Overview of Diabetes in Illinois. Overview of Diabetes in Illinois Diabetes - General Information. Diabetes - General Information. Diabetes - General Information …

Diabetes in Children A Resource Guide for School Health Personnel Table of Contents
Acknowledgments
Acknowledgments 5

Overview of Diabetes
Overview of Diabetes in Illinois 9 Diabetes - General Information 1 0 Type 1 Diabetes 1 1 Type 2 Diabetes 1 2 Nutrition 1 4 Physical Activity 1 7 Schedule Student Physical Activity Schedule 1 8 Student Activity Pyramid 1 9 Blood Sugar Monitoring 2 1 Hypoglycemia 2 3 Hyperglycemia and Monitoring for Presence of Ketones 2 7 Insulin and Insulin Delivery Systems 2 9 Treatment Oral Medications Used in Diabetes Treatment 3 0 Giving Insulin 3 3 Students Age Related Responsibilities of Students 3 5 Psychosocial Aspects of the Student with Diabetes 3 7

Tools and Information for School Health Personnel
Care Planning 4 1 Appropriate Accommodations Under Illinois Law 4 4

Tools for Staff Education
School Handling the Student with Diabetes at School 5 3 Illness at School 5 5 Camp Travel, Vacations or Camp 5 6 Actions for the Principal 5 7 Actions for the Teacher 5 8

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Table of Contents
Actions for Health Personnel 5 9 Actions for the Counselor 6 0 Actions for Coaches and Physical Education Teachers 6 1
Actions for Bus Drivers 6 2 Actions for Food Service Personnel, Parents, Teachers, and Others Providing Food 6 3

Sample Forms
Letter From Doctor to School Personnel 6 7 Authorization for the Mutual Exchange of Medical Information 6 8 Authorization and Permission for Administration of Medication 6 9 Medical Statement for Children Requiring Modification in School Meals 7 3

Appendix
Diabetes Definitions 7 7 Diabetes Resources 8 3 Other Publications 9 1 Diabetes Websites 9 3 Care of Children with Diabetes in the School and Day Care Setting 9 5 Type 2 Diabetes in Children and Adolescents 9 5

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Acknowledgements

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Acknowledgments
The Illinois Department of Human Services acknowledges and greatly appreciates the the cooperation and assistance of the following organizations and individuals in providing and reviewing the information contained in this document A special thank you to the New York State Department of Health for their generosity in sharing information from Children With Diabetes: A Resource Guide For Schools

Workgroup Members
KathrynCox Division Administrator, Special Education Illinois State Board
of Education Ramesh Khardori, MD Professor/Vice Chair DepartmentofMedicine Director of Division of Endocrinology Southern Illinois University School of Medicine Rodney A Lorenz, MD William H Albers Professor and Chair University of Illinois College of Medicine at Peoria William Maurer, MD DepartmentofPediatrics University of Illinois College of Medicine at Peoria Marcella J McIntyre, RN, MSN, CDE Director Diabetes Services Central DuPage Health Systems Jacque McKernan, PhD, RN, MS, CDE Diabetes Case Manager, Co-Chair SS Edward Center For Diabetes Education Cynthia Mears, DO Associate Medicine Specialist Division of General Academic Pediatrics Childrens Memorial Hospital Thomas L Pitts, MD Assistant Professor Northwestern University Medical School Past President Great Lakes Region American Diabetes Association Margaret Winters, RN, BA Executive Secretary Illinois Association of School Nurses W Patrick Zeller, MD Director Edward Center for Diabetes Education

Office of Family Health Staff
Stephen E Saunders, MD, MPH Associate Director, Office of Family Health Staff Marie Irwin Office Coordinator, School Health Program Victoria Jackson, RN, MS, NCSN School Nurse Consultant Cheryl
Metheny, MS, RD, CDE DiabetesControlProgram Mary L Miller Administrator, Special Projects Chandana Nandi, RD, MS Coordinator,DiabetesControlProgram Judith Redick, BA, MS Administrator, School Health Program Jill Sproat, BA PublicAdministrationIntern

Agency/Organization
New York State Department of Health American Diabetes Association Juvenile Diabetes Research Foundation

For more information contact: Illinois Department of Human Services Division of Community Health and Prevention Office of Family Health 535 W Jefferson Springfield, Illinois 62702 School Health Program Diabetes Control Program 217-785-4525 217-782-2166

Issued April, 2002

Overview of Diabetes

Overview of Diabetes in Illinois Diabetes - General Information Nutrition Physical Activity Blood Sugar Monitoring Hypoglycemia Hyperglycemia Insulin Age Related Responsibilities of Students Psychosocial Aspects of the Student with Diabetes

Issued April, 2002

Overview of Diabetes in Illinois
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 complications Early diagnosis of diabetes and control of glucose levels are proven elements in the prevention of complications related to diabetes

Illinois: Diabetes in Illinois

Approximately 56 513,735 of adults in Illinois have been diagnosed with diabetes1 Direct and indirect costs of diabetes exceed 76 billion annually2 More than 4,176 school-age children were estimated to have a diagnosis of type 1 diabetes2 Hospitalization charges for 1,911 children age 0-19 were 16,230,550 in 2000, averaging 7,606 per child3 In 2000, the most common causes of diabetes-related hospitalizations of children age 619 were ketoacidosis 929, diabetes without complication 477, and diabetes without other specific manifestations 673

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 and sedentary life-styles The Centers for Disease Control and Prevention CDC reports that one of every three newly diagnosed adolescents has type 2 diabetes, once thought to impact only
adults over age 40 According to CDC, young people affected tend to be 10-19 years old, with a strong 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 ethnic groups; and obese rather than normal weight

This manual is a compilation of resources designed to provide a reference for Illinois school health personnel to utilize in the school setting for the management of the student with diabetes The complete needs of each individual student with diabetes must be evaluated by a health care provider who should develop an Individual Diabetes Management Plan to address those needs The tools provided in this manual can assist school personnel in affecting positive health outcomes and helping students with diabetes improve self-management skills and fully participate in mainstream activities
Illinois Department of Public Health Behavioral Risk Factor Surveillance System BRFSS Aggregate years 1998-2000 Burden of Diabetes in Illinois Centers for Disease Control and Prevention, 1997 3 Illinois Health Care Cost Containment Council, 2000
1 2

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Diabetes -
General Information
iabetes is a disorder of metabolism — the way in which your body converts the food you eat into energy Most of the food you eat is broken down by digestive juices into the fuel you need to survive One such fuel is a sugar called glucose Glucose is the bodys main source of energy and the brains only source of energy After digestion, glucose passes into your bloodstream, where it is available for cells to take in and use or store for later use In order for your cells to take in glucose, a hormone called insulin must be present in your blood Insulin acts as a key that unlocks doors on cell surfaces to allow glucose to enter the cells Insulin is produced by special cells islet cells in an organ called the pancreas, which is about 6 inches long and lies behind your stomach

In people who do not have diabetes, the pancreas automatically produces the right amount of insulin to enable glucose to enter cells Type 1 diabetes occurs when the pancreas stops making any insulin In people who have type 2 diabetes, cells do not respond to the effects of the insulin that the pancreas produces If glucose cannot get inside cells, it builds up in the bloodstream The buildup of
glucose in the blood–sometimes referred to as high blood sugar or hyperglycemia–is the hallmark of diabetes When the glucose level in your blood goes above a certain level, the kidneys two organs that filter waste from the bloodstream work to get rid of the glucose in the urine The glucose takes water with it, which causes frequent urination and extreme thirst These two symptoms–frequent urination and unusual thirst– may be the first noticeable signs of diabetes Weight loss, the result of loss of calories and water, may also be noticed

American Diabetes Association Recommendations for Diabetes Classification,Testing and Diagnosis revised 1997
Name Changes Type 1 - Formerly IDDM - insulin dependent diabetes mellitus Type 2 - Formerly NIDDM - non-insulin dependent diabetes mellitus
Simplified Testing and Diagnosis
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:

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 meal200 mg/dl with the classic diabetes symptoms of
increased urination, increased thirst and unexplained weight loss 3 An oral glucose tolerance test OGTT value of 200 mg/dl in the two hour sample

Preferr efer administra convenience, accepta ptability low Preferred test: ease of administration, convenience, acceptability to student, and lower cost
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Type 1 Diabetes
ype 1 diabetes usually has a very rapid onset It was previously called Juvenile Diabetes because most people develop it as children or teenagers This type of diabetes occurs when the pancreas stops making insulin The underlying cause for this damage has not been identified yet, although research is currently underway Approximately five to ten percent of all people with diabetes have type 1 diabetes, and the majority of students with diabetes have type 1 There is no single way to treat type 1 diabetes To date, insulin injection is necessary for survival Each students life events vary and experienced diabetes teams are necessary to set up individualized treatment plans For treatment plans to be most successful, an insulin regimen must be tailored to the needs of the student, as well as a meal plan and recommendations for physical activity New
information on diabetes management allows people with diabetes to be more liberal with food intake as well as meal and exercise times Students with diabetes must be allowed to participate fully in all school activities Students need the cooperation and support of school staff members to help with the treatment plan

Blood sugar monitoring may be ordered by the childs health care provider to help assess how well the treatment plan is working Most students can perform blood sugar checks by themselves but may need a private place to do so Some students may need supervision to see that the procedure is done properly and results are recorded accurately It is helpful for the student to have a meter at school so the blood can be checked when needed The student should use the same brand and model meter at home and school Use of the same meter will enable the student to accurately interpret results and make appropriate decisions regarding medication, food and/or exercise Whether or not the student checks blood sugar levels at school, and how often, are decisions made by the students diabetes team in conjunction with the student, family, and school personnel It is the local board of
educations responsibility to ensure that staff, including school health personnel, have adequate training and current knowledge in order to assist students with diabetes School health personnel are responsible for recognizing when additional staff training is needed to perform a particular procedure and determining where the appropriate training can be obtained

Symptoms of High Blood Sugar that Characterize Type 1 Diabetes
-frequent urination including during the night -unusual thirst -extreme hunger/weakness -unexplained weight loss -extreme fatigue -blurred vision -slow healing of cuts and bruises -frequent infections of skin/gums/ vagina/bladder -tingling/numbing in legs, feet, hands

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Type 2 Diabetes
ype 2 diabetes is the most common form of the disease, representing ninety to ninety-five percent of adults with diabetes It was previously known as adult-onset or non-insulin dependent diabetes because it was most often diagnosed after age 40 A recent trend has emerged in which type 2 diabetes is being diagnosed in children, adolescents and young adults Studies are currently underway to better define the populations at highest risk for this form of
diabetes, so that preventive measures may be taken and appropriate behavioral and medical therapies can be developed The latest findings from the Centers for Disease Control and Preventions CDC National Health and Nutrition Examination Survey NHANES show that increasingnumbersofchildrenandteensareoverweight The initial results for 1999 show 13 percent of children ages 6-11 are overweight, which is an 11 percent increase from the previous NHANES survey The number of overweight teens ages 12-19 years increased from 11 percent to 14 percent in the same time period In Illinois, there are an estimated 145,420 children in the 6-11 years age group and 199,833 teens in the 12-19 years age group who are overweight Overweight students are at increased risk for cardiovascular disease, diabetes, and other serious health problems

Impaired glucose tolerance IGT may be another precursor of type 2 diabetes Impaired glucose tolerance occurs when the pancreas becomes exhausted and can no longer produce enough insulin to move glucose out of the bloodstream into cells Glucose begins to build 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 order and in any combination While all of these harmful activities are going on inside the body, the affected individual may feel perfectly fine Type 2 diabetes is considered a silent disease because it works its destruction over many years without causing any noticeable symptoms One-third of the people who have type 2 diabetes do not know it Type 2 diabetes is treated by controlling food intake and activity level Oral medication may be added to the treatment to help maintain glucose levels If these management tools do not achieve normalization of blood sugar levels, the addition of insulin may be indicated

Acanthosis Nigricans
Acanthosis nigricans AN is a skin problem often found on the neck, axilla, groin, and other flexural areas Literally, AN means thick, coarse, and dark
In students of color who are also overweight and have a family history of type 2 diabetes, AN may be an early warning sign of insulin resistance Acanthosis Nigricans is not a screening tool for type 2 diabetes

The Path Toward Type 2 Diabetes
One of the greatest risk factors for type 2 diabetes is excess weight As an individual gains weight, the extra
weight causes the cells of the body to become resistant to the effects of insulin The pancreas responds by producing more and more insulin, which eventually begins to build up in the blood

Source: Centers for Disease Control National Health and Nutrition Examination Survey 1999 http://wwwcdcgov/nchs/nhaneshtm Source: More American children and teens are overweight News Releases, March 12, 2001 National Center for Health Statisitcs

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Testing for Type 2 Diabetes in Children
Criteria:
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:
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 10 years or at onset of puberty, if puberty occurs at a younger age

Frequency:
Test is recommended every two years

Test:
Fasting plasma glucose preferred Note:
Clinical judgement should be used to test for diabetes in high-risk children who do not meet these criteria
Reprinted with permission from: American Diabetes Association Type 2 diabetes in children and adolescents Diabetes Care Vol 23: 81-389 March, 2000

Preventing and Managing Type 2 Diabetes
The best way to help prevent and manage type 2 diabetes is to adopt and follow a healthy life-style Healthy life-style recommendations are important for everyone

Gestational Diabetes Mellitus
Gestational Diabetes Mellitus GDM is a type of diabetes mellitus that can occur when a woman is pregnant In the second half of pregnancy, the woman may have glucose sugar in the blood at a higher than normal level However, when the pregnancy ends, the blood glucose levels return to normal in about 95 percent of all cases Women who have gestational diabetes should work closely with their health care team to learn how to monitor their blood sugars, plan their meals, and adjust their activity levels in order to control blood sugar levels Women who have had GDM are more likely to develop type 2 diabetes later in life

Components of Healthy Living for Prevention and/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

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Nutrition
edical nutrition therapy is one of the cornerstone treatments of diabetesThe goals of nutrition therapy include: an adequatecaloricandnutritionalintakeforoptimalgrowth and development, and the proper balance of food, insulin and activity to achieve appropriate blood glucose levels A meal plan is developed by the health care provider to meet the individual needs of the student with diabetes, taking into consideration food preferences, cultural influences, family eating patterns and schedules, weight, activity level, and insulin action peaks The students health care provider will specify whether the students nutritional plan affords them the means of eating with flexibility and then calculate an insulin dose that is appropriate for their appetite or a plan which requires a controlled amount of carbohydrate at each meal The meals and snacks should be timed appropriately to
coincide with the peak effect of the students insulin It is recommended that students with diabetes see a Registered Dietitian, who is also a Certified Diabetes Educator, once a year to discuss their meal plan The Food Guide Pyramid is a guide for choosing healthy foods

There are 3 major nutrients found in the food groups identified on the Food Guide Pyramid: protein, fat, and carbohydrate

Protein builds and repairs body tissues Protein is
important for normal growth and development Over the years, many popular body building and weight loss regimens have overemphasized the role protein plays in a healthy, well-balanced meal plan It is not uncommon for individuals to turn to protein supplements in the forms of powders, shakes, and bars to boost their protein intake It is important to note that protein needs for even vigorous athletes can be easily met with everyday food sources It is especially important for students with diabetes to communicate with their health care provider if they are considering a protein supplement or any other nutritional supplement, due to the potential impact supplements may have on blood sugar levels

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

Fats carry the flavor of our foods, and are a very concentrated source of energy for the body They also slow the time it takes for the stomach to empty after a meal

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

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Carbohydrates provide most of the energy we
need to move, work and live As such, the majority of calories consumed should come from carbohydrate sources, spaced appropriately throughout the day Of all the food components, carbohydrates have the greatest effect on blood sugar The total amount of carbohydrates consumed has more of an effect on blood sugar than the type of carbohydrate

Carbohydrate information can be obtained from many sources, including the Food Guide Pyramid, food labels, and any number of books that contain the nutrient information of specific foods Knowing the carbohydrate content of given foods allows for more flexibility in the meal plan One serving from the starch/grain, fruit, milk or sweets group contains 15 grams of carbohydrates The following chart illustrates examples of foods that contain approximately 15 grams of carbohydrates

Food Group Sources of Carbohydrates:

Starches Fruit Milk and Yogurt Sugary Foods

Choose M ore O ften 1 cup l w fat m ik o l 1 ounce j i e box 4 uc 1 pi ce fresh frui e t 8 ani alcrackers m 1-1 1/2 w hol graham e crackers 1 m i ibag pretzel n s 4 peanut butter cheese crackers

Choose Less O ften 1 m i ibag potato chi s n p 1 sm al cupcake l 2 sm al cooki s l e 1 snack pack puddi g n 1 sm al pi ce of cake le

Meal planning for diabetes includes all the principles of good nutrition that are recommended for good health Students with diabetes are encouraged to choose a well-balanced diet with an appropriate amount of carbohydrate at each meal and snack in order to help manage blood sugar levels Healthy carbohydrates from starches, fruits and milk are encouraged as part of the daily meal plan Sweets foods high in sugar and low in other nutrients can be worked into a meal plan occasionally, as long as the carbohydrates they contain are taken into account

