the glucagon dilutant, draw up an appropriateUsing the same syringe that contained the glucagon dilutant, draw up an appropriateUsing the same syringe that contained the glucagon dilutant, draw up an appropriateUsing the same syringe that contained the glucagon dilutant, draw up an appropriate

    dose of the solution from the vial based on the weight of the student and orders fromdose of the solution from the vial based on the weight of the student and orders fromdose of the solution from the vial based on the weight of the student and orders fromdose of the solution from the vial based on the weight of the student and orders fromdose of the solution from the vial based on the weight of the student and orders from

    the health care provider.the health care provider.the health care provider.the health care provider.the health care provider.

    2 .2 .2 .2 .2 . The glucagon syringe is marked with only 2 dosages--0.5 mg and 1.0 mg. The recom-The glucagon syringe is marked with only 2 dosages--0.5 mg and 1.0 mg. The recom-The glucagon syringe is marked with only 2 dosages--0.5 mg and 1.0 mg. The recom-The glucagon syringe is marked with only 2 dosages--0.5 mg and 1.0 mg. The recom-The glucagon syringe is marked with only 2 dosages--0.5 mg and 1.0 mg. The recom-

    mended manufacturers dose of glucagon to inject is:mended manufacturers dose of glucagon to inject is:mended manufacturers dose of glucagon to inject is:mended manufacturers dose of glucagon to inject is:mended manufacturers dose of glucagon to inject is:

    0.5 mg for a student 50 pounds or under, or0.5 mg for a student 50 pounds or under, or0.5 mg for a student 50 pounds or under, or0.5 mg for a student 50 pounds or under, or0.5 mg for a student 50 pounds or under, or

    1.0 mg for a student over 50 pounds.1.0 mg for a student over 50 pounds.1.0 mg for a student over 50 pounds.1.0 mg for a student over 50 pounds.1.0 mg for a student over 50 pounds.

    3 .3 .3 .3 .3 . Cleanse injection site on buttock, arm, or thigh with alcohol swab.Cleanse injection site on buttock, arm, or thigh with alcohol swab.Cleanse injection site on buttock, arm, or thigh with alcohol swab.Cleanse injection site on buttock, arm, or thigh with alcohol swab.Cleanse injection site on buttock, arm, or thigh with alcohol swab.

    4 .4 .4 .4 .4 . Insert the needle into the loose tissue under the cleansed injection site and inject theInsert the needle into the loose tissue under the cleansed injection site and inject theInsert the needle into the loose tissue under the cleansed injection site and inject theInsert the needle into the loose tissue under the cleansed injection site and inject theInsert the needle into the loose tissue under the cleansed injection site and inject the

    glucagon solution. Withdraw the needle and apply light pressure at the injection site.glucagon solution. Withdraw the needle and apply light pressure at the injection site.glucagon solution. Withdraw the needle and apply light pressure at the injection site.glucagon solution. Withdraw the needle and apply light pressure at the injection site.glucagon solution. Withdraw the needle and apply light pressure at the injection site.

    5 .5 .5 .5 .5 . Keep the student lying on his/her side in case of vomiting.Keep the student lying on his/her side in case of vomiting.Keep the student lying on his/her side in case of vomiting.Keep the student lying on his/her side in case of vomiting.Keep the student lying on his/her side in case of vomiting.

    6 .6 .6 .6 .6 . The blood sugar should rise at least 50-75 mg/dl within 15-20 minutes.The blood sugar should rise at least 50-75 mg/dl within 15-20 minutes.The blood sugar should rise at least 50-75 mg/dl within 15-20 minutes.The blood sugar should rise at least 50-75 mg/dl within 15-20 minutes.The blood sugar should rise at least 50-75 mg/dl within 15-20 minutes.FEED FEED FEED FEED FEED THE STUDENTTHE STUDENTTHE STUDENTTHE STUDENTTHE STUDENT AS SOON AS SOON AS SOON AS SOON AS SOON AS HE/SHE AS HE/SHE AS HE/SHE AS HE/SHE AS HE/SHE AAAAAWWWWWAKENS AKENS AKENS AKENS AKENS AND IS AND IS AND IS AND IS AND IS ABLE ABLE ABLE ABLE ABLE TO SWTO SWTO SWTO SWTO SWALLOW.ALLOW.ALLOW.ALLOW.ALLOW.

    1996 by Joslin Diabetes Center. Adapted and reprinted with permission from Caring for Children Living with Diabetes, published byJoslin Diabetes Center, Boston, Ma. All rights reserved.

    TO PREPARE GLUCAGON FOR INJECTIONTO PREPARE GLUCAGON FOR INJECTIONTO PREPARE GLUCAGON FOR INJECTIONTO PREPARE GLUCAGON FOR INJECTIONTO PREPARE GLUCAGON FOR INJECTIONNOTE:NOTE:NOTE:NOTE:NOTE: Glucagon should not be prepared for injection until the emergency arises.Glucagon should not be prepared for injection until the emergency arises.Glucagon should not be prepared for injection until the emergency arises.Glucagon should not be prepared for injection until the emergency arises.Glucagon should not be prepared for injection until the emergency arises.

    1.1.1.1.1. Glucagon is available in a kit containing the glucagon powder/pellet in a vial (bottle) and theGlucagon is available in a kit containing the glucagon powder/pellet in a vial (bottle) and theGlucagon is available in a kit containing the glucagon powder/pellet in a vial (bottle) and theGlucagon is available in a kit containing the glucagon powder/pellet in a vial (bottle) and theGlucagon is available in a kit containing the glucagon powder/pellet in a vial (bottle) and the

    dilutant in a syringe.dilutant in a syringe.dilutant in a syringe.dilutant in a syringe.dilutant in a syringe.

    2.2.2.2.2. Check the date of the glucagon kit. Discard if past the expiration date.Check the date of the glucagon kit. Discard if past the expiration date.Chec


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