What is diabetes?
-
Diabetes is a disorder that affects the way the body uses or converts food for energy and growth.
-
There are 2 types of diabetes.
-
Type 1 diabetes is a disease in which the immune system destroys the cells in the pancreas that make insulin. Insulin is the hormone that helps our bodies metabolize sugar. Children with type 1 diabetes need to take insulin injections to live.
-
Type 2 diabetes is a condition in which the pancreas produces insulin, but the body cannot use it, often because of obesity; this is known as insulin resistance.
-
-
Both types of diabetes cause glucose, or sugar, to build up in the blood. This glucose can’t be used by the body as fuel. The body excretes the excess sugar in the urine, causing increased urination.
How common is it?
-
Diabetes affects 20.8 million people in the United States, or about 7% of the population.
-
Type 1 diabetes is most common in children, with about 3 million affected. About 1 in 500 US children have type 1 diabetes.
-
Type 2 diabetes typically develops in people after age 40, but can be seen earlier. It has recently begun to appear more frequently in children, especially among children who are obese.
What are some characteristics of children with diabetes?
-
Symptoms of diabetes can include excessive thirst, frequent urination, increased appetite with weight loss, fatigue, or lethargy. Sudden onset of unexplained wetting (incontinence) is also a warning sign to check for diabetes.
-
Children with type 1 diabetes can develop
diabetic ketoacidosis (DKA), a condition in which their blood glucose is extremely high. A dangerous electrolyte imbalance accompanies the child’s high blood glucose. Children in DKA may have vomiting, dehydration, a “fruity” smell to their breath, labored breathing, and progression to unconsciousness and death if not treated. -
Type 2 diabetes generally has a slower and more gradual onset of the same symptoms caused by high sugar levels. Sometimes type 2 diabetes has no symptoms in children and adults.
-
Short-term complications of diabetes are related to blood sugars being too high or too low.
-
Long-term complications include vision problems, early heart disease, poor wound healing, high blood pressure, nerve damage, and kidney failure.
-
Children with diabetes need exercise and a healthy diet as part of their treatment. They should be given the same opportunities to participate in child care and school activities but may need some adjustment of their insulin or food to accommodate changes in activity.
Who is the treatment team?
-
A pediatric endocrinologist and dietitian often direct the medical management of children with diabetes in association with diabetes nurse educators.
-
Often, but not always, there are social workers or psychologists working with such multidisciplinary teams. These professionals may serve as a resource for information or training for your program.
What are some elements of a Care Plan for diabetes?
-
All children with diabetes should have an individualized health Care Plan in place before the start of the school year or prior to entrance into child care.
-
Following are components of a plan for type 1 diabetes.
-
Managing diabetes requires frequent finger-stick blood tests (to check for blood glucose levels), diet adjustments, and insulin injections. Most children with type 1 diabetes receive their insulin by injections. Some others use a mechanical insulin pump with a plastic catheter placed under their skin.
-
The Care Plan should include
-
When finger sticks should be checked and how the testing material should be disposed of safely.
-
What blood sugar range is expected for the child and what actions should be taken immediately if the blood sugar is abnormally high or low.
-
Where and how insulin injections are given. Ideally there should be a written plan to describe how to adjust insulin doses, how to recognize and treat low blood sugars, and when to call for parental or diabetes-team assistance.
-
What are typical symptoms of hyperglycemia (blood sugar too high) or hypoglycemia (blood sugar too low) for this child.
-
The type, frequency, and amount of insulin used. Insulin comes in long- and short-acting varieties that are frequently used together. During the day, most children require only premeal or pre-snack doses of the fast-acting insulin.
-
Be sure all staff who will care for the child go over the Care Plan with the child’s parents/guardians, and keep foods that will correct low blood glucose levels available at all times (eg, juice, glucose tablets or gels).
-
Close communication with parents/guardians is essential. The program staff or school nurse should keep a log of the child’s blood glucose levels and ask parents/guardians to keep the program informed of blood sugars at home. Parents/guardians should be able to provide logbooks and can work with the program staff to develop a successful communication process.
-
There should be a written plan concerning how to respond to a low or high blood glucose level, and how to reach parents and the pediatric diabetes team for further advice or assistance.
-
-
What adaptations may be needed?