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Food Labels
Another method of determining how a food may fit into the students daily meal plan is through the nutrition information found on the Nutrition Facts label This label can help determine the appropriate portion size to provide the
right amount of carbohydrate needed at any given meal or snack The sample nutrition fact label for macaroni and cheese lists the Serving Size, Servings Per Container and Total Carbohydrate Using this information, you can determine that, if the student needs to eat 30 grams of carbohydrate, and macaroni and heese is available, the student should have 1 cup macaroni and cheese One cup is the serving size, the container has two servings, total carbohydrate in one serving is 31 g

Special Nutrition Issues
School Parties:
Sweets can be eaten on a special occasion such as a birthday party or Halloween Party The carbohydrates should be included as part of the students meal plan The class might also consider planning the party snacks for a time when the student normally needs a snack or before a physical activity Some students will need to check their blood glucose before the snack or start of the party to determine what treat is appropriate Parents/guardians of all students in the classroom should be notified of the need to send appropriate serving size items to ensure that all students can participate

Label for Macaroni and Cheese

Field Trips:
Students should carry convenient snacks
when traveling away from school, on the bus and at field trips Bus drivers and chaperones should be notified that the student has diabetes and may need to eat a snack on the bus or during the trip

Nutrition Facts
Serving Size 1 cup 228g Servings Per Container 2

Total Fat 12g Saturated Fat 3g Cholesterol 30mg Sodium 470mg Total Carbohydrate 31g
Dietary Fiber 0g Sugars 5g Protein 5g Vitamin A Vitamin C Calcium Iron 0

After Care:
The student should have a convenient snack available if staying after school or attending after school activities or programs Notify school personnel that the student may need to eat during the session

4 2 20 4

School Meal Programs:
Students with diabetes may participate in school meal programs Families can review the school menu ahead of time and make modifications as needed Families should be encouraged to contact the school food service director to discuss any modifications or additional foods they might send to compliment the meal provided

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

Calories Total Fat Less than Sat Fat Less than Cholesterol Less than Sodium Less
than Total Carbohydrate Dietary Fiber

2,000 65g 20g 300mg 2,400mg 300g 26g

2,500 80g 25g 300mg 2,400mg 375g 30g

Adapted from Children with Diabetes: A Resource Guide for Schools New York State Department of Health

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Physical Activity
hildren and teenagers are naturally active and play is their work Physical activity is an important part of the overall management of diabetes The benefits of physical activity include cardiovascular fitness, long term weight control, improved insulin sensitivity, social interaction and the promotion of selfesteem fostered by team play Additionally, physical activity can help to lower blood sugar Physical activity is a fundamental part of a healthy life-style for all students including those with diabetes Students with diabetes can participate in physical education class and after school sports The students health care provider will determine adjustments in medication and food for appropriate blood glucose control during physical activity Families should be encouraged to include more physical activity at home The physical activity pyramid is a guide for increasing activity See pages 18 and 19

General Physical Activity
Guidelines:
The student participating in sports or physical activity 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 care provider 4 Wear diabetes ID 5 If low blood sugar is a problem after exercise, eat more carbohydrates or talk with the health care provider about reducing the amount of insulin taken prior to physical activity

Carbohydrate Replacement for Physical Activity
The blood sugar should be checked according to the students individual health care plan and proper measures taken to keep the level in the appropriate range The following chart illustrates actions that might be recommended by the students health care provider to maintain a safe blood sugar during physical activity

T ype of A cti i y vt S hort D urati n o Les t an 3 0 m i ut s sh ne

If B l od S ugar Pri r to A cti i y i : o o vt s Les t an 1 0 sh 0 G reat r t an 1 0 eh 0 Les t an 1 0 sh 0

T hen eat the folow i g carb ohydrate b efore acti i y: ln vt 1 gram s carb ohydrat 5 e no carb ohydrat neces ary e s 2 5 - 0 gram s carb ohydrat pl s prot i
s urce 5 eu en o 1 gram s carb ohydrat 5 e no carb ohydrat neces ary e s 5 0 gram s carb ohydrat pl s prot i s urce eu en o 2 5 - 0 gram s carb ohydrat pl s prot i s urce 5 eu en o 1 gram s carb ohydrat 5 e

M oderate D urati n o 1 hour

1 0 -1 0 0 8 1 0 - 240 8 Les t an 1 0 sh 0

S trenuous 1 2 hours -

1 0 -1 0 0 8 1 0 - 240 8

If blood sugar is greater than 240, check for presence of ketones in the urine For more details on ketones, see section entitled Hyperglycemia and Monitoring for Presence of Ketones page 27 According to the most recent position statement from the American Diabetes Association Diabetes Care, Volume 23, 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 if glucose levels are 300 and no ketones are present Eat additional carbohydrates if glucose levels are 100 mg/dl

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Student Physical Activity Schedule
Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

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Student Activity Pyramid

CUT DOWN ON

TV watching Video/computer games Sitting more
than 30 min at a time

2-3 TIMES A WEEK
Leisure Playtime
Swinging Canoeing Tumbling Miniature Golf

Strength Flexibility
Push-ups/pull-ups Martial arts Dancing Rope climbing

3-5 TIMES A WEEK
Aerobic Exercises at least 20 minutes
Roller blading Biking Skateboarding Rope climbing Swimming Running

Recreational activities at least 20 minutes
Volleyball Basketball Soccer Skiing Kickball Relay races

EVERYDAY

Play outside Take the stairs instead of the elevator Help around the house or yard

Pick up your toys Walk to the store Go for a walk

Source: 2000 University of Missouri Published by University Extension, University of Missouri-Columbia http:/muextensionmissouriedu/xplor

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Snack Choices for Physical Activity
15 grams carbohydrate:
1 - 4 ounce juice box 1 cup Gatorade 1 sliced orange or apple 1 small box raisins 6 saltine crackers 1 cup light yogurt 3/4 cup dry unsweetened cereal

30 grams carbohydrate:
1 cereal bar 1 - 8 ounce juice box 2 slices bread 1 small bagel

45-50 grams carbohydrate plus protein:
1 sports nutrition bar 1 package 6 cheese or peanut butter sandwich crackers plus 4 oz juice

Protein Sources:
Peanut Butter Sliced or String Cheese
Lunch Meat Egg Peanuts, Walnuts or Almonds

Physical Activity Special Issues:
A low blood sugar can occur long after a physical activity session Treatment:
1 2 Test blood sugar after physical activity, before bedtime and even during the night, as ordered by the health care provider Ensure that a snack, which includes carbohydrate and protein, is eaten before bedtime, as recommended by the health care provider

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Blood Sugar Monitoring
lood sugar glucose monitoring is a necessary and useful tool in the management of diabetes Monitoring helps detect patterns of blood sugar values as well as in identifying acute problems of high or low blood sugar Students with an intensive management plan monitor their blood sugar before all meals to help them decide how much insulin to take There are numerous brands of monitors available, each with specific features that a student may find useful School health personnel need to become familiar with the various monitors being used In Illinois, most insurance companies cover the cost of monitors for persons with type 1, type 2 and gestational diabetes, regardless of whether or not they use insulin

Be positive when referring
to blood sugar levels Values are either within range or out of range which can be called high or low, rather than good or bad Use a non-judgmental approach when a result is abnormal If the blood sugar reading is unusually high or unusually low, repeat the test Treat for hyperglycemia or hypoglycemia according to the second test result

What is a normal blood sugar level?
For a person who does not have diabetes, a normal blood sugar level is 70-120 mg/dl Blood sugar levels in a student with diabetes will vary depending on insulin action times, food consumed, and activity level The diabetes health care professional will advise the students family of an appropriate target range for the blood sugar level, and the necessary action to take when blood sugar levels are outside of this range The professional will also specify how often the blood sugar should be checked

Criteria for Determining Appropriateness of Self-Testing Blood Sugar at School
The student demonstrates accurate blood
sugar testing technique as outlined on p 22

The student consistently uses appropriate
infection control practices

Points to Consider
Allow the student to assist in the steps of the monitoring
procedure The amount of involvement will depend upon the age of the student, their individual development and personality Even small children can help with some of the steps, such as choosing the finger or getting the strip out of the container

The student appropriately disposes of
sharps

The student is able to interpret blood
sugar results and institute appropriate treatment if necessary

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Blood Sugar Testing
Equipment Provided by parent/guardian Alcoholwipes Lancet device Ultrafine lancets Blood glucose meter Meter owners guide Blood glucose testing strips-use the kind Preparation
1 2 3 4 5 Gather supplies and prepare work surface Ready the blood glucose meter and strip according to the manufacturers instructions The student washes hands in warm, soapy water If assisting in the procedure, wash your own hands and put on gloves Load the lancet into the lancet device 15 specifically required for students meter Communicationlog 11

Provided 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 Gently, but firmly, apply a tissue or cotton ball to the puncture site Apply bandaid as needed Carefully remove the lancet from the lancet device and discard in a sharps container

Clean Up
12

Do not reuse lancets
13 14 Discard the tissues, cotton balls, and other paper products in plastic-lined covered trash can Wash and sanitize the area Use soapy water followed by a 1:10 bleach/water solution Remove gloves

Procedure
6 7 8 9 Select a site on the side of any fingertip The student stands with his/her arm below the level of the heart for 30 seconds Puncture the site with the lancet Gently massage from wrist to palm to finger withadownwardmotiontoformanadequate drop of blood Do not squeeze the finger too tightly Apply the drop of blood to the target site on the strip, being sure the target site is covered by blood and not smeared Most meters begin testing when blood is detected on the strip Review and follow the manufacturers instruction book

Documentation
16 Record result in the daily procedure log and in the students communication book The result is recorded as ____mg/dl Example: 60 mg/dl Refer to the students Care Plan to determine if 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 Return supplies to storage Advise parent or guardian of supplies that need to be replenished Allow at least one weeks notice

Issued April, 2002

Hypoglycemia
Hypoglycemia: Low Blood Sugar Insulin Reaction
Warning signs and symptoms of low blood sugar insulin reaction happen suddenly Signs and symptoms can easily be mistaken for misbehavior The student may or may not be able to recognize symptoms developing The severity of a low blood sugar reaction may rapidly progress from mild to severe if untreated Severe reactions are often preventable by early detection and treatment of low blood sugars Be familiar with identification and treatment of low blood sugar to avert an emergency situation Blood sugar can go too low if the student with diabetes has: Taken too much insulin Not eaten enough food Had extra exercise without extra food or decrease in insulin Poor concentration or day dreaming Shakiness, dizziness, lightheadedness Lack of response to verbal communication Sweatiness Headache

Treatment
Optimally, check blood sugar before treating
a student suspected of hypoglycemia When in doubt treat To treat, give the student some quick-acting sugar see chart on p27 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 the student still has symptoms, repeat the quick sugar treatment and blood sugar testing cycle until the student is symptom-free and the blood sugar result is above 70 mg/dl When the student feels better and the blood sugar result is above 70 mg/dl, give one 1 of the following foods if the students next meal is more than 1 hour away and/or the student will be participating in active play/sports following this low blood sugar episode: 4 graham cracker squares with 2 tablespoons peanut butter or 1 ounce cheese, 6 saltine crackers with 2 tablespoons peanut butter or 1 ounce cheese, or the equivalent combination of carbohydrate approximately 15 grams and protein approximately 1 oz The student may return to class after the blood sugar is above 70 mg/dl and he/she no longer has
symptoms

If the student appears to be having signs or symptoms, check blood sugar immediately If the blood sugar level cannot be determined, go ahead and treat the symptoms Never send a student suspected of having a low blood sugar to the health service office alone Send another student to get help if needed

Hypoglycemia-blood sugar between 50 and 70 mg/dl
Signs 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

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Hypoglycemia-blood sugar 40 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

What is Glucagon?
Glucagon is a hormone which helps the liver release sugar, thus increasing the level of sugar in the blood It must be injected with a syringe into the skin, like insulin

When To Use Glucagon
Glucagon is administered when the student has low blood sugar and is unable to take liquid or food by mouth because of severe sleepiness, unconsciousness, or
seizure activity Check the students health care plan for orders from the health care provider about the use of glucagon

Treatment
Double the treatment amounts indicated in the treatment for hypoglycemia with blood glucose 50-70 mg/ dl If the student has difficulty drinking but is able to swallow student may not be able to follow directions, place cake gel or glucose gel in between the students cheek and gums Administer the entire tube Rub the cheek 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 next meal or snack

When Possible, Check a Blood Sugar Before and/or After Giving Glucagon

If the student becomes:
D ISPLAYS U NCONSCIOUS U NRESPONSIVE CONVULSIONCONVULSION - LIKE
MOVEMENT

What You Need Glucagon Emergency Kit
The parent or guardian will need a prescription to purchase the kit at a pharmacy It is recommended that the student have one kit for home and a second kit for school Use of glucagon should be part of a students health care plan and be supplied to the school by the parent or guardian with accompanying physician order Keep glucagon at room temperature in a central location
Inform appropriate staff of the location of the kit Whenpossible,practicedrawingupglucagonwith an expired kit Check the expiration date of the glucagon kit on a regular basis Inform parents when it is close to the expiration date and ask them to obtain a replacement kit for school prior to that date Dispose of the expired kit appropriately

This is a Medical Emergency
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, nausea and vomiting may occur Notify parent/guardian, school administrator, and/or diabetes team as soon as possible

Issued April, 2002

TO PREPARE GLUCAGON FOR INJECTION
NOTE: Glucagon should not be prepared for injection until the emergency arises
1 Glucagon is available in a kit containing the glucagon powder/pellet in a vial bottle and the dilutant in a syringe 2 Check the date of the glucagon kit Discard if past the expiration date 3 Remove the flip-off seal from the vial of glucagon Wipe rubber
stopper on vial with alcohol swab 4 Remove the needle protector from syringe, and inject entire contents of the syringe into vial of glucagon 5 Remove syringe from the vial Shake vial gently until glucagon dissolves and the solution becomes clear

GLUCAGON SHOULD NOT BE USED UNLESS THE SOLUTION IS CLEAR AND OF A WATER-LIKE CONSISTENCY

TO ADMINISTER GLUCAGON
1 Using 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 from the health care provider 2 The glucagon syringe is marked with only 2 dosages–05 mg and 10 mg The recommended manufacturers dose of glucagon to inject is:

05 mg for a student 50 pounds or under, or 10 mg for a student over 50 pounds

3 Cleanse injection site on buttock, arm, or thigh with alcohol swab 4 Insert 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 5 Keep the student lying on his/her side in case of vomiting 6 The blood sugar should rise at least 50-75 mg/dl within 15-20 minutes FEED THE STUDENT AS SOON AS HE/SHE AWAKENS
AND IS ABLE TO SWALLOW SWALLOW

CAUTION
If 1 If the student does not awaken within about 15 minutes, give another dose of glucagon and CALL 911 IMMEDIATELY 2 Low blood glucose may cause convulsions 3 When an unconscious student awakens, he/she may vomit To prevent the student from choking on vomit, turn the student on their side

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

1996 by Joslin Diabetes Center Adapted and reprinted with permission from Caring for Children Living with Diabetes, published by Joslin Diabetes Center, Boston, Ma All rights reserved
Issued April, 2002

Suggested Hypoglycemia Treatment by Age
Suggested Hypoglycemia Treatment by Age Source of Sugar Glucose tablets large 1 tablet 5 grams Glucose tablets small 1 tablet 4 grams Glucose gel 31 gram tube Cake icing small tube 1 teaspooon 4 grams Honey, maple or K aro syrup 1 teaspoon 5 grams O range juice 1/3 cup 10 grams Apple juice 1/3 cup 10 grams Table sugar 1 teaspoon 4 grams Regular soda pop/soft drink 1 ounce 3 grams Unde r 6 Y ars e 5 - 10 grams 1 - 2 tablets 1 - 2 tablets 1/6 - 1/3 tube 2 teaspoons 1 - 2 teaspoons 1/4 - 1/2 cup 1/4 - 1/2 cup 2 teaspoons
2 - 3 ounces 6 - 10 Y ars e 10 - 15 grams 2 - 3 tablets 3 - 4 tablets 1/3 - 1/2 tube 3 teaspoons 2 - 3 teaspoons 1/2 - 3/4 cup 1/2 - 3/4 cup 3 teaspoons 4 - 5 ounces 1 1/2 - 2 tablespoons 4-5 Ove r 10 Y ars e 15 - 20 grams 3 - 4 tablets 4 - 5 tablets 1/2 - 2/3 tube 4 - 5 teaspoons 3 - 4 teaspoons 3/4 - 1 cup 3/4 - 1 cup 4 - 5 teaspoons 5 - 6 ounces 2 1/2 - 3 tablespoons 5-7

Raisins 1 tablespoon 1 tablespoon 7 1/2 grams Lifesavers 1 3 grams 2-3

Issued April, 2002

Hyperglycemia high blood sugar and monitoring for presence of ketones
Hyperglycemia-blood sugar above 240 mg/dl
Signs and Symptoms:
Loss of appetite Increased thirst Frequenturination Tiredness, sleepiness Inattentiveness Rapid breathing Fruity odor to the breath Nausea Vomiting

