Walton County School District Diabetes Training for Transportation By Cheryl Tillman, RN WCSD Lead Nurse 7/2012
Diabetes What is Diabetes?Diabetes is a serious, chronic disease that impairs the body’s ability to use food. Diabetes must be managed 24 hours a day in order to avoid the potentially life-threatening consequences of blood glucose levels that are either too high(hyperglycemia) or too low(hypoglycemia)
Two types of Diabetes• Type 1 Diabetes• Type 2 Diabetes
Type 1 Diabetes• Type 1 Diabetes: the pancreas stops producing insulin. Type 1 requires daily insulin injections for survival.• It can occur at any age but typically starts in children or young adults.• The cause is unknown but research indicates it may involve a disorder in the functioning of the body’s immune system.• In Type 1 Diabetes the body destroys its own insulin- producing beta cells.
Type 2 Diabetes• In Type 2 Diabetes the body still produces insulin, but the body does not use the insulin normally• The body does not adequately convert carbohydrates into the energy the body needs.• Usually develops in adults over 40; however there is an increasing incidence of newly diagnosed Type 2 Diabetes in the youth of the United States.
Factors for Developing Type 2 Diabetes• Obesity• Physical inactivity• Family history of Type 2 Diabetes• Exposure to diabetes in utero• Non-European origin (Hispanic, African-American, Native American)• Signs of insulin resistance called acanthosis nigricans(dark, velvety patches on the skin around the neck or armpits)
Symptoms of Hyperglycemia High Blood Sugar • Frequent urination • Excessive thirst • Dry, hot skin • Abdominal pain • Chest pain • Drowsiness, lethargy • Increased hunger • Weight loss • Fatigue • Slow, healing wounds • Fruity, sweet or wine-like odor on breath • Stupor, unconsciousness • Seizure • Death
Causes of Hyperglycemia • Too little insulin or other glucose lowering medication • Food intake that has not been covered adequately by insulin • Decreased physical activity • Illness • Infection • Injury • Severe physical or emotional stress • Pump malfunction
Treatment of Hyperglycemia• Check blood glucose level• Glucometer: a small machine that records blood glucose• Finger prick for blood to be applied to strip inserted in glucometer• Administer insulin dose according to medical plan• Encourage person to drink more fluids
Hyperglycemia• Check blood glucose/sugar level• If sugar is over 300, check for ketones• Ketones are substances made when the body breaks down fat for energy• To check for ketones:wash hands, put on gloves; apply urine sample to strip and follow directions and chart on ketone bottle• If ketones are present, the person needs medical attention• Follow sliding scale for insulin dosages• After procedure, remove gloves, dispose of gloves,wash hands
Causes of Hypoglycemia• Too much insulin• Missing or delaying meals/snacks• Not eating enough food; carbohydrates• Getting extra, intense or unplanned physical activity• Illness especially a gastrointestinal illness
Treatment of Hypoglycemia• Hypoglycemia or low blood sugar/glucose, a level below 70, is an EMERGENCY• Check blood glucose level with a glucometer• Treat at once with fast acting carbohydrate such as 3-4 glucose tablets, fruit juice or regular soda; follow with some type of protein• Monitor glucose levels every 15 minutes until level returns above 70• Never leave a person with a low blood glucose level alone• Always treat for low blood sugar levels if unsure whether is low or high• Follow the student’s medical care plan for treatment guidelines• Administer glucagon if person is unconscious and unable to swallow; Glucagon is only given if blood glucose is low and person is unconscious
Signs to watch for• Erratic behavior, such as aggression, abnormal hostility or profanity, could indicate abnormal blood sugar levels.• Low blood sugar levels require food or drink immediately.• Unusual complaints of thirst, needing to use the restroom, extreme drowsiness, all could indicate abnormal blood sugar levels.
Diabetic Ketoacidosis• DKA results from untreated hyperglycemia• Hyperglycemia is considered an emergency if symptoms of DKA occur• Symptoms of DKA: nausea, vomiting, deep breathing, decreasing levels of consciousness; coma
Treatment of DKA• Can generally be reversed by providing adequate insulin and fluids over time• Check ketones• Monitor blood glucose levels• Administer insulin according to medical care plan