Medications
-
Children with type 1 diabetes receive insulin injections to control the disorder. More detailed information is listed under “What are some elements of a Care Plan for diabetes?”.
-
Children with type 2 diabetes are usually on oral medications to control their blood sugar, but sometimes also receive insulin.
-
Glucagon is an emergency medication, usually given by injection, that can raise the blood glucose level in an emergency when the child has a critically low glucose level.
Dietary considerations
-
Talk to parents/guardians or a registered dietitian/nutritionist to help plan the child’s meals. A written copy of the child’s meal plan should be available so that the entire staff is aware of the child’s food and snack needs.
-
Have parents suggest or supply foods for their child that can be given during class celebrations or birthdays. Be creative about using activities as rewards rather than sweets for all children but especially for the child with diabetes.
-
Children with type 2 diabetes are often overweight and may be on a special lower calorie diet.
-
Develop strategies for accommodating children with diabetes. Suggestions include
-
Learn about the symptoms of low blood sugar and high blood sugar in children, and know what to do about these symptoms.
-
Know what causes low blood sugar. A child may develop low blood sugar if a meal or snack is delayed, if her physical activity is higher than normal, or if she does not eat enough food to match the insulin given. Hypoglycemia is rarely seen in Type 2 diabetes.
-
Symptoms of low blood sugar include hunger, shakiness, confusion, vomiting, headache, irritability, or sleepiness.
-
Severe low blood sugar (hypoglycemia) can occur if such symptoms are undetected and might cause loss of consciousness or seizures. Severe hypoglycemia is a medical emergency and requires glucagon injection and specialty medical assistance. Most low blood sugar levels can be avoided by frequent blood glucose monitoring and awareness of the early signs and symptoms of hypoglycemia by the adults caring for these children.
-
Orange juice, granulated sugar, jam, or jelly can be given to quickly raise the child’s blood sugar.
-
Glucagon emergency injections are also available for treatment of severe low blood sugar (hypoglycemia) if the child is unable to drink or eat.
-
-
Know what causes high blood sugar. A child may develop high blood sugar if he is ill or extremely emotionally upset, has not been active, has missed an insulin injection, or has eaten too much food of any kind but especially too many carbohydrates.
-
Symptoms of high blood sugar include frequent urination, thirst, and stomachache.
-
If you suspect high blood sugar, you should check blood glucose levels with a finger stick. If levels are high, drinking water or sugar-free liquid may help. Check the child’s Care Plan for other details about interventions such as additional insulin.
-
-
Physical environment
Physical activity is important to the health of children with type 2 diabetes, so outdoor play is part of their therapy. Children with type 1 diabetes should be able to play normally. Staff should take a portable pack with insulin, syringes, high-calorie supplements, and glucagon in case of emergency whenever the child is in a different location or on a field trip. A glucometer to check blood sugar should also be available.
What should be considered an emergency?
-
Call emergency medical services/911 if the child
-
Vomits repeatedly and becomes disoriented or unconscious.
-
Cannot keep any food or fluids down when his blood sugar is low.
-
Develops lethargy or has a seizure.
-
-
Call the parents/guardians or the diabetes team for
-
High blood glucose
-
Low blood glucose if the child is alert and taking food
-
More frequent urination
-
-
In the event of a programmatic emergency needing evacuation, the child’s insulin and any necessary emergency equipment must be brought with the child.
What types of training or policies are advised?
-
Medication administration
-
Dietary guidelines
-
Diabetes education for all staff
-
Emergency management
-
Standard precautions (eg, gloves, hand washing)
-
Glucose monitoring
What are some resources?
-
Juvenile Diabetes Research Foundation International, 800/533-CURE (533-2873),www.jdrf.org
-
The National Diabetes Education Program school guide,
Helping the Student with Diabetes Succeed: A Guide for School Personnel (free),http://ndep.nih.gov/media/Youth_NDEPSchoolGuide.pdf -
Children With Diabetes online community,www.childrenwithdiabetes.com
-
American Diabetes Association,www.diabetes.org
-
International Society for Pediatric and Adolescent Diabetes,www.ispad.org
Source: Managing Chronic Health Needs in Child Care and Schools: A Quick Reference Guide.
Products are mentioned for informational purposes only. Inclusion in this publication does not imply endorsement by the American Academy of Pediatrics.
Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication.
The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.