Diabetic Ketoacidosis
Diabetic Ketoacidosis DKA is caused by a combination of dehydration and a lack of insulin When there is a lack of insulin or a prolonged inadequate carbohydrate intake, the body starts breaking down fat Ketones are by-products of this process and are normally removed by the kidneys through urine In DKA, ketone formation happens so rapidly that kidneys cannot keep up Ketones accumulate in the urine and blood
and the blood becomes acidic Meanwhile, blood sugar may continue to rise due to lack of insulin and the kidneys must work to get the sugar out of the body by increasing the output of urine If the lost fluids are not replaced, the body becomes dehydrated DKA is the result of ketones in the blood combined with dehydration DKA can make students confused, sick to the stomach, extremely thirsty, tired and short of breath Students with type 2 diabetes are less likely than those with type 1 to develop DKA Left untreated, DKA can result in coma or death DKA is the most common cause of diabetes related hospitalizations in Illinois 929 cases in 2000 for the 0-19 year age group The frequency of DKA increases with age

Possible causes: Notenoughinsulin Too much food Illness/Infection Stress
If the student has warning signs of hyperglycemia, check the blood sugar If blood sugar becomes very high, the student may begin to utilize fat for energy, and produce a harmful by-product of fat metabolism called ketones If the blood sugar level is higher than 240 mg/dl, the students urine should be checked for presence of ketones as ordered by the health care provider

How to avoid DKA
Recognizing
risk factors is the first big step in avoiding DKA The greatest risk exists when the body is stressed by illness or injury In fact, the most common contributors to DKA are flu and stomach viruses It is importanttostickwithinsulinregimenandmonitorblood sugar more frequently during illness The American Diabetes Association ADA recommends checking ketones every four to six hours during times of illness, using a ketone testing kit

Never withhold food or make student perform extra exercise for high blood sugar episodes

Source: Illinois Health Care Cost Containment Council, 2000
Issued April, 2002

When to get help
The ADA recommends monitoring for signs of DKA whenever blood sugars are higher than 250 mg/dl regardless of how the student feels If the student has any of the following signs along with high blood sugar, notify the parent/guardian right away: Lack of appetite, Pain in abdomen, Vomiting or sick to stomach, Blurred vision, Dry or flushed skin, Difficulty in breathing, Feelings of weakness, Sleepiness, Fruity odor of breath or urine, Intense thirst, Dry mouth, Frequent urination DKA usually develops over many hours but may develop very quickly It is important
for students to check their blood sugar as ordered by the health care provider If blood sugar is elevated or student is ill, the urine should also be checked for ketones as ordered by the health care provider

Urine Testing for Ketones
Ketones are a warning sign that the body is burning fat for fuel instead of sugar, and this could mean diabetes is out of control The student may have an order to monitor urine ketones if the blood sugar is over 240 mg/dl or if the student is ill Urine testing products are read by comparing the test color to a standard color chart Factors such as handling the color pad with your hands as well as placing test materials on a counter recently cleaned with bleach can cause inaccurate results Be sure to read the package insert for proper handling of the product Be aware of expiration dates When a bottle of strips is opened, date it The strips are good only for a specified time, usually 3-6 months after opening When first opening the package, check the label to determine how long the particular package will be good for Ketone strips available in individually foil wrapped packages will last until the expiration date on the bottle The family should be
notified if replacement is needed Ketone test strips may need to be requested from the pharmacy as a special order item if they are not routinely stocked

Treatment
If ketones are high, the health care provider may recommend extra insulin or send the student to the hospital If the student has type 2 diabetes and does not usually take insulin, the health care provider may prescribe insulin In the meantime, have the student drink plenty of water If he/she cannot keep water down, call for emergency help right away At the hospital, insulin and IV fluids are used to treat DKA However, if DKA has been present for a long time, recovery is more difficult Other medical conditions which may be present infection, high blood pressure, thyroid or heart disease further complicate treatment and recovery DKA is a condition which must be taken seriously If left untreated it can cause serious consequences
Issued April, 2002

Interpreting Urine Ketone Results
If Urine Ketones are:
Negative to small: Give lots of fluids, such as water or sugar free drinks Recheck blood glucose and urine for ketones in several hours Allow free access to the water fountain and rest room Moderate to large: Advise the
parent or guardian immediately if the student is spilling moderate or large ketones A serious medical condition called ketoacidosis may be developing If the parent cannot be reached and the student is vomiting and unable to take fluids by mouth, call emergency personnel for transport to the emergency room and notify the parent/guardian and school administration per district policy

Insulin and Insulin Delivery Systems
Insulin
There are many different types of insulin, for different situations and life-styles

Storage
Opened vials may be left at room temperature for 28-30 days after opening, or as indicated on package Avoid exposure to extreme temperatures Unopened vials should be stored in the refrigerator and are good until the expiration date on the package

Characteristics
The three characteristics of insulin are: Onset - The length of time before insulin reaches the bloodstream and begins lowering blood sugar Peak time - The time during which insulin is at its maximum strength in terms of lowering blood sugar levels Duration - How long the insulin continues to lower blood sugar

Expiration date
Make sure that the insulin that is supplied will be used before its expiration
date

Types and Duration of Insulin Action
I su l n n i P r par t on e ai Animal Regular N PH Lente Human Insulin aspart Insulin lispro Regular N PH Lente Ultralente Insulin glargine 5- 10 minutes 15 minutes 05- 1 hour 2- 4 hours 3- 4 hours 6- 10 hours 1 hour 1- 3 05- 15 2- 3 4 - 10 4- 12 ——–3- 5 2- 4 3- 6 10- 16 12- 18 18- 20 24 4- 6 4- 6 6- 10 14 - 18 16- 20 20- 24 24 05- 2 hours 4- 6 hours 4- 6 hours 3- 4 8 - 14 8- 14 4- 6 16- 20 16- 20 6- 8 20- 24 20- 24 T yp i a l c O n se t P eak our h s U su a lE f e ct ve f i D ur t on our ai h s U su a lM a x i u m m D ur t on our ai h s

Diabetes Forecast January 2002 Insulin Volume 55, A Core Curriculum for Diabetes Education Diabetes Management Therapies, 4th Edition 2001 American Association of Diabetes Educators
Issued April, 2002

Oral Medications Used in Diabetes Treatment
Dr g u T yp e /C l ss a
Biguanide

M e ch a n i m o f s E f e ct f
Increases glucose uptake by muscles; decreases liver glucose production

T r de N am e a

G ener c N am e i

A va i a b i i y l lt

Glucophage

Metformin Metformin Extended Release Glyburide/Metformin Acarbose Miglitol Repaglinide N ateglinide Glimepiride Glyburide Acetohexamide
Glipizide Glipizide, extended release Glyburide, micronized Glyburide Chlorpropamide Tolbutamide Tolazamide

Tablets: 500, 850, 1000 mg

Glucophage XR Glucovance Alpha- Glucosidase Inhibitors Delay digestion of ingested carbohydrates Precose Glyset N onsulfonylurea Hypoglycemics Stimulate insulin release from pancreas Prandin Starlix Sulfonylureas Stimulate insulin release from pancreas Amaryl Diabeta Dymelor Glucotrol Glucotrol XL Glynase PresTab Micronase Diabinase O rinase Tolinase

Tablets: 500 mg Tablets: 250, 500 mg Tablets: 25, 50, 100 mg Tablets: 25, 50, 100 mg Tablets: 05, 1, 2 mg Tablets: 120 mg Tablets: 1, 2, 4 mg Tablets: 125, 25, 5 mg Tablets: 250, 500 mg Tablets: 5, 10 mg Tablets: 5, 10 mg Tablets: 15, 3, 6 mg Tablets: 125, 25, 5 mg Tablets: 100, 250 mg Tablets: 500 mg Tablets: 100, 250, 500 mg

Thiazolidinediones TZDs

Increase tissue glucose utilization

Actos

Pioglitazone

Tablets: 15 mg

Avandia

Rosiglitazone

Tablets: 2, 4, 8 mg

Few oral medications for hyperglycemia control are currently approved by the FDA for use in children Physicians may determine a particular oral medication is appropriate on an individual basis

Issued April, 2002

Insulin Delivery
Systems
Syringes, pumps, and pens all do the same thing- deliver insulin These items deliver insulin into the tissue so it can be used by the body This category also includes injection aids — products designed to make giving an injection easier

Pumps
Insulin pumps are computerized devices, about the size of a beeper or pager, which are worn on the belt or in a pocket Pumps deliver a steady, measured dose of insulin through a cannula a flexible plastic tube with a small needle that is inserted through the skin into the fatty tissue The cannula is taped in place — not the needle Insulin pumps may be worn during most athletic activities as recommended by the health care provider The pump may be placed on one of several sites on the body including the abdomen, buttocks, thigh or arm

Syringes
Todays syringes are smaller, have finer needles and have special coatings that work to make injecting as easy and painless as possible When insulin injections are done properly, most people discover they are relatively painless

Points to Consider for Optimal Insulin Delivery by Syringe
The syringe being used should be the right size for the insulin dose It should be easy to draw up and
visualize the dosage devices are available to make this task less complicated Shorter, smaller needles are available which allow for ease of administration

Advantages Pumps most closely mimic the bodys normal
release of insulin

Pumps deliver insulin in two ways: Basal dose: small, continuous dose that is
pre-programmed, and Bolus dose: given to cover food or cover high blood sugar Wearing a pump does not prohibit a student from participating in any school activities

Insulin Pens
There are a wide range of insulin pen options available Pens can make taking insulin much more convenient Some students find the pen needles make injection more comfortable

Responsibilities of Pump Wearer
The student must: be willing to test blood sugar a minimum of 4 times/day, learn how to make adjustments in insulin, food and exercise in response to test results, check to assure the pump is functioning properly if high or low blood sugar readings occur, and keep back up insulin, syringe or pen, and pump supplies available at school

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

Issued April, 2002

Disposing of Sharps Safely
Millions of individuals with serious health conditions manage their care at home, work or school For example, people with diabetes use syringes to inject their own insulin and lancets to test their blood sugar every day This creates a lot of medical waste The best way to protect trash handlers and sewage treatment workers against disease or injury, and avoid attracting drug abusers looking for syringes to reuse, is to follow the guidelines listed below for containment and disposal of sharps

DO NOT PUT THE SHARPS CONTAINER OUT WITH THE RECYCLABLE PLASTICS SHARPS ARE NOT RECYCLABLE

Containment
A red sharps container may be purchased at local pharmacies or health supply stores Use a puncture-proof plastic container with tight-fitting screw top A laundry detergent or bleach bottle works well Dont use glass because it can break Coffee cans are not recommended because the plastic lids come off too easily Label the container clearly Write Contains Sharps with a waterproof marker directly on the container Once a syringe or lancet is used, immediately put it into a container and seal the container Dont clip, bend
or recap the needles because of potential injury Keep the container away from children Store the container in a safe, secure location-out of the reach of children and safe from theft When the container is full, seal it tightly and dispose properly, as follows

Disposal
There are different options for disposing of the container of sharps Some cities and towns have more options than others Here are some good choices that promote health and safety, and protect the environment

Call local doctors, pharmacies, clinics, hospitals or nursing homes and ask if they accept properly contained sharps for disposal Ask local diabetes educators or the local American Diabetes Association chapter about sharps disposal programs Call the local public works department or solid waste manager Some communities have special medical waste collection or drop-off days Call local health departments environmental health section for special medical waste disposal programs

Issued April, 2002

Giving Insulin
Equipment Provided by parent/guardian Healthcare providers written order Parent/guardian written permission Insulin Insulin syringes Alcoholwipes Communicationlog Preparation
1 2 3
4 Provide for privacy If adult is giving injection, explain to the student what will be done Wash hands Set out supplies Check insulin bottle a Does the label on the bottle match the type listed on the medication order? b Is the insulin in date not expired? c How many units are to be given? d Is the Insulin clear or cloudy? Regular, Humalog, Novalog, and Lantus insulins should always be clear Lantus should not be mixed with any other insulin 5 If this is a new bottle of insulin, remove the flat, colored cap and throw it away Do not remove the rubber stopper or the metal band 6 Gently mix cloudy insulin by rolling the vial between the palms of your hands Do not shake Shaking the bottle can break down the insulin molecules and change the way and time in which insulin acts 7 Put on latex/vinyl gloves 15 14 13 12 11 9 10 Remove the cover from the insulin syringe Pull back on the plunger until the tip is at the line for the desired number of units This will pull air into the syringe Push the insulin syringe needle through the rubber stopper and press on the plunger to push the air into the bottle of insulin Turn the bottle and syringe upside down with the needle still in the bottle Hold
the bottle with one hand and the syringe in the other The tip of the needle should be in the insulin with the needle pointing up Slowly pull back on the plunger until the line of the plunger is at the desired number of units This will pull insulin from the bottle to that mark Make sure there are no air bubbles in the syringe Air bubbles in the syringe will prevent the syringe being filled with the correct dose of insulin Gently tap the side of the syringe to bring the air bubbles to the top, push them out, and again fill to the appropriate number of units, still keeping the needle pointing up Pull the needle out of the rubber stopper

Provided by school Latex or vinyl gloves–do not have to be
sterile Tissues or cotton balls Approved container for disposal of syringes Procedure log and pen Second adult

Draw up Medication
8 Clean the rubber stopper on the insulin bottle with an alcohol wipe
Issued April, 2002

Check and Verify Dose
16 With another adult, check the dose of insulin comparing the amount ordered for the student with the amount drawn into the syringe Compare the bottle label to the name of the insulin listed on the medication order 17 Check the order to
determine where on the body the student is to receive his insulin shot Insulin is given subcutaneously into the fat layer under the skin but above the muscle layer The areas used are the thighs, arms, abdomen, and buttocks

Clean Up
22 23 24 25 26 27 Discard the syringe in a sharps container Do not put the cap back on the needle Cover the site with a band aid if needed Reassure and praise the student Discard paper products in plastic lined container Remove gloves and discard in plastic lined container or trash can Document the insulin injection on the medication log and in the students communication log Return supplies to storage Note supplies which need to be replenished and advise parent or guardian

School Personnel are referred to the

Give the Medication
18 Select the injection site and wipe it with alcohol, if ordered by the physician Allow area to air dry 19 Grasp a large area of skin and push the needle into the skin at a 90 angle Some children, or thin individuals, may need to pinch the skin and inject at a 45 angle to avoid intramuscular injection Be sure the needle is all the way in 20 Push in the plunger all the way This will inject the insulin into the students body
Count to five before removing the needle to prevent the insulin from leaking out of the needle track 21 Pull the needle straight out and press down firmly over the injection site with a cotton ball or tissue
Issued April, 2002

Recommended Guidelines for Medication Administration in Schools, a joint publication Schools,
of the Illinois Department of Human Services and the Illinois State Board of Education Copies of the guidelines may be obtained by contacting: Illinois Department of Human Services School Health Program 217-785-4525

Age Related Responsibilities of Students
ge alone should not be the guideline used to assume that a student is ready to accept responsibility for managing components of diabetes care It is important to realize that children develop at different rates There is no such thing as the magic age when a student can suddenly perform a certain skill or be responsible for his/her care Students need to be encouraged and supported to gradually assume diabetes self care as they mature and demonstrate confidence The adult must be sure that when the responsibility is given, the student is willing to take it Keep in mind that a students ability or desire to perform
certain diabetes related tasks might vary from day to day It is normal for the student to regress and depend once again on an adult to handle the responsibility Parents, guardians, school nurses, and school personnel must be sensitive to the students needs and be available to take over with no questions asked

The charts below provide the adult with guidelines to follow when determining the average age of assuming diabetes-related skills Keep in mind that these are general recommendations and each student must be evaluated individually Independence takes a long time and requires a lot of help and supervision from adults The student who feels that they have a network of adults to support and assist with diabetes management will generally be in better diabetes control

Responsibilities of Students at Different Ages
Be aware of the normal stages of development in children Recognize that responsibilities related to diabetes must depend on the age and development of the child Accommodation may be necessary for students with special needs

A verage Responsi ii i s b lt e A ge 3-7 years N on-D i betes Rel ted a a Im agi ati e/concrete thi kers nv n Cannot thi k abstractl n y S el
-centered f D i betes Rel ted a a A dul supervi i n for al tasks t so l G radualy l arns to cooperate for bl od sugar tests and le o i suln shots ni Inconsi tent w i h food choi es s t c G radualy l arns to recogni e hypogl cem i le z y a N ot m uch concept of ti e m Can l arn to test bl od sugars e o A t age 10 or 11 can draw up and gi e shots on occasi n v o Can m ake ow n food choi es c Can recogni e and treat hypogl cem i z y a By 11 or 12 years can be responsi l for rem em beri g be n snack,but m ay stilneed assi tance of al rm w atches or l s a adul rem i ders t n Capabl of doi g the m aj ri y of shots and bl od tests but e n ot o stilneeds som e parentalsupervi i n and revi w at ti es to l so e m m ake deci i ns about dosages so Know s w hi h foods to eat c G radualy recogni es the i portance of good sugar control l z m to prevent l ter com plcati ns a io M ay be m ore w ilng to i j ct m ul i l shots per day li ne tp e

7-12 years

Concrete thi kers n M ore l gi aland understandi g oc n M ore curi us o M ore soci l a M ore responsi l be

12-18 years

M ore i dependent n Behavi r vari s o e Body i age i portant m m A w ay from hom e m ore M ore responsi l be A bstract thi ki
g nn

Adapted and reprinted with permission from Diabetes in Children-A Resource Guide for Schools Published by New York State Department of Health 1999
Issued April, 2002

Average Age for Diabetes Related Skills
Skill Re comme nde d by the ADA Surve y of Care Provide rs

Hypoglyce mia
Recognizes and reports Able to treat Anticipates/prevents 8 - 10 10- 12 14- 16 4- 9 6- 10 7- 11

Blood Glucos e
Testing by meter 8- 10 7- 11

Ins ulin Inje ction
Gives to self at least sometimes Draws up insulin Able to adjust dose N/A 12- 14 14- 16 8- 11 8- 12 12- 16

Die t
Identifies appropriate pre- exercise snack States role of diet in care Able to alter food in relation to blood glucose level 10- 12 14- 16 14- 16 10- 13 9- 15 10- 15

Abst ract ed f rom a surv ey done by Srs T Wysock i, P Meinhold, DJ Cox and WL Clark e at Ohio St at e Univ ersit y and The Univ ersit y of Virginia Diabet es Care 11:54-58, 1990 Adapt ed f rom Underst anding Insulin-dependent diabet es Univ ersit y of Colorado Healt h Sciences Cent er 1995

Issued April, 2002

Psychosocial Aspects of the Student with Diabetes
he diagnosis of diabetes in a child can have a major impact on the entire family In many cases,
diabetes is the worst thing that has ever happened to them Each individual in the family is affected and the feelings experienced often follow a similar pattern These feelings may linger for a long time if they are not recognized and expressed Dealing with feelings openly can help a child and their family learn to face the daily challenges and facilitate an acceptance of having diabetes as part of their lives Families who are experiencing difficulty should be referred to the students health care provider

Anger
Why me? Why my child? Why do I have to do it all? It isnt fair
Anger may be vented toward nurses, doctors, God, spouse, friends, siblings, teachers–the list is endless Although anger is a normal feeling, it may interfere with the students or family members ability to adjust to the daily pressures of managing diabetes If it is having a major impact on the student or the family as a unit, individual or family counseling may be helpful

Denial
This cant really be happening

Fear
What will this mean for my childs life? Whats going to happen? How can we ever leave our child alone?
There are many fears expressed by the family and the student Parents and guardians may fear the
increase in responsibility and expenses, worry about the future and/or doubt their ability to manage diabetes every day Siblings fear they may get diabetes too The student fears hospitals, injections, finger sticks, low blood sugars and even death As a result of these treatments, he/she may feel different from other students and fear not fitting in All of these fears are certainly justified, but can be allayed if they are openly discussed and support given as needed

I dont need to take my insulin today Its not that serious No one has to know I have diabetes
The student or family members may find it difficult to even talk about diabetes It may be too painful to face This can interfere with the medical teams ability to educate and treat the student At times, the student or other family members may try to hide their feelings in order to be strong or to avoid upsetting the others This denial may make the students ability to adjust to the daily struggles much more difficult

Sadness
The student or a family member may cry, feel depressed, or hopeless Feeling sad is normal, and brief periods of sadness can occur for years after diagnosis It is important for all family members to express
feelings of sadness They should be encouraged to seek professional help if these feelings continue for an extended period of time

Issued April, 2002

Factors Causing Emotional Distress at Diagnosis of Diabetes in a Child
Uncertainty about the outcome of the immediate situation Feelings of intense guilt and anger about the occurrence of diabetes Responsibility for management of the illness Loss of valued life goals and aspirations because of illness Anxiety about planning for an uncertain future Recognition of the necessity for a permanent change in living pattern due to diabetes

Guilt
What did I do to deserve this? If I just hadnt eaten so much sugar The diabetes may have come from my side of the family
Parents commonly feel that they gave their child diabetes This idea occurs even when they know other factors also play a role in the onset of diabetes The child may feel diabetes is a punishment for bad behavior These feelings are very common at the time of diagnosis As time goes on, the student feels guilty if he/she sneaks extra candy, skips doing blood tests, lies about blood sugar results or does not follow the rules Parents and guardians may experience feelings of
guilt whenever they have to enforce the rules of self-management or deny their child a treat The opportunities to feel guilty are always there All members of the family need to receive support and reassurance in order to assist their child in managing his/her diabetes

Acceptance
I dont like having diabetes but I guess I can handle it The shots arent so bad, I just wish I could eat whatever I want
Acceptance may take a long time to reach and some may never come to accept diabetes as part of their life A well-adjusted family learns to cope with the endless demands and struggles diabetes can add to their life They feel more confident and hopeful Sadness and anger may still occur but these periods are temporary The family needs to seek out resources in the community and within their family to ease the burden of daily management Dealing with all of these emotions can be a challenge for the family with a diabetic child They must come to the understanding that diabetes should not prevent a student from living a full and active life They are not alonethere are many resources available in the community and many other families traveling the same road
Adapted from: Understanding
Insulin-dependent Diabetes University of Colorado Health Sciences Center 1995

Issued April, 2002

Care Planning Appropriate Accommodations Under the Law Staff Training Memo to School Staff

There will be many people who will be responsible for the care and supervision of the student with diabetes Each day the student will encounter teachers, coaches, bus drivers, babysitters, friends, relatives who will need information in order to safely supervise the students care

Issued April, 2002

Tools and Information for School Health Personnel

Issued April, 2002

Care Planning

C
1

are planning in the school has four components:

4 Training
The school health professional should arrange for training for all school staff The training should be done with the assistance of the students parents or guardians and/or invited members of the students health care team This may involve one or more sessions depending on the roles assigned to different people NOTE: A list of resources that may help the schools staff with care planning is included in the Diabetes Resources section in the Appendix

Parent/Guardian Conference

A conference with the parents or guardians and the school health
professional should be held to identify the students needs, discuss components of the care plan, and develop the agenda for a school wide planning meeting

2 Planning Meeting
This meeting of key staff should be held each year before school starts, when a student is first enrolled, when a student is newly diagnosed, or when there is a change in the treatment plan

Parent/Guardian Conference
This meeting is held with the parent or guardian, the principal, the school health professional and others who may be invited by these parties The purpose is to get to know one another, share information about the student and school, prepare for the initial planning meeting, and determine who will need to attend the planning meeting A parent/guardian checklist might be prepared at the conference so that the necessary forms and supplies can be brought to the planning meeting Sample forms are included in the back of this manual The information needed from the parent or guardian is included on the form This may be completed in advance of, or during, the conference

Individual Care Plan

The school health professional, using information gathered at the planning meeting, should prepare the written
plan Key staff and the students family must agree to the plan The plan may be incorporated into an Individualized Education Program or Section 504 plan if the students needs will be covered by this legislation See Appropriate Accommodations Under Law p44 for a description of legislative rules that may apply to children with diabetes

Parent Check List
This checklist is provided to help parents identify the forms, supplies and other materials they need to bring to school The list should be modified for individual children All items on the checklist should be sent to the school health professional
Data/Information form Photograph of child Signed release of information for physicians Monitoring supplies: lancets, meter, strips, alcohol, ketone strips, etc Snack low packs Number:___ Glucose tablets, Gel tubes Number: ___ Pump supplies if applicable

Record keeping sheets Insulin and related supplies Syringes, alcohol, etc Prescription medication order and permission form for insulin Glucagon kits with pre-measured dosage Number__ Prescription medication order and permission form for glucagon

Adapted from Vermont Manual — Recommendations for Management of Diabetes for
Children in School Adapted from Vermont Manual Recommendations for Management of Diabetes in School
Issued April, 2002

Planning Meeting
At the beginning of the school year, and at other times during the school year for students who are newly diagnosed or have changes in treatment plan or schedule, the school health professional should organize and facilitate a planning meeting to develop an individual diabetes care plan for use in the school setting Meeting participants should include everyone that may have a role in the students diabetes care

Training requirements for staff with specific responsibilities, and/or Identification of what a diabetic emergency is and what steps should be taken

Additional Ideas to Improve Communication, Learning Opportunities and Diabetes Management Home/School Communication
1 Establish procedure for ongoing communication between parents or guardians and school 2 Schedule parent/guardian and teacher meetings at regular times, especially at the beginning of the school year and other transition times 3 Maintain consistency in academic plans Contact parent or guardian immediately if any academic or social concerns arise 4 Address health concerns
as the need arises 5 Schedule transition meetings and include previous and current teaching staff, school health personnel, and parent or guardian

Participants may include: Family and student, Principal, School health professional, Current year classroom teachers, Past year classroom teachers, Food service manager, Physical education teacher/coach, Counselor or social worker, Bus driver, Other school staff with direct responsibility for
student, and/or Members of the health care team, if invited by the parent or guardian

Organization/Management
1 Modify the instructional day as indicated by the students individual care plan long lunch, extra snack time on occasion

Suggested agenda items: Overview of type 1 or type 2 diabetes and its
management as appropriate for the individual student, Roles and responsibilities of staff members, Identification of staff in the school who will serve as resources for others, Determination of the hierarchy of personnel expected to respond in emergency situations, Determination of the location of food kits, glucagon, and other supplies in the school building, Determination of where the plan will be kept and how individual components
will be shared with appropriate staff,

Alternative Teaching Strategies
1 Modify teaching methods as necessary 2 Individualize classroom and homework assignments: Fluctuation in blood sugar may affect the students level of concentration and attendance Verbal/written instructions may need to be repeated If the student has to interrupt a test to deal with an issue related to diabetes, special accommodations may need to be made to repeat instructions or to lengthen the testing time

Issued April, 2002

Accommodations Student may need to have a snack at times
and intervals different from other students Student may need to have open bathroom privileges including during standardized tests Allow student to be seated so he/she can come and go from the room easily Student should be allowed to keep his/her backpack with equipment and snacks easily accessible in the classroom

Individual Care Plan
Planning is key to the successful management of care for students with diabetes In schools, the individual care plan is an essential tool for accomplishing successful implementation of the health care plan developed by the family and health care provider School health personnel, in
collaboration with parents, guardians and others, develop a plan outlining specific care to be given at school based on the students individual needs It should be available to all staff working with the student The school health personnel may prepare a summary of pertinent information on the individual student for his/her use and provide it to each of the students teachers

Student Precautions
1 Designate individuals responsible for assisting student 2 Develop a plan for training of personnel 3 Allow student to carry glucose monitor and strips, lancet, lancing device and snack as ordered by the health care provider 4 Provide for storage of extra snack in classroom and gym area 5 Provide for storage and access to insulin, syringes, glucagon and extra supplies 6 Inform students family of need to provide all equipment and supplies

Routine daily care plan includes:
Phone numbers of parents, guardians, care providers and emergency contacts Bloodglucosemonitoringinstructions Blood glucose values and specific responses required Daily schedule of food, insulin and activity Location of supplies and food Disposal procedure for syringes and lancets Instructions for special
events/circumstances

Emergencies:
Students with diabetes can have problems despite the best efforts at control School staff need to determine and record what constitutes an emergency situation and what to do about it Parent/guardian and health- care teams should provide guidance for the care plan

Developmental levels and cognitive and physical abilities of the school-aged child and adolescent should be considered in the development of the care plan for the student with diabetes

Adapted from Vermont Manual - Recommendations for Management of Diabetes in School

Issued April, 2002

Appropriate Accommodations Under Illinois Law
Under both Section 504 of the Rehabilitation Act of 1973 and the Individuals with Disabilities Education Act IDEA, any school receiving federal funding must provide a free appropriate public education FAPE for students with identified disabilities There are differences in the definition of FAPE under Section 504 in comparison with IDEA Under Section 504, reasonable accommodations must be provided and documented in what is commonly called a Section 504 Plan Under IDEA, the needs of students with disabilities found eligible for special education and
related services must be addressed in an Individualized Education Program IEP

Some of the issues that a written plan might address:
1 Eating whenever and wherever necessary 2 Going to the bathroom or water fountain as needed 3 Participating fully in all extracurricular activities, including sports and field trips 4 Eating lunch at an appropriate time with enough time to finish eating 5 Absence related to medical visits 6 Assistance with blood glucose monitoring or insulin injections, where appropriate 7 Opportunity to make up missed schoolwork or receive additional instruction when absent These are some examples of things to include in an individual plan Consult members of your students health care team when determining individual recommendation

Parent/Guardian Rights
The parent or legal guardian of a student with diabetes in the public school system has the right to:

Request that a Section 504 Plan be developed to address the students needs for reasonable
accommodations and participate in the meeting scheduled for this purpose

Request that the student be evaluated to determine eligibility for special education and related
services under IDEA and, if the student is found
eligible, participate in the meeting to develop the IEP Bring experts to the Section 504 or IEP meeting to better explain the students diabetes management As a member of the team, provide input in the development of the Section 504 Plan or IEP to identify the students needs and the accommodations and/or services to address those needs Disagree with the Section 504 Plan or IEP if it does not appropriately address the students needs and, if necessary, invoke certain procedural safeguards in accordance with the respective laws Participate and provide input in any subsequent revisions to the Section 504 PLan or IEP

Issued April, 2002

More detailed information on the rights of parents/guardians of students with disabilities is available in the document entitled A Parents Guide: The Educational Rights of Students with Disabilities, which may be obtained by contacting the Illinois State Board of Education at 217/782-2221 or by visiting the agencys website at http:/ /wwwisbenet/spec-ed/ /wwwisbenet/spec-ed/ Educating school personnel about students individual needs is an important step in managing the student with diabetes at school The process of developing a Section 504 plan
or an IEP provides an opportunity to educate school personnel about diabetes and how it affects the student Establishing an accommodation plan that meets the students needs is an ongoing process that requires good communication The student has a right to request and receive reasonable accommodations to ensure that he/she receives a free appropriate public education

Further information can be obtained from the following:

Illinois State Board of Education Division of Special Education Compliance 100 North First Street Springfield, IL 62777-0001 217-782-5589

US Department of Education Office for Civil Rights 330 C Street SW Washington, DC 20020 1-800-421-3481

For information about an Individualized Education Program or Section 504 Accommodation Plan:

For technical assistance and referrals for local support:

National Information Center for Children and Youth with Disabilities PO Box 1492 Washington, DC 60013 1-800-695-0285

Help Me Grow Helpline 2501 North Dirksen Parkway Springfield, Il 62762 1-800-323-GROW
1-800-323-4769

Issued April, 2002

Sample

504 Accommodation Plan
STUDENT ________________________________________________________
_________________________________________________________ GRADE NAME______________________________________ PARENT/GUARDIAN NAME DATE MEETING DATE _________________________________________________

1 Nature of the concern for which this plan is being written: 2 Describe how the concern affects a major life activity: caring for ones self, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, and working a b c 3 List the reasonable accommodations that appear necessary: a b c d DATE REVIEW DATE Example: The first week of every term Participants at meeting: Name and Title

Original placed in the students cumulative file and copies given/sent to the following: Name, title, and date given/sent Section 504 Procedural Safeguards explained and given to the parents or guardians

_______________________ Administration Representative

Issued April, 2002

Training Goals for training:
Everyone mentioned in the plan will know his/her role in carrying out the plan, how it relates to the roles of others and when and where to seek help

Suggested Components of Training:
Introduction to the students individual care
plan

Type 1 or type 2 diabetes: what it is, how
it is
managed if not covered at planning meeting

Preparation:
Contactschoolpersonneltodeterminetheirknowledge of and comfort level with caring for the student Modify the training session accordingly

Monitoring tools: glucose monitor, written
records

Signs and symptoms of hypoglycemia and
hyperglycemia

Procedures for routine care of the individual
student Emergency procedures Overview of universal health and safety guidelines according to Occupational Safety and Health Administration OSHA and disposal of supplies Monitoring techniques for those named in the emergency plan Glucagon storage and administration for those named in the emergency plan Insulin storage and administration if in the plan

Time:
The initial session should take about 30 minutes Some members of the staff may need additional individual training concerning their specific roles

Attendance:
Include all staff mentioned in the plan plus administrative and counseling staff and any others who may interact with the student during the school session

Issued April, 2002

Staff Training Record
S taff M em b er N am e D iab etes B asics D ate T raining R eceived N otes M onitoring Insulin and G
lucagon

Issued April, 2002

Memo to School Staff
To: From: Subject: School Staff The School Health Professional Students with Diabetes

Diabetes is a chronic disease that results from the bodys inability to use and store glucose, the bodys main energy source It is not contagious There are two major types of diabetes type 1 and type 2 Type 1 diabetes, the type seen most commonly in students, occurs when the pancreas stops making insulin, the hormone that helps the body use glucose Diabetes can be controlled Type 1 diabetes is treated with daily injections of insulin, physical activity, and an individualized meal plan In type 2 diabetes, the body produces some insulin, but not enough to maintain blood glucose levels It is treated with an individualized meal plan, activity, pills and/or insulin The proper balance between insulin, food, and physical activity is essential to the successful management of diabetes Insulin When the blood sugar level is too low hypoglycemia an insulin reaction can occur The symptoms are: change in personality inability to think clearly, confusion weak, tired, sleepy sweating, shaking Note: Some students may not recognize these symptoms Early
treatment of low blood sugar can help to avoid potentially serious problems Initial treatment consists of giving the student sugar to raise the blood sugar level This can be given in the form of: 4 oz fruit juice 6 oz REGULAR not diet soda 3-4 glucose tablets 8 oz sports drink High blood sugar hyperglycemia develops over time It is the result of not enough insulin and the student should consult his/her health care provider for adjustment of the insulin dosage Students should be allowed to drink plenty of water and may need more frequent trips to the restroom when their blood sugar is high Checking the amount of sugar in the blood of a student with diabetes serves as an effective guide to proper diabetes control Blood sugar checks may be performed before meals or at other times throughout the day depending on the individuals health care plan Some students self-check, others have alternate arrangements Nutrition

Snacks may be necessary to help maintain balance Please allow the student time to eat a snack when they need to do so Students may need to eat prior to physical activity Students usually follow a prescribed meal plan which allows them to select their foods from the
school lunch menu or bring their own lunch Students with diabetes need to have liberal restroom privileges and access to drinking water

Physical Activity Students with diabetes should not be considered different from other students They can actively engage in all school functions and sports by following the health care plan designed by their health care provider and parent/ guardian Teamwork can help the student with diabetes participate fully in all school activities Please contact me with any questions regarding this information

Issued April, 2002

Tools for Staff Education

Handling the Student with Diabetes at School Diabetes ID Card Travel, Vacations, or Camp Illness at School Actions for: Principal Teacher Health Personnel Counselor Coaches and Physical Education Teachers Bus Drivers Food Service Personnel

Issued April, 2002

Handling the Student with Diabetes at School
he student with diabetes needs to be treated like any other student The only difference is that this students body requires insulin from an external source to function properly Exercise helps the insulin work better Involving the student in physical
activity and sports is highly desirable It is important that the student develop exercise habits at a young age The other students in the classroom, especially the students friends, are often very eager to learn more about diabetes Ask the student and family how this might be discussed with the class Even very young friends can help recognize low blood sugar reactions Things can be more comfortable for everyone when diabetes is not a secret

Parties
The student with diabetes can participate in parties just like all other students Notify the parent or guardian when a party will take place and include information about what food will be served so that they can decide, with the student, what he/she may have to eat

Extracurricular Activities
The student with diabetes should be encouraged and allowed to participate in all extracurricular activities Notify the parent or guardian as soon as possible of the activity, and invite them to participate in the planning meeting, especially if the activity involves an overnight The students diabetes kit, which includes a glucose monitor and supplies, insulin if needed, and a snack source, should always accompany the student on any field trip
Extra snacks need to be taken along in case lunch is delayed or the student gets more exercise than usual An overnight activity will require insulin injections, so the parent or guardian may need to make special arrangements The parent or guardian of a young student may wish to chaperone the event Make sure this is okay with the student

Confidentiality
It is important for staff to be aware that information contained in the student medical record must not be released to unauthorized individuals See Illinois School Student Records Act 105 ILCS 10 However, according to section 37560 of the Act, Information may be released without parental consent in connection with an emergency to appropriate persons if the knowledge of such information is necessary to protect the health or safety of the student

Safety
It is the responsibility of the school to provide a safe environment for all students School staff in direct contact with any student with diabetes should receive instructions about special needs as well as emergency action procedures

Diabetes ID Card
A useful resource is the Diabetes ID Card The card includes basic information about the care of the student with diabetes It is
suggested that this form be laminated or printed on card stock to be used as a quick reference for teachers, coaches, bus drivers, cafeteria aides, friends, field trip chaperones This approach works quite well when you need to communicate to a large staff or groups of people Many families have a large number of cards printed and always have their student carry cards to be distributed as needed to educate someone new

Issued April, 2002

Diabetes ID Card
My Photo

My name is I am ______years old and I HAVE DIABETES

This means that my pancreas does not make insulin Without insulin, the food I eat cannot be used for energy To treat diabetes, I must take insulin everyday and also try to balance my activity level and the food I eat Several times a day I must check my blood sugar level using a special meter I always have with me Its important that you understand some facts about diabetes while Im in your care Please read this and keep it nearby

FACT 1: MEALS AND ACTIVITY
My blood sugar is affected by the food I eat, the amount of activity I get and the amount of insulin I take Please make sure that: My meals and snacks are eaten on time I eat my meals at
_____________,________________,_______________________ I may need an extra snack before, during or after a strenuous activity I will check my blood sugar to see if I need to eat Please allow me to do this

FACT 2: LOW BLOOD SUGAR REACTIONS
Occasionally, my blood sugar may be too low insulin reaction A reaction is most likely to occur: just before lunch, right after strenuous activity, if my meal is delayed, or if I do not eat enough food If my blood sugar goes too low, I may have the following symptoms or signs:

1 3
If this happens I NEED SUGAR IMMEDIATELY

2 4

You can give me________________________________________________________________ You will find this________________________________________________________________ If I am not better in 10-15 minutes, give me__________________________________________ My blood sugar needs to be checked You may need to help me with this

If my blood sugar drops too low, I may become sleepy, unconscious, or have a seizure DO NOT TRY TO FEED ME CALL 911 Give me GLUCAGON by injection, if ordered by my healthcare provider Notify my parent or guardian immediately of this incident

EMERGENCY
NUMBERS:
______________________________________________ Mother: ______________________________________________ Father: ______________________________________________ Other: relationship _____________________________ Phone: _____________________________ Phone: _____________________________ Phone:

Illness at School

tudents with diabetes may become ill while at school or during school-sponsored activities and the general school policy for illness should be followed Illness may cause the blood glucose sugar to rise or drop Orders from the health care provider for glucose monitoring and urine ketone testing should be followed After beginning the same comfort measures offered to all other students, school health personnel should attempt to determine the students current blood sugar level

Although the family should provide regular and sugarfree soda pop, pre-packaged cheese and crackers or peanut butter and crackers for use during emergency situations, the school should have an emergency
supply of these items on hand If a student with diabetes has deep, labored respirations, or if the breath smells fruity, the student may be developing ketones see page 27 Report what you see, hear and/or smell to the parent or guardian and health care provider immediately Additional instructions may be given at that time The student may need to be transported for emergency treatment Students with type 1 diabetes whose blood sugar becomes too high or too low, may become unconscious, unresponsive or uncooperative If this occurs, or if they are severely injured, notify the appropriate emergency personnel immediately Under these circumstances, administer the usual first aid measures, then check the blood glucose level When emergency assistance arrives, the blood glucose level you obtained will assist the emergency personnel as they begin care

Low Blood Sugar 70 mg/dl or symptomatic
Without nausea or vomiting Offer small sips of a clear, regular soda pop as tolerated, or at 5-10 minute intervals Offer treatment for low blood glucose see page 23 With nausea or vomiting Offer small sips of regular soda pop at 5-10 minute intervals Contact the parent or guardian

High Blood Sugar 240
mg/dl
With or without nausea or vomiting Offer small sips of a clear, sugarfree soda pop at 5-10 minute intervals Attempt to check urine for ketones if ordered by health care provider Contact the parent or guardian

If the student becomes unconscious, unresponsive or uncooperative, call for emergency assistance

immediately
Then institute the students individual emergency care plan

Issued April, 2002

Travel, Vacations or Camp
student with diabetes faces unique challenges when traveling The family, student and school staff must work together to ensure a safe activity The family and student should discuss the details of the trip with the diabetes management team for additional support and instructions It is important for the school to: supply the parent or guardian with as complete an itinerary as possible so they can discuss with their healthcare team any changes in treatment plan timing of medications or meals/snacks, ensure that staff and chaperones know the warning signs of and treatment for low blood sugar hypoglycemia, and have a copy of the management regimen, contact names and numbers for family and the health care team, and prescriptions Families are responsible
to make sure the student: wearsandcarriesidentificationdetailingthemanagement regimen, and contact names and number for family and management team, has prescriptions for medication and management tools in case an emergency supply is needed, has all diabetes supplies properly labeled with the students name and properly stored, has enough diabetes supplies medication, lancets, strips, etc for the length of the trip plus extra in case of emergency, and has emergency food in a carry-on that will be kept with the student at all times The family should also: contact the airline, bus or train to determine any storage procedures for sharps needles, lancets, and discuss special food requirements with the airline, bus or train company

If the trip involves flying, the school staff, parents and student may wish to jointly contact the airliner to discuss requirements for the safe transportation of diabetes medication and management supplies Some general guidelines include: 1 Passengers may board with syringes or insulin delivery systems only if they can produce a vial of insulin withaprofessional,pharmaceuticalpreprintedlabelwhich clearly identifies the medication No exceptions will
be made Since the prescription label is on the outside of the box containing the vial of insulin, the FAA recommends that passengers refrain from discarding their insulin box and come prepared with their vial of insulin in its original pharmaceutically labeled box 2 For passengers who have diabetes and must test their blood glucose levels but who do not require insulin, boarding with their lancets is acceptable as long as the lancets are capped, and as long as the lancets are brought on with the glucose meter that has the manufacturers name embossed on the meter ie One Touch meters say One Touch, Accucheck meters say Accucheck 3 Glucagon is dispensed and normally kept in a preprinted labeled plastic container or box Those individuals with diabetes who are traveling should keep their glucagon kit intact in its original preprinted pharmaceutically labeled container 4 Although accepted in the past, prescriptions and letters of medical necessity will not be accepted because of forgery concerns 5 FAA security measures apply to travel within the 50 United States only Passengers should consult their individual air carrier for both domestic US and international travel regulations Be
advised that the FAAs policy and the policy of each airline is subject to change
Source: Federal Aviation Administration, Security and Policy Planning Division Washington, DC verbal communication, Dec 2001

Issued April, 2002

Actions for the Principal
The goal of school personnel is to offer assistance and support to ensure that the student who has diabetes feels safe and secure in school Children with diabetes have certain rights at school as a result of Section 504 of the Rehabilitation Act of 1973 and may have additional rights under the Individuals with disabilities Education Act if determined eligible for special education and related services These laws provide for protection against discrimination for children with disabilities, including diabetes Therefore, while at school, each student with diabetes should be allowed to:

Perform blood sugar monitoring Treat low blood sugars as needed Carry treatment for low blood sugar Give self or receive insulin if indicated Be allowed adequate time for blood sugar checks and eating all meals and snacks Be allowed to fully participate in all the same activities as students who do not have diabetes

Action Steps
Meet with
the family, teachers, school health personnel, playground supervisors,
and food service workers Discuss what the school needs to do to assure that the student with diabetes is treated the same as all other children while accommodating the requirements of the diabetes treatment plan The following areas may need to be addressed: Develop a plan to educate staff including teachers, cafeteria staff, and bus drivers about diabetes and their responsibilities Identify resources available to staff, students, and family

Recognize the signs, symptoms, and treatment of low blood sugar Recognize the signs, symptoms, and treatment of high blood sugar Plan Develop an Emergency Action Plan Identify policies and procedures regarding the treatment plan

With just a few special considerations, the student with diabetes can have a normal life-style and a positive school experience

Source: http://wwwchildrenwithdiabetescom/d_0q_5c0htm Last Updated: Friday, May 11, 2001 04:01:36 PM Copyright 1995-2001 Diabetes 123 and Children with Diabetes ALL RIGHTS RESERVED Used with permission
Issued April, 2002

Actions for the Teacher
The goal of school personnel is to offer assistance and support
to ensure that the student who has diabetes feels safe and secure in the classroom setting With just a few special considerations the student with diabetes can have a normal life-style and a positive school experience

Action Steps
Meet with the family, principal, school health personnel, playground supervisors,
and food service workers Collectively develop an understanding of diabetes and the diabetes related needs of the individual student The following areas may need to be addressed: Recognize the signs and symptoms of low blood sugar insulin reaction, when it is most likely to occur, how to prevent it, and how to treat it Develop a plan of action for emergencies Recognize the signs and symptoms of high blood sugar Identify food and snack requirements and routines Identify blood sugar monitoring needs, routine, privacy, school safety procedures Ensure communication with the family

For specific information regarding the recognition of high and low blood sugars and the appropriate prevention and treatment, please refer to the resource information accompanying this action plan The information will be most beneficial to you and the student if you are familiar with
the information and if it is readily accessible to you at all times

Actions for Health Personnel
The goal of school personnel is to offer assistance and support to ensure that the student who has diabetes feels safe and secure in the classroom setting With just a few special considerations, the student with diabetes can have a normal life-style and a positive school experience

Action Steps
Coordinate through the school counselor, a meeting with the family, teachers, principal,
coach, playground supervisors, office personnel, and lunchroom workers to collectively develop an understanding of diabetes and the individual students requirements to manage it effectively Provide diabetes education materials to appropriate personnel Conduct in-service trainings with the appropriate personnel on the following: Signs and symptoms of low blood sugar, Times low blood sugar is likely to occur, Prevention, Specific treatment, Snack routines, Blood glucose
monitoring routines, Communication with family, Coping mechanisms of student and family, and Issues of diabetes management Be familiar with the signs, symptoms and treatments of high and low blood sugar Assist with administration of medication and/or blood glucose monitoring in accordance with school policy and the orders of the students health care provider Communicate with parents about acute low blood sugar episodes, high blood sugar, and the students general progress in coping with diabetes management at school

For specific information regarding the recognition of high and low blood sugars, the appropriate prevention and treatment, please refer to the resource information accompanying this action plan The information will be most beneficial to you and the student if you are familiar with it, and it is readily accessible to you at all times NOTE: If there is not a nurse at your school, another staff member will need to be trained to assist the student

Actions for the Counselor
The goal of school personnel is to offer assistance and support to ensure that the student who has diabetes feels safe and secure in the classroom setting With just a few special considerations the student with diabetes can have a normal life-style and a positive school experience

Action Steps
With school health personnel, coordinate a conference with the family, teacher, principal, coach, playground supervisors, lunchroom workers, and any significant other persons involved in the students school life, to collectively develop an understanding of diabetes and the individual students requirements to manage it effectively

Recognize that learning to cope with diabetes can be difficult, and attention to management routines is required 24 hours a day

Teachers may notice low self-esteem, withdrawal from activities with other students, and discouragement over the routines required to manage diabetes In addition, fluctuations in blood sugar levels may produce mood swings, and sudden behavior changes may signify acute low blood sugar requiring immediate treatment Understand that the student with diabetes may feel singled out and different from
peers because of special routines and needs required for good diabetes management The student may need your assistance with a variety of adjustment issues surrounding the following: Special scheduling requirements, such as meals and snacks, physical education, and blood glucose monitoring, Uncomfortable feelings regarding the above situations experienced by the student with diabetes or experienced by fellow classmates, Family communication, Coping mechanisms of student and family, and Compliance with diabetes management needs

Coordinate if appropriate a classroom discussion about diabetes and the students
management needs This often works best if the student is willing to participate in the presentation

Actions for Coaches and Physical Education Teachers
The goal of school personnel is to offer assistance and support to ensure that the student who has diabetes feels safe and secure in the physical education setting With just a few special
considerations, the student with diabetes can enjoy and actively participate in school, physical education and sports

Action Steps

Encourage exercise and participation in sports for students with diabetes Be aware that more than usual physical activity, exercise, or sports event participation outdoor activities on a sunny day vs quiet activities on a rainy day, a physically active field trip vs quieter classroom activities, or a longer than usual period of activity can precipitate an acute episode of low blood sugar insulin reaction This can be prevented with an extra snack prior to the activity

Encourage students with diabetes to take responsibility by trying to prevent low blood sugar reactions Low blood sugar prevention guidelines need to be discussed with the parents/ guardians and established as part of the students individual diabetes management program Be familiar with the signs, symptoms and treatment of low blood sugar insulin reaction Develop a plan of action for managing low blood sugar and emergencies

Refer to the parent/guardian and school health professional if you have questions about the students ability to fully participate in physical education For
specific information regarding the recognition of high and low blood sugars, the appropriate prevention and treatment, please refer to the resource information accompanying this action plan The information will be most beneficial to you and the times student if you are familiar with it It should be readily accessible to you at all times

Actions for Bus Drivers
The goal of school personnel is to offer assistance and support to ensure that the student who has diabetes feels safe and secure in all school activities The student with diabetes can enjoy and actively participate in school, physical education and sports

Action Steps
General
Learn about diabetes Promote a supportive learning environment Treat the student normally and help other students do the same Participate in development of the individual care plan Understand ones own role and the role of others Know what to do in an emergency and the order of responsibility for emergency care
Know the phone numbers of the students parents or guardians and the health care provider

Specific
Recognize the signs, symptoms, and treatment of low blood sugar Recognize the signs, symptoms, and treatment of high blood sugar Know how to respond in accordance with the emergency plan Know that the end of the school day is often the time of low blood glucose episodes Communicate diabetes-related needs to substitute drivers and transportation assistants Allow the student to consume a snack on the bus as indicated in his/her care plan

Actions for Food Service Personnel, Parents, Teachers, and Others Providing Food
tudents with diabetes may be purchasing meals from the school menu, eating their own sack lunches in the cafeteria, or participating in school events where food is involved There are a few special considerations that can help the student make wise food choices and enjoy food at school

The Diabetes Meal Plan
Most students with diabetes follow a
meal planThe meal plan is a healthy pattern of eating consisting of: ordinary foods, in carefully controlled amounts, at regularly spaced intervals of eating Meal plans are tailored specifically to meet the needs of each individual student The type of meal plan utilized reflects the preference of the students diabetes team Therefore, it is extremely important to discuss these issues with the student and his/her parents or guardians The most typical meal planning systems are: Carbohydrate Counting, The Exchange System, or Calorie Points A meal plan for a student with diabetes will basically follow the Food Guide Pyramid with some differences Two major differences are that cheeses are in the protein group and the bottom of the pyramid is all carbohydrates: starches, grains and starchy vegetables Sweets are usually considered in the same way as in the regular Food Guide Pyramid They may be employed in small amounts by looking at the food label and fitting the particular item into the students meal plan eg, 2 Oreo cookies equal 1 carbohydrate serving

The School Meal Program
The students diabetes management team usually takes the school meal program into consideration when creating
a meal plan for a school-aged child with diabetes While lunch menus offer a variety of foods, some replacements may be necessary: carbohydrates may need to be added or deleted, and some parents may want especially sweet desserts replaced with fruit of some sort Most students with diabetes can make their own choices from a school lunch menu Parents should be given school lunch menus in advance so they can help their child make appropriate choices

Snacks
Healthy snacks are important for the student with diabetes Incorporating healthy snacks into the daily classroom routine and including all students will not only help the student with diabetes feel less different, but will help all students eat healthier

It is critical that meals and snacks be eaten on the schedule outlined by the students health care provider in order to avoid a low blood sugar reaction Flexible meal timing is acceptable if part of the students treatment plan
Issued April, 2002

If meal times are delayed, an extra snack needs to be eaten Encourage students with diabetes to take responsibility by trying to prevent low blood sugar reactions Discuss low blood sugar prevention guidelines with the parents or
guardians and establish them as part of the students individual diabetes management program Be familiar with the signs, symptoms and treatment of low blood sugar insulin reaction Develop a plan of action for managing low blood sugar and emergencies Keep a list of appropriate snacks to use on hand should this situation arise

Parties And Occasions Involving Food Treats
There are many occasions eg birthdays, holidays, school functions where treats are provided by parents or guardians, teachers, and the school food service personnel It is important that the student with diabetes participate in all celebrations and events The student with diabetes can usually have the same treats as other students, provided they are figured into the students diabetic meal plan The following may help make inclusion of such students easier: Make sure the students parents or guardians are aware of the party Send a note to whoever is responsible for the food and ask that they provide copies of all recipes Share copies of all recipes with parents or guardians of the student with diabetes If purchased food is used, review the food labels for carbohydrate content to see how the treat can fit into the
students meal plan

Suggestions for Classroom Snacks Bread sticks Pretzels Bagels with low-fat cream cheese Muffins Crackers with peanut butter or cheese filling Graham or saltine crackers Cereal Milk Frozen yogurt Fruit sorbet Fruit Fruit kabobs Fruit with plain yogurt Popcorn

Forms included in this section are designed to indicate the types of information that might be included in the treatment plan for a student with diabetes Specific forms should be developed by the individual school district in conjunction with district legal counsel

Issued April, 2002

Sample Forms

Sample Letter from MD to School Personnel Authorization for Mutual Exchange of Medical Information Authorization and Permission for Administration of Medication Medication Administration Record Medical Statement for Students Requiring Modifications in School Meals

Issued April, 2002

Letter From Doctor to School Personnel
Date: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Re:_______________________________________________________ The above student has Type 1 Diabetes or Type 2 Diabetes and is currently taking the following medications:

Medication ___________________ ___________________ ___________________

Dose ________________ ________________ ________________

Time __________________ __________________ __________________

This student must check blood sugars _____ Before lunch ______After lunch _____ Before Physical Activity _____During Physical Activity _____After Physical Activity _____ When symptoms of hypoglycemia or hyperglycemia are present _____ Other______________________________________________ This student may need to take regular or short acting insulin while at school per attached prescribed algorithm This student should have glucagon available to be administered at the time of a severe hypoglycemic reaction when she/he is unresponsive or may choke on oral treatments This student should have food available at all times to treat hypoglycemia Check those that apply ________Fruit juice Other ________Glucose tabs ________Regular soda This student should have unrestricted access to water fountain and restroom

Physicians
Signature_________________________Phone Number___________________________ Date______________________________________ Diabetes Educator: Name_____________________Phone Number_________________________

Issued April, 2002

Authorization for the Mutual Exchange of Medical Information
I_________________________________________________________________________________ Printed Name of Parent/Guardian authorize the mutual exchange of medical information regarding my child: __________________________________________________________________________________ Print Students Name Birth date:_____/_____/_____ between Physician:___________________________________________________________________ Print Name and/or Diabetes Educator:________________________________________________________ Print Name and school___________________________________________________________ Print Name

Signed:_____________________________________________________________________________ Parent/Guardian Signature Printed Name of Parent/Guardian______________________________________ Date:_____________________

Witness:_________________________________________________________________________ Printed Name of
Witness:______________________________________________________________ Date:_____________________

Authorization and Permission for Administration of Medication
Students Name Last First Middle / / Birthdate School Date

School medications and health care services are administered following these guidelines: Physician/Prescriber signed dated authorization to administer the medication Parent signed, dated authorization to administer the medication The medication is in the original labeled container as dispensed or the manufacturers labeled container students The medication label contains the students name, medication name, directions for use and date Annual renewal of authorization and immediate notification, in writing, of changes

Physician Authorization:
Medication/Health Care Treatment: Dosage Time to be administered

Intended effect of this medication Expected side effects, if any Other medications student is taking

May student self-administer medication under supervision of Health Service personnel or designee? Please circle YES / NO completed A A student self-administration form must be completed Administration instructions

Discontinue/Re-Evaluate/Follow-up Date circle
one

Prescribe ribers Prescribers Name Printed

Prescribers Signature

Date signed

Prescribe ribers Emergency Prescribers Emergency Phone

Prescribe ribers Prescribers Address

Authorization and Permission for Administration of Medication page 2

Parental/Guardian Authorization:
herewith for administering However, I herewith acknowledge that I am primarily responsible for administering medication to my child However, in or emergency, hereby authorize the event that I am unable to do so or in the event of a medical emergency, I hereby authorize name of School District and its employees and agents, on my behalf and stead, to administer or to attempt to administer to my or self-administer, under supervision child or to allow my child to self-administer, while under the supervision of the employees and agents of the School District, lawfully prescribed medication in the manner described herein I acknowledge that it may be necessary for the administration of medications to my child to be performed by an individual other than a school nurse, and specifically consent to such practices I further acknowledge and agree that, when the lawfully prescribed medication is so administered or
attempted to be administered, I waive any claims I might have against the School District, its employees and agents arising out of the administration of said medication In addition I agree to hold harmless and indemnify the School District, its employees and agents, either jointly severally, or or or severally, from and against any and all claims, damages, causes of action or injuries incurred or resulting from the administration or attempts at administration of said medication

Parent/Guardian Name Printed

Parent/Guardian Signature

Date Signed

Parent/Guardian Address

Home Phone

Business Phone

Additional Information

Source: Recommended Guidelines for Medication Administration in Schools September, 2000 Illinois Dept of Human Services and Illinois State Board of Education

Medical Statement for Children Requiring Modification in School Meals
Name of Student: Name of Parent/Guardian Disability or Medical Condition requiring modification of school meals: Birth Date: Daytime Phone:

Major life activity affected by students disability please check all that apply: caring for ones self eating performing manual tasks walking learning hearing speaking breathing

seeing
working

other_____________________
Required Meal Modification check all that apply:

Restricted Nutrient
Calorie Controlled Carbohydrate Protein Sodium Fat/Cholesterol

Increased Nutrient
Calorie Protein Fiber Other

Modified Texture Describe required modification

Foods to be omitted from the diet: List all that apply:

Foods that may be substituted:

Special Utensils Needed:

Tube Feeding Required:

Other Accommodations Needed:

For student with a disability: Signature of Physician:

Date:

For non-disabled student: Signature of Other Medical Authority:

Date:

Adapted from Vermont Manual - Recommendations for Management of Diabetes for Children in School

Issued April, 2002

Appendix

Definitions Diabetes Resources Illinois Diabetes Control Program Publications Other Publications Diabetes Websites Care of Children with Diabetes in the School and Day Care Setting, 2002 Type 2 Diabetes in Children and Adolescents

Issued April, 2002

Diabetes Definitions
A
Acetone - A chemical formed in the blood when the body uses fat instead of glucose sugar for energy If acetone forms, it usually means that the cells do not have enough insulin, or
cannot use the insulin that is in the blood, to use glucose for energy Acetone passes through the body into the urine Someone with a lot of acetone in the body can have breath that smells fruity and is called acetone breath See also: Ketone bodies Adrenal Glands - Two organs that sit on top of the kidneys and make and release hormones such as adrenaline epinephrine This and other hormones, including insulin, control the bodys use of glucose sugar Albuminuria - More than normal amounts of a protein called albumin in the urine Albuminuria may be a sign of kidney disease, a problem that can occur in people who have had diabetes for a long time Antagonist - One agent that opposes or fights the action of another For example, insulin lowers the level of glucose sugar in the blood, whereas glucagon raises it; therefore, insulin and glucagon are antagonists Blood Glucose Monitoring - A way of testing how much glucose sugar is in the blood A drop of blood, usually taken from the fingertip, is placed on the end of a specially coated strip, called a testing strip The strip has a chemical on it that makes it change color according to how much glucose is in the blood A person can tell if the
level of glucose is low, high, or normal in one of two ways The first is by comparing the color on the end of the strip to a color chart that is printed on the side of the test strip container The second is by inserting the strip into a small machine, called a meter, which reads the strip and shows the level of blood glucose in a digital window display Blood testing is more accurate than urine testing in monitoring blood glucose levels because it shows what the current level of glucose is, rather than what the level was an hour or so previously

C
CDE Certified Diabetes Educator - A health care professional who is qualified by the American Association of Diabetes Educators to teach people with diabetes how to manage their condition The health care team for diabetes should include a diabetes educator, preferably a CDE Carbohydrate - One of the three main classes of foods and a source of energy Carbohydrates are mainly sugars and starches that the body breaks down into glucose a simple sugar that the body can use to feed its cells The body also uses carbohydrates to make a substance called glycogen that is stored in the liver and muscles for future use If the body does not have
enough insulin or cannot use the insulin it has, then the body will not be able to use carbohydrates for energy the way it should This condition is called diabetes Carbohydrate Counting - A meal plan method which allows for the greatest flexibility and variety in the types of foods consumed Individuals must learn how to read food labels and consistently estimate the amount of carbohydrate in prepared foods for specific

B
Beta Cell - A type of cell in the pancreas in areas called the islets of Langerhans Beta cells make and release insulin, a hormone that controls the level of glucose sugar in the blood Blood Glucose - The main sugar that the body makes from the three elements of food-proteins, fats, and carbohydrates-but mostly from carbohydrates Glucose is the major source of energy for living cells and is carried to each cell through the bloodstream The cells cannot use glucose without the help of insulin

Issued April, 2002

portion sizes The dietitian works with the individual to determine the range of carbohydrate to be consumed at a meal or snack The individual then may select amounts and type of foods within the suggested range Staying within the suggested range
provides consistent carbohydrate intake and should result in less fluctuation in blood sugar level Cerebrovascular Disease - Damage to the blood vessels in the brain, resulting in a stroke The blood vessels become blocked because of fat deposits or they become thick and hard, blocking the flow of blood to the brain Sometimes, the blood vessels may burst, resulting in a hemorrhagic stroke People with diabetes are at higher risk of cerebrovascular disease Complications of Diabetes - Harmful effects that may happen when a person has diabetes Some effects, such as hypoglycemia, can happen any time Others develop when a person has had diabetes for a long time These include damage to the retina of the eye retinopathy, the blood vessels angiopathy, the nervous system neuropathy, and the kidneys nephropathy Studies show that keeping blood glucose levels as close to the normal, nondiabetic range as possible may help prevent, slow, or delay harmful effects to the eyes, kidneys, and nerves Conventional Therapy - A system of diabetes management practiced by most people with diabetes; the system consists of one or two insulin injections each day, daily self-monitoring of blood glucose, and a
standard program of nutrition and exercise The main objective in this form of treatment is to avoid very high and very low blood glucose sugar

rising, adjustments in evening snacks or insulin dosages may be recommended See also: Somogyi effect Dehydration - Great loss of body water A very high level of glucose sugar in the urine causes loss of a great deal of water, and the person becomes very thirsty Diabetic Ketoacidosis DKA - Severe, out-ofcontrol diabetes high blood sugar that needs emergency treatment DKA happens when blood sugar levels get too high This may happen because of illness, taking too little insulin, or getting too little exercise The body starts using stored fat for energy and ketone bodies acids build up in the blood Ketoacidosis starts slowly and builds up The signs include nausea and vomiting, which can lead to loss of water from the body, stomach pain, and deep and rapid breathing Other signs are a flushed face, dry skin and mouth, a fruity breath odor, a rapid and weak pulse, and low blood pressure If the person is not given fluids and insulin right away, ketoacidosis can lead to coma and even death Diabetic Retinopathy - A disease of the small blood vessels
of the retina of the eye When retinopathy first starts, the tiny blood vessels in the retina become swollen, and they leak a little fluid into the center of the retina The persons sight may be blurred This condition is called background retinopathy About 80 percent of people with background retinopathy never have serious vision problems, and the disease never goes beyond this first stage However, if retinopathy progresses, the harm to sight can be more serious Many new, tiny blood vessels grow out and across the eye This is called neovascularization The vessels may break and bleed into the clear gel that fills the center of the eye, blocking vision Scar tissue may also form near the retina, pulling it away from the back of the eye This stage is called proliferative retinopathy, and it can lead to impaired vision and even blindness

D
Dawn Phenomenon - A sudden rise in blood glucose levels in the early morning hours This condition sometimes occurs in people with insulindependent diabetes and rarely in people with noninsulin dependent diabetes Unlike the Somogyi effect, it is not a result of an insulin reaction People who have high levels of blood glucose in the mornings before
eating may need to monitor their blood glucose during the night If blood glucose levels are

E
Endocrine Glands - Glands that release hormones into the bloodstream They affect how the body uses food metabolism They also influence other body functions One endocrine gland is the pancreas It releases insulin so the body can use sugar for energy

Issued April, 2002

Exchange Lists - A grouping of foods by type to help people on special diets stay on the diet Each group lists food in serving sizes A person can exchange, trade, or substitute a food serving in one group for another food serving in the same group The lists put foods in six groups: 1 starch/bread, 2 meat, 3 vegetables, 4 fruit, 5 milk, and 6 fats Within a food group, each serving has about the same amount of carbohydrate, protein, fat, and calories

H
Hemoglobin A1C HbA1C - The substance of red blood cells that carries oxygen to the cells and sometimes joins with glucose sugar Because the glucose stays attached for the life of the cell about 4 months, a test to measure hemoglobin A1C shows what the persons average blood glucose level was for that period of time Hyperglycemia - Too high a level of glucose sugar in the
blood; a sign that diabetes is out of control Many things can cause hyperglycemia It occurs when the body does not have enough insulin or cannot use the insulin it does have to turn glucose into energy Signs of hyperglycemia are a great thirst, a dry mouth, and a need to urinate often For people with insulin-dependent diabetes, hyperglycemia may lead to diabetec ketoacidosis Hyperinsulinism - Too high a level of insulin in the blood This term most often refers to a condition in which the body produces too much insulin Researchers believe that this condition may play a role in the development of non insulin-dependent diabetes and in hypertension Hypoglycemia - Too low a level of glucose sugar in the blood This occurs when a person with diabetes has injected too much insulin, eaten too little food, or has exercised without extra food A person with hypoglycemia may feel nervous, shaky, weak, or sweaty, and have a headache, blurred vision, and hunger Taking small amounts of sugar, sweet juice, or food with sugar will usually help the person feel better within 10-15 minutes

F
Fasting Blood GlucoseTest FBG/Fasting Blood Sugar - A method for finding out how much glucose sugar is in the
blood The test can show if a person has diabetes A blood sample is taken in a lab or doctors office The test is usually done in the morning before the person has eaten The normal, nondiabetic range for blood glucose is from 70 to 110 mg/dl, depending on the type of blood being tested If the level is 126 mg/dl or greater, it means the person has diabetes except for newborns and some pregnant women

G
Glucagon - A hormone that raises the level of glucose sugar in the blood The alpha cells of the pancreas in areas called the islets of Langerhans make glucagon when the body needs to put more sugar into the blood An injectable form of glucagon, which can be bought in a drug store, is sometimes used to treat insulin shock The glucagon is injected and quickly raises blood glucose levels Glucose Tolerance Test - A test to see if a person has diabetes The test is given in a lab or doctors office in the morning before the person has eaten A first sample of blood is taken from the person Then the person drinks a liquid that has glucose sugar in it After one hour, a second blood sample is drawn, and, after another hour, a third sample is taken The object is to see how well the body deals with
the glucose in the blood over time Glycosylated Hemoglobin Test - A blood test that measures a persons average blood glucose sugar level for the 2- to 3-month period before the test See Hemoglobin A1C
Issued April, 2002

I
Injection Sites - Places on the body where people can inject insulin most easily These are: The outer area of the upper arm Just above and below the waist, except the area right around the navel a 2-inch circle The upper area of the buttock, just behind the hip bone The front of the thigh, midway to the outer side, 4 inches below the top of the thigh to 4 inches above the knee These areas can vary with the size of the person

Injection Site Rotation - Changing the places on the body where a person injects insulin Changing the injection site keeps lumps or small dents from forming in the skin These lumps or dents are called lipodystrophies People should try to use the same body area for injections that are given at the same time each day-for example, always using the stomach for the morning injection or an arm for the evening injection Using the same body area for these routine injections lessens the possibility of changes in the timing and action of
insulin Insulin - A hormone that helps the body use glucose sugar for energy The beta cells of the pancreas in areas called the islets of Langerhans make the insulin When the body cannot make enough insulin on its own, a person with diabetes must inject insulin made from other sources, ie, beef, pork, human insulin recombinant DNA origin, or human insulin pork-derived, semisynthetic Insulin Pump - A device that delivers a continuous supply of insulin into the body The insulin flows from the pump through a plastic tube that is connected to a needle inserted into the body and taped in place Insulin is delivered at two rates: a low, steady rate called the basal rate for continuous day-long coverage, and extra boosts of insulin called bolus doses to cover meals or when extra insulin is needed The pump runs on batteries and can be worn clipped to a belt or carried in a pocket It is used by people with type 1 diabetes or during pregnancy Insulin Resistance - Many people with type 2 diabetes produce enough insulin, but their bodies do not respond to the action of insulin This may happen because the person is overweight and has too many fat cells, which do not respond well to insulin Also,
as people age, their body cells lose some of the ability to respond to insulin Insulin resistance is also linked to high blood pressure and high levels of fat in the blood Another kind of insulin resistance may happen in some people who take insulin injections They may have to take very high doses of insulin every day 200 units or more to bring their blood glucose sugar down to the normal range This is also called insulin insensitivity Intensive Management - A form of treatment for insulin-dependent diabetes in which the main objective is to keep blood glucose sugar levels as
Issued April, 2002

close to the normal range as possible The treatment consists of three or more insulin injections a day or use of an insulin pump; four or more blood glucose tests a day; adjustment of insulin, food intake, and activity levels based on blood glucose test results; dietary counseling; and management by a diabetes team

K
Ketone Bodies - Chemicals that the body makes when there is not enough insulin in the blood and it must break down fat for its energy Ketone bodies can poison and even kill body cells When the body does not have the help of insulin, the ketones build up in the blood and then
spill over into the urine so that the body can get rid of them The body can also rid itself of one type of ketone, called acetone, through the lungs This gives the breath a fruity odor Ketones that build up in the body for a long time lead to serious illness and coma See also: Diabetic ketoacidosis Ketonuria - Having ketone bodies in the urine; a warning sign of diabetic ketoacidosis DKA

L
Lipodystrophy - Lumps or small dents in the skin that form when a person keeps injecting the needle in the same spot Lipodystrophies are harmless People who want to avoid them can do so by changing rotating the places where they inject their insulin Using purified insulin may also help See also: Injection site rotation

M
Mg/dl - Milligrams per deciliter Term used to describe how much glucose sugar is in a specific amount of blood In self-monitoring of blood glucose, test results are given as the amount of glucose in milligrams per deciliter of blood A fasting reading of 70 to 110 mg/dl is considered in the normal nondiabetic range Mixed Dose - Combining two kinds of insulin in one injection A mixed dose commonly combines regular insulin, which is fast acting, with a longer acting
insulin

such as NPH A mixed dose insulin schedule may be prescribed to provide both short-term and long-term coverage

if they take good care of their feet, do not smoke, and keep both their blood pressure and diabetes under good control Point System - A way to plan meals that uses points to rate food The foods are placed in four classes: calories, carbohydrates, proteins, and fats Each food is given a point value within its class A person with a planned diet for the day can choose foods in the same class that have the same point values for meals and snacks Polydipsia - A great thirst that lasts for long periods of time; a sign of diabetes Polyphagia - Great hunger; a sign of diabetes People with this great hunger often lose weight Polyuria - Having to urinate often; a common sign of diabetes

N
Necrobiosis Lipoidica Diabeticorum - A skin condition usually on the lower part of the legs The lesions can be small or extend over a large area They are usually raised, yellow, and waxy in appearance and often have a purple border Young women are most often affected This condition occurs in people with diabetes, or it may be a sign of diabetes It also occurs in people who do not have
diabetes Noninvasive Blood Glucose Monitoring - A way to measure blood glucose without having to prick the finger to obtain a blood sample Several noninvasive devices are currently being developed

R
Receptors - Areas on the outer part of a cell that allow the cell to join or bind with insulin that is in the blood

P
Pancreas - An organ behind the lower part of the stomach that is about the size of a hand It makes insulin so that the body can use glucose sugar for energy It also makes enzymes that help the body digest food Spread all over the pancreas are areas called the islets of Langerhans The cells in these areas each have a special purpose The alpha cells make glucagon, which raises the level of glucose in the blood; the beta cells make insulin; the delta cells make somatostatin There are also the PP cells and the D1 cells, about which little is known Peak Action - The time period when the effect of something is as strong as it can be such as when insulin in having the most effect on lowering the glucose sugar in the blood Peripheral Vascular Disease PVD - Disease in the large blood vessels of the arms, legs, and feet People who have had diabetes for a long time may get this
because major blood vessels in their arms, legs, and feet are blocked and these limbs do not receive enough blood The signs of PVD are aching pains in the arms, legs, and feet especially when walking and foot sores that heal slowly Although people with diabetes cannot always avoid PVD, doctors say they have a better chance of avoiding it
Issued April, 2002

S
Sliding Scale - Adjusting insulin on the basis of blood glucose tests, meals, and activity levels Somatostatin - A hormone made by the delta cells of the pancreas in areas called the islets of Langerhans Scientists think it may control how the body secretes two other hormones–insulin and glucagon Somogyi Effect - A swing to a high level of glucose sugar in the blood from an extremely low level, usually occurring after an untreated insulin reaction during the night The swing is caused by the release of stress hormones to counter low glucose levels People who experience high levels of blood glucose in the morning may need to test their blood glucose levels in the middle of the night If blood glucose levels are falling or low, adjustments in evening snacks or insulin doses may be recommended This condition is named after Dr
Michael Somogyi, the

man who first wrote about it Also called rebound Split Dose - Division of a prescribed daily dose of insulin into two or more injections given over the course of a day, may also be referred to as multiple injections Many people who use insulin feel that split doses offer more consistent control over blood glucose sugar levels

people who are over age 40 Most of the people who have this type of diabetes are overweight Type 2 diabetes mellitus used to be called adult-onset diabetes, maturity-onset diabetes, ketosis-resistant diabetes, stable diabetes, and non insulindependent diabetes

U
Ulcer - A break in the skin; a deep sore People with diabetes may get ulcers from minor scrapes on the feet or legs, from cuts that heal slowly, or from the rubbing of shoes that do not fit well Ulcers can become infected Unit of Insulin - The basic measure of insulin U100 insulin means 100 units of insulin per milliliter ml or cubic centimeter cc of solution Most insulin made today in the United States is U-100 Unstable Diabetes - A type of diabetes in which a persons blood glucose sugar level often swings quickly from high to low and from low to high Also called brittle
diabetes or labile diabetes Urine Testing - Checking urine to see if it contains glucose sugar and ketones Special strips of paper or tablets called reagents are put into a small amount of urine or urine plus water Changes in the color of the strip show the amount of glucose or ketones in the urine Urine testing is the only way to check for the presence of ketones, a sign of serious illness However, urine testing is less desirable than blood testing for monitoring the level of glucose in the body See also: Blood Glucose Monitoring

T
Team Management - Describes a diabetes treatment approach in which medical care is provided by a physician, diabetes nurse educator, dietitian, and behavioral scientist working together with the patient Type 1 Diabetes Mellitus - A chronic condition in which the pancreas makes little or no insulin because the beta cells have been destroyed The body is then not able to use the glucose blood sugar for energy Type 1 comes on abruptly, although the damage to the beta cells may begin much earlier The signs of type 1 are a great thirst, hunger, a need to urinate often, and loss of weight To treat the disease, the person must inject insulin, follow a diet
plan, exercise daily, and test blood glucose several times a day Type 1 usually occurs in children and adults who are under age 30 This type of diabetes used to be known as juvenile diabetes, juvenile-onset diabetes, and ketosis-prone diabetes Type 2 Diabetes Mellitus - The most common form of diabetes mellitus; about 90 to 95 percent of people who have diabetes have type 2 diabetes Unlike the insulin-dependent type of diabetes in which the pancreas makes no insulin, people with non-insulin dependent diabetes produce some insulin, sometimes even large amounts However, either their bodies do not produce enough insulin or their body cells are resistant to the action of insulin see Insulin Resistance People with type 2 diabetes can often control their condition by losing weight through diet and exercise If not, they may need to combine insulin or a pill with diet and exercise Generally, type 2 diabetes occurs in

Source: Adapted from The Diabetes Dictionary National Diabetes Information Clearinghouse NIH Publication No 94-3016 August 1994 wwwniddknihgov/health/diabetes/pubs/dmdict/ dimdicthtm

Issued April, 2002

Diabetes Resources
This directory lists government agencies,
voluntary associations, and private organizations that provide diabetes information and resources Some of these diabetes organizations offer educational materials and support to people while others primarily serve health care professionals This list is for informational purposes only and does not imply endorsement by the Illinois Department of Human Services or the State of Illinois

Department of Health and Human Services
National Institutes of Health NIH

Diabetes Research and Training Centers DRTCs

offer educational seminars and workshops for health care professionals National Institute of Diabetes and Digestive and Kidney provide referrals to people with diabetes Disorders NIDDK For more information on publications and programs contact the centers listed below:
Indiana University DRTC David G Marrero, PhD Indiana University School of Medicine The National Institute for Fitness and Sport Room 122 Indianapolis, IN 46202 Tel: 317 278-0905 Fax: 317 278-0911 E-mail: dmarrero@mdepiupyedu University of Chicago DRTC Wylie L McNabb, EdD Center for Research in Medical Education and Health Care University of Chicago Department of Medicine 5841 S Maryland Ave, MC 6091 Chicago, IL 60637
Tel: 773 753-1310 Fax: 773 753-1316 University of Illinois DRTC Department of Pediatrics College of Medicine Peoria, IL 61637 Tel: 309 655-4242 Fax: 309 655-2565

Home page: wwwniddkgov -Governments lead agency for diabetes research -Funds six Diabetes Research and Training Centers -Has the following three information clearinghouses: National Diabetes Information Clearinghouse NDIC 1 Information Way Bethesda, MD 20892-3560 Tel: 301 654-3327 Fax: 301 907-8906 E-mail: ndic@infoniddknihgov Home page: wwwniddkgov National Kidney and Urologic Diseases Information Clearinghouse NKUDIC 3 Information Way Bethesda, MD 20892-3580 Tel: 301 654-4415 Fax: 301 907-8906 E-mail: nkudic@infoniddknihgov Home page: wwwniddkgov Weight-Control Information Network WIN 1 WIN Way Bethesda, MD 20892-3665 Tel: 800 WIN-8098 or 301 984-7378 Fax: 301 984-7196 E-mail: win@infoniddknihgov Home page: wwwniddkgov

Issued April, 2002

Washington University DRTC Edwin B Fisher, Jr, PhD medical research only Washington University School of Medicine Division of Health Behavior Research 444 Forest Park Ave, Ste 6700 St Louis, MO 63108 Tel: 314 286-1900 Fax: 314 286-1919 National Eye Institute NEI National Eye
Health Education Program Box 20/20 Bethesda, MD 20892 Tel: 800 869-2020 for health professional only or 301 496-5248 Fax: 301 402-1065 E-mail: 2020@b31netnihgov Home page: http://wwwneinihgov National Heart, Lung, and Blood Institute NHLBI Information Center PO Box 30105 Rockville, MD 2084-0105 Tel: 301 592-8573 Fax: 301 592-8563 E-mail: nhlbilc@dgsyscom Home page: http://wwwnhlbinihgov/health/infoctr/ Centers for Disease Control and Prevention CDC Division of Diabetes Translation National Center for Chronic Disease Prevention and HealthPromotion Mail Stop K-10 4770 Buford Highway NE Atlanta, GA 30341-3717 Tel: 800 CDC-DIAB Fax: 301 562-1050 E-mail: diabetes@cdcgov Home page: http://wwwcdcgov/diabetes Home page includes facts sheets, statistics, publications, and information about State diabetes control program Office of Minority Health Resource Center OMH-RC PO Box 37337 Washington, DC 20013-7337 Tel: 800 444-6472 Fax: 301 589-0884

Professional and Voluntary Associations
American Association of Clinical Endocrinologists AACE 1000 Riverside Ave, Ste 205 Jacksonville, FL 32304 Tel: 904 353-7878 Fax: 904 353-8185 Home page: http://wwwaacecom American Association of Diabetes
Educators AADE 100 W Monroe, 4th Fl Chicago, IL 60603 Tel: 312 424-2426 Fax: 312 424-2427 Diabetes Educator Access Line: 800 TEAMUP4 800-832-6874 Home page: http://wwwaadenetorg American Diabetes Association ADA American Diabetes Association National Service Center 1701 N Beauregard St Alexandria, VA 22311 Tel: 703 549-1500 National Service Center, also 800 232-3472 or 800 342-2382 800 DIABETES Fax: 703 549-6995 Home page: http://wwwdiabetesorg American Dietetic Association ADA 216 W Jackson Blvd, Ste 800 Chicago, IL 60606-6995 Tel: 312 899-0040 Fax: 800 877-1600 Home page: http://wwweatrightorg American Indian Health Services 838 W Irving Park Rd Chicago, IL 60613 Tel: 773 883-9100 Fax: 312 922-8713 Diabetes Care and Education Dietetic Practice Group DCE For more information contact the American Dietetic Association

Issued April, 2002

National Center for Nutrition and Dietetics, Consumer Nutrition Hotline part of the American Dietetic Association Tel: 800 366-1655 Home page: http://wwweatrightorg Illinois Podiatric Medical Association IPMA 53 W Jackson Blvd Suite 1103 Chicago, IL 60604 Tel: 312-427-5810 Home page: http://wwwipmanet Diabetes Action Research and Education
Foundation 426 C St, NE Washington, DC 20002 Tel: 202 333-4520 Fax: 212 785-9595 Home page: http://wwwdareforg International Diabetes Federation IDF Rue Defacqz 1 B-1000 Brussels, Belgium Tel: 32-2/538-5511 Fax 32-2/538-5114 E-mail: idf@idforg Home page: http://wwwidforg Illinois Society for the Prevention of Blindness 407 S Dearborn Suite 1000 Chicago, IL 60605 Tel: 312 922-8710 Fax: 312 922-8713 Home page: http://wwweyehealthillinoisorg International Diabetes Athletes Association IDAA 1647 W Bethany Home Rd, B Phoenix, AZ 85015 Tel: 800 898-433 or 602 433-2113 Fax: 602 433-9331 E-mail: idaa@getnetcom Home page: http://wwwdiabetes-exerciseorg Juvenile Diabetes Foundation International JDF 120 Wall St New York, NY 10005 Tel: 800 533-2873 or 212 785-9500 Fax: 212 785-9595 E-mail: info@idfcurecom Home page: http://wwwjdforg

National Certification Board for Diabetes Educators NCBDE 330 E Algonquin Rd, Ste 4 Arlington Heights, IL 60005 Tel: 847 228-9795 Fax: 847 228-8469 Home page: http://wwwncbdeorg National Kidney Foundation, Inc NKF 30 E 33rd St New York, NY 10016 Tel: 800 622-9010 or 212 889-2210 Fax: 212 689-9261 or 212 779-0068 Home page: http://wwwkidneyorg Pedorthic Footwear
Association PFA 710 columbia Gateway Dr Suite G Columbia, MD 21046-1151 Tel: 410 381-7278 or 800 973-8447 Fax: 410 381-1167 Home page: http://wwwpedorthicsorg

Private Organizations
Joslin Diabetes Center One Joslin Place Boston, MA 02215 Tel: 617 732-2400 Home page: http://wwwjoslinharvardedu

The following diabetes education programs in your area are recognized by the American Diabetes Association These recognized programs set the National Standards for Excellence in Diabetes Education For current update call 800-342-2382 The facilities are listed in alphabetical order by location
Saint Anthonys Health Center Diabetes Self-Management Skills Program Saint Anthonys Way, PO Box 340 Alton, IL 62002-0340 618-474-5012 Suburban Endocrinology and Diabetes Center The Outpatient Diabetes Education Program at Suburban Endocrinology Center 2010 S Arlington Heights Rd, Ste 209 Arlington Heights, IL 60005 847-228-3200 x208

Issued April, 2002

Northwest Community Healthcare The Outpatient Diabetes Education program 800 W Central Rd Arlington Heights, IL 60005 847-618-4475 Carle Clinic Association The Diabetes Outpatient Education Program at Bloomington 1701 E College Ave Bloomington, IL
61704 309-664-3130 Michael Reese Hospital The Diabetes Center 2929 S Ellis Chicago, IL 60616 312-791-2205 University of Chicago Hospitals Diabetes Health and Education Program 5758 S Maryland Ave, CAM 5A MC 9015 Chicago, IL 60637 773-702-1532 St Elizabeths Hospital Center for Diabetes Education Program 1431 N Claremont Ave Chicago, IL 60622 312-633-5949 Sobel Medical Associates, Ltd Diabetes Self-Management Program Gerald W Sobel, MD, CDE Robert J Sobel, MD, CDE 30 N Michigan Ave Ste 1720 Chicago, IL 60602 312-72-60005 Mount Sinai Hospital Medical Center The Diabetes Self-Management Outpatient Education Program 15th and California Avenue Chicago, IL 60608 773-257-5245

LaRabida Childrens Hospital and Research Center and The Univ of Chicago The Chicago Childrens Diabetes Center Education Program East 65th St at Lake Michigan Chicago, IL 60649 800-770-2232 Swedish Covenant Hospital The Self-Management Training Program of the Diabetes Community Center 5145 N California Ave Chicago, IL 60625 773-878-8200 x 5256 Diabetes Treatment Center of Mercy Hospital Diabetes Education Program 2525 S Michigan Ave Chicago, IL 60616 312-567-2478 St James Center for Diabetes St James Outpatient
Diabetes Self-Management EducationProgram 30 E 15th St, Ste 314 Chicago Heights, IL 60411 708-709-2010 Carle Clinic Association The Diabetes Outpatient Education Program at Danville 2300 N Vermilion St Danville, IL 61832 217-431-7800 Downers Grove Family Practice Diabetes Education Program 4900 Main St Downers Grove, IL 60515 630-963-5440 OSF Saint Francis Medical Center Adult Diabetes Resource Center 100 N Main St, Ste 203 East Peoria, IL 61611 309-624-9426 Provena Saint Joseph Hospital The Outpatient Diabetes Education Program 77 N Airlite St Elgin, IL 60123 847-695-3200 x 5742

Issued April, 2002

Sherman Hospital Sherman Diabetes Education Center Program 934 Center St Elgin, IL 60120 847-429-8991 Elmhurst Memorial Hospital The Self-Management Education Program of The Learning Center for Diabetes 200 Berteau Ave Elmhurst, IL 60126 630-993-5108 St Francis Hospital Harry Hay Wolf Jr Diabetes Center The Diabetes Education Program 355 Ridge Ave Evanston, IL 60602 847-316-7337 The Freeport Health Network Diabetes Education Program 1045 W Stephenson St Freeport, IL 61032 815-235-0459 Delnor-Community Hospital Outpatient Diabetes Education Program 300 Randall Rd Geneva, IL
60134-4202 630-262-6077 Evanston Northwestern Healthcare-Highland Park Hospital The Diabetes Education Program 718 Glenview Ave Highland Park, IL 60035-2497 847-432-8000 x5032 St Alexius Medical Center Diabetes Education Program 1555 N Barrington Rd Hoffman Estates, IL 60194 847-490-2929 Jersey Community Hospital JCH Diabetes Education Service 400 Maple Summit Rd Jerseyville, IL 62052 618-498-8465

Silver Cross Hospital Silver Cross Diabetes Center 1200 Maple Rd Joliet, IL 60432 815-740-5990 Mercy Medical in Justice Diabetes Education Program 81st St and Kean Ave Justice, IL 60458 708-594-3500 Riverside HealthCare Diabetes Outpatient Self-Management Education Program 350 N Wall St Kankakee, IL 60901 815-936-6515 Anderson Hospital Outpatient Diabetes Self-Management Education Program 6800 State Rte 162 PO Box 1000 Maryville, IL 62062 618-288-5711 x209 or 386 Sarah Bush Lincoln Health Center, Community Health Plan, Outpatient Diabetic Clinic 1000 Health Center Dr Mattoon, IL 61938 217-258-2130 Carle Clinic Association The Diabetes Outpatient Education Program at Mattoon/Charleston 200 Lerna Rd South Mattoon, IL 61938 217-258-5900 Loyola University Medical Center - Diabetes Care
Center Living With Diabetes Building 106, Room 0400 2160 S First Ave Maywood, IL 60153 708-216-4137 Edward Hospital The Edward Center for Diabetes Education 120 Spalding Dr, Ste 411 Naperville, IL 60540 630-527-3213

Issued April, 2002

West Suburban Hospital Medical Center The Diabetes Education Program Erie at Austin Oak Park, IL 60302 708-763-2927 Oak Park Hospital The Diabetes Education Program at The Center for Healthy Living 520 S Maple Ave Oak Park, IL 60304 708-660-5900 Palos Community Hospital The Outpatient Diabetes Education Program 12251 S 8th Ave Palos Heights Il 60463 708-923-4145 Advocate Lutheran General Hospital Diabetes Care Center 1775 Dempster Park Ridge, IL 60068 Methodist Medical Center of Illinois Diabetes Care Center/Self-Management Education Program 120 NE Glen Oak Ave, Ste 306A Peoria, IL 61603 309-672-5980 MacNeal Health Network The MacNeal Diabetes Centers Comprehensive Diabetes Self-Management Program 3722 S Harlem Ave, Ste 204 Riverside, IL 60546 708-442-0044 Iowa Health System Trinity Medical Center 2701 17th St Rock Island, IL 61201 309-779-5384 Swedish American Hospital Diabetes Center The Outpatient Diabetes Education Program 1400 Charles St
Rockford, IL 61104 815-489-4396

OSF Saint Anthony Medical Center Outpatient Education and Self-Management Training 5666 E State St Rockford, IL 61108-2472 815-395-5159 Rockford Health System Diabetes Services Education Program 2300 N Rockton Ave Rockford, IL 61103 815-971-2555 Shelby Memorial Hospital Shelby Memorial Hospital Outpatient Diabetes Self-Management Program 200 S Cedar St Shelbyville, IL 62565 217-774-3961 x3130 Evanston Northwestern Healthcare Partners in Diabetes Care 9977 Woods Dr Skokie, IL 60077 847-663-8508 Springfield Diabetes Endocrine Center Diabetes Outpatient Self-Management Training Program 2528 Farragut Dr Springfield, IL 62704 217-787-6799 Southern Illinois University School of Medicine The Diabetes Self-Management Program PO Box 19230 Springfield, IL 62794-1619 217-782-0182 x2386 CGH Medical Center Type 2 Diabetes Outpatient Education Program 100 E LeFevre Rd Sterling, IL 61081 815-625-0400 x 5586 Carle Clinic Association The Diabetes Outpatient Education Program at Urbana 602 W University Ave, Dept S2RE Urbana, IL 61801 217-383-3490

Issued April, 2002

Other Publications
This resource provides
information regarding books, videotapes, and other educational materials about diabetes This list is for informational purposes only and does not imply endorsement by the Illinois Department of Human Services or the State of Illinois The Best Year of My Life: Book 1: Getting Diabetes by Jed Block Illustrated by Caitlin Block 1999 ISBN 0-9672728-0-7 Making the Best of Life: Book 2: Learning to Live With Diabetes by Jed Block 2000 ISBN 0-9672728-15 Diabetes Care Made Easy by Allison Nemanic RN BA, Gretchen Kauth RD CDE, and Marion J Franz MS, RD, CDE Illustrated by Jan Westberg IDC Publishing, 1992 ISBN 1-885115-31-8 Donnie Makes a Difference by Sandra Haines Illustrated by Paul Hart Writers Press Service, 1994 ISBN 1885101066 Even Little Kids Get Diabetes by Connie White Pirner Pictures by Nadine Bernard Westcott Published by Albert Whitman Company, 1991 ISBN 08075-2158-2 hardcover or 0-8075-2159-0 paperback In Control — A Guide for Teens with Diabetes by Jean Betschart, MN, RN, CDE, and Susan Thom, RD, LD, CDE 1995 ISBN 1-56561-061-X Its Time to Learn About Diabetes by Jean Betschart, MN, RN, CDE Illustrations by Nancy Songer, RN, MSN, CPNP 1995 ISBN 0471347434 Shot Matthew Takes
His Sho by Owen Coleman Illustrated by Judy Bullock 2001 ISBN 1-57197-255-2 Meeting the Challenge: Children Living with Diabetes by Thomas Bergman Published by Gareth Stevens, 1992 ISBN 0-8368-0738-3 Gareth Stevens, 1555 North River Center Drive, Suite 201, Milwaukee, WI 53212 1-800-542-2595 USA, 414 225-0333, info@GSInccom email My Sister Rose Has Diabetes by Monica Driscoll Beatty Illustrated by Kathy Parkinson Published by Health Press, 1997 ISBN 0-929173-27-9 Health Press, PO Drawer 1388, Sante Fe, New Mexico 87504 1-800-643-2665 Sugar Isnt Everything by Willo Davis Roberts Published by Aladdin Books, 1987 ISBN 0-689-712251 190 pages Paperback Taking Diabetes to School by Kim Gosselin Illustrated by Moss Freedman Published by JayJo Books, LLC, 1994 ISBN 1-891383-00-0 JayJo Books, LLC, PO Box 213, St Louis, MO 63088-0213 636 861-1331 Teddy Ryder Rides Again by the American Diabetes Association Softcover, 24 pages ADA order number is CCHTRRA US 225 for nonmembers, US 175 for members Trick-or-Treat for Diabetes by Kim Gosselin Illustrated by Tom Dineen Published by JayJo Books, LLC, 1999 ISBN 1-891383-07-8 JayJo Books, LLC, PO Box 213, St Louis, MO 63088-0213 636 8611331 When a
Family Gets Diabetes by Marge Heegard, MA, ATR and Chris Ternand, MD Published by DCI Publishing, 1990 ISBN 0-937721-75-1 Brown Bag Success: Making Healthy Lunches Your Kids Wont Trade by Sandra K Nissenberg, MS, RD and Barbara N Pearl, MS, RD Published by Chronimed Publishing, 1997 US 995 ISBN 156561-123-3 Children with Diabetes by Linda Siminerio and Jean Betschart Published by the American Diabetes Association, 1986 US 995 nonmembers US 795 members ISBN 0-945448-08-2

Issued April, 2002

Caring for Children with Diabetes by Belinda Childs, RN Published by the American Diabetes Association, 1990 ISBN 0-945448-14-7 Clinical Management of the Child and Teenager with Diabetes by Leslie Plotnick, MD and Randi Henderwson Published by The Johns Hopkins University Press, 1998 US 2495 paperback ISBN 0-8018-5909-3 Growing Up With Diabetes: What Children Want Their Parents to Know by Alicia McAuliffe Published by Chronimed Publishing, 1998 ISBN 156561-150-0 Paperback, 110 pages US 1095 The Johns Hopkins Guide to Diabetes by Christopher D Saudek, MD, Richard R Rubin, PhD, CDE, and Cynthia S Shump, RN, CDE Published by The Johns Hopkins University Press, 1997 ISBN 0-80185581-0 US 1695
The Joslin Guide to Diabetes by Richard S Beaser MD with Joan VC Hill, RD, CDE Published by Simon Schuster, 1995 ISBN 684-802082 Optimal Pumping by Linda Freddi Fredrickson, MA, RN, CDE, Richard Rubin, PhD, CDE, and Stefan Rubin Published by MiniMed No ISBN 1200 Pumping Insulin by John Walsh, PA, CDE, and Ruth Roberts, MA Published by Torrey Pines Press, 2000 272 pages, paperback US 2395 Raising A Child With Diabetes by Linda Siminerio, RN, MS, CDE, and Jean Betschart, RN, MN, CDE Published by the American Diabetes Association, 1995 ISBN 0-945448-48-1 US 1495 nonmember or US 1195 member plus 300 Shipping Handling to US addresses when ordered from the ADA Sweet Kids: How to Balance Diabetes Control Good Nutrition with Family Peace by Betty Page Brackenridge, MS, RD, CDE Richard R Rubin, PhD, CDE Published by the American Diabetes Association, 1996 314 pages Softcover US 1495 ISBN 0-945448-67-8

Teens Pumping It Up: Insulin Pump Therapy Guide for Adolescents by Elizabeth Boland, MSN, APRN, PNP, CDE Published by MiniMed No ISBN US 1295 The Ten Keys to Helping Your Child Grow Up With Diabetes by Tim Wysocki, PhD Published by the ADA ISBN 0-945448-74-0 US 1495 Understanding
Insulin-Dependent Diabetes, 9th Edition by H Peter Chase, MD Published by the Childrens Diabetes Foundation at Denver, 1999 ISBN 0-9675398-0-3 US 1500 to US addresses includes shipping

Games, Periodicals and Other Products
Diabetes Forecast is a one year subscription 12 issues US 2995 Phone 1-800-787-1414 Diabetes Interview is a one year subscription 12 issues US 1995 Phone 1-800-394-8877 Pediatric Diabetes is a quarterly journal Editorial Assistant: Sandra K Arjona, Dept of Pediatrics, Childrens Hospital of Pittsburgh, 3705 Fifth Ave, Pittsburgh, PA 15213-2583, USA, Phone 412-6927765, Fax 412-692-7813, email: arjonas@chplinkchpedu Wizdom: Wizdom: A kit of wit and wisdom for kids with diabetes and their parents Free to parents of diabetic child A project of the American Diabetes Association To order Wizdom, call 1-800-DIABETES and select option 6 or email @ wwwdiabetesorg/wizdom

Issued April, 2002

Diabetes Websites
Resources listed in this appendix are intended only as a guide in accessing additional information regarding diabetes Inclusion in this list does not imply endorsement by the Illinois Department of Human Services or the State of Illinois American Academy of Family
Physicians Joslin Diabetes Center wwwfamilydoctororg wwwjoslinorg One Joslin Place American Diabetes Association Boston, MA 02215 An organization devoted to diabetes cures cares Ph: 617-732-2400 wwwdiabetesorg/defaultasp Juvenile Diabetes Research Foundation Amputation Prevention International JDRFI Diabetic foot care information wwwjdforg wwwnoahcunyedu/diabetes/diabetes/html 120 Wall St New York, NY 10005 Barbara Davis Center for Childhood Diabetes Ph: 800-223-1138 http://wwwuchscedu/misc/diabetes/bdchtml Lower Extremity Amputation LEAP wwwbphchrsadhhsgov/leap Center for Food Safety Applied Nutrition Nutritional Information Medlineplus Health Information http://vmcfsanfdagov/ http://medlineplusnlmnihgov/medlineplus/ medlineplushtml Centers for Disease Control Diabetes and Public Health Resource National Center for Chronic Disease Prevention wwwcdcgov/nccdphp/ddt/ddthhomehtm and Health Promotion wwwcdcgov/nccdphp Children with Diabetes Issues for diabetic children Naomi-Berrie Diabetes Treatment Center wwwchildrenwithdiabetescom/ Columbia-Presbyterian Hospital http://cpmcnetcolumbiaedu/dept/diabetes Curediabetes Diabetes endocrinological information National Diabetes Education
Program wwwcurediabetesorg wwwndepnihgov Diabetes and Periodontal Disease National Diabetes Information Clearinghouse Diabetes and gum disease information Patient education, statistical data wwwnidrnihgov wwwniddknihgov Diabetes Control Center Sugarbugs Information on good diabetes control wwwsugarbugsorg wwwdr-diabetescom 2354 Highway 41, Ste J Greenbrier, TN 37073 Diabetes Forecast wwwdiabetesorg/diabetesforecast/ Ph: 888-699-2847 Diabetes Interview Magazine Current research in diabetes wwwdiabetesinterviewcom Illinois Dept of Human Services Diabetes Control Program wwwstateilus/agency/dhs/Diabetes/dhome3htm 535 W Jefferson St Springfield, Il 62702 Ph: 217-782-2166
Issued April, 2002

The Daily Apple Diabetes Center wwwthedailyapplecom/public/bouncedindexhtml The Healing Handbook for Persons with Diabetes wwwumassmededu/diabeteshandbook/tochtm

Issued April, 2002

Care of Children with Diabetes in the School and Day Care Setting
This article appears in the journal, Diabetes Care, Volume 25, Supplement 1, January 2002 To view the complete article, go to: http://carediabetesjournalsorg/content/vol25/suppl_1/

Type 2 Diabetes in Children and Adolescents
This article appears
in the journal, Diabetes Care, Volume 23, Number 3, March 2000 To view the complete article, go to: http://carediabetesjournalsorg/content/vol23/issue3/

Issued April, 2002

Source:pswi.org

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