Diabetes Education for Schools

Last Revised November 2023

What is blood sugar?

• Blood sugar refers to how much sugar (energy) is in the blood
• The body needs sugar to work normally. To use sugar, the body must have insulin. Insulin moves sugar into the cells so the body can use it.

​

2

INSULIN is the KEY that unlocks the cell and allows glucose in to be used for ENERGY

What is diabetes?

Diabetes is a condition that occurs when the body has too much sugar in the blood.

​

Blood sugar is the body’s main source of energy and comes from the food we eat. 

​

Insulin, a hormone made by the pancreas, helps sugar from food get into the cells to be used for energy.

(remember: Insulin is the key that unlocks the cell to let glucose in to use for energy)

​

With have diabetes, the body doesn’t make enough—or any—insulin or doesn’t use insulin well. 

Type 1 Diabetes

• In Type 1 Diabetes the immune system sees the beta cells (cells that make insulin) in the pancreas as an invader and attacks them
• This attack damages the beta cells (insulin producing cells) and causes them to stop producing insulin
• Without insulin, the body cannot use sugar in the blood for energy
• Type 1 Diabetes is always treated by replacing the “keys” with insulin given by injection under the skin

​

​

In Type 1 Diabetes the body doesn’t make enough KEYS (Insulin)

Type 2 Diabetes

• In Type 2 diabetes the body is usually able to make insulin, but the cells don’t respond as well to the insulin that is being made. This is called “insulin resistance”
• The body might make a lot of insulin at first, but over time the pancreas may not be able to keep up with the demand for insulin
• Some people think that Type 2 diabetes is only diagnosed in adults, but it can be diagnosed in children and teens, too
• Type 2 Diabetes is managed with nutrition and exercise therapy, along with medicines that make the body more sensitive to insulin and sometimes insulin injections.

In Type 2 Diabetes the body may make enough KEYS (Insulin) but the locks aren’t greased, or it takes more keys to get the cell door open to let glucose in.

Kids with all kinds of diabetes should know…

• You did not cause this disease by eating too many sweets or not being active enough
• Your diabetes team will work with you to make a safe plan for managing blood sugars at home and school
• You can lead a long and healthy life as you live with diabetes, and you should work with your diabetes provider to plan for how to care for yourself around your desired activities

Carbohydrate Counting

Carbohydrate Counting Resources for Staff

• UW Health Helping your Child Carb Count (Handout)
• DiSH Carb Counting Basics (video)
• DiSH To Eat Carbs or Not to Eat Carbs (video)
• Omnipod Basic Carb Counting Guide
• English Version
• Spanish Version

​

Carbohydrate Counting

• Use this handout to review carbohydrate counting: UW Health Helping your Child Carb Count
• Consider use of available tools in the school setting to estimate carb counts in meals provided at school
• Consider use of these:
• Calorie King
• Food Nutrition Facts and Free Calorie Counter | CalorieKing
• Or as an App in the App or Google Play store
• My Fitness Pal
• MyFitnessPal | MyFitnessPal
• Or as an App in the App or Google Play store

​

​

Insulin Dose Calculation

Resources for Staff

• DiSH Insulin Calculation (Video)
• CHOA Dosing Worksheet

How to Calculate Insulin Doses

There are 2 parts to calculating a Rapid-Acting insulin dose at meals. This is usually given with Humalog, Novolog, Apidra, or Fiasp insulin.

​

1. Insulin to Carbohydrate Ratio (insulin to cover food)
2. Correction Insulin (Insulin taken to bring a high blood sugar down to desired range)

​

You will calculate these doses (using the steps on the following slides) and add them together to get your total rapid-acting insulin dose.

A. Insulin to Carbohydrate Ratio (the insulin you take to cover food)

• This dose is usually written as:
• 1 unit per ____ grams
• To calculate the insulin you need to cover the food you are eating you will use the following formula:

​

Total number of carbohydrates (in grams)

÷ Insulin to carbohydrate Ratio

= Units of Insulin for coverage of Food

​

Review - Insulin Dose Calculation

If you were going to eat 65 grams of carbs, how many units of Rapid-acting insulin would you need to give?

​

B. Correction Insulin (Insulin taken to bring a high blood sugar down to target range)

• This dose is usually written as:
• 1 unit for every _______ mg/dL above ______ mg/dL
• Example: 1 unit for every 50 mg/dL above 150 mg/dL
• This is the same as:
• 151-200 mg/dL *** unit
• 201-250 mg/dL *** units
• 251-300 mg/dL *** units
• …etc
• The dose typically means that 1 unit of insulin will lower your blood sugar ____ mg/dL (in the example above we would expect 1 unit of insulin to lower the blood sugar by 50 points)

Review - Insulin Dose Calculation

If your blood sugar was 240 mg/dl at bedtime how much rapid-acting insulin would you give?

​

How to Calculate Insulin Dose

• To calculate the total meal dose you add the

Insulin to cover food (calculated using Insulin to Carbohydrate Ratio)

+ Insulin for high blood sugar (Correction Factor)

= Total Insulin Dose

• Or A + B = Total Insulin dose

Review - Insulin Dose Calculation

If you were going to eat 47 grams of carbs, and your blood sugar was 210 mg/dL how many units of Rapid-acting insulin would you give?

​

A1C & Complications Related to High Blood Sugars

Resources for Staff

• DiSH Complications of Diabetes Session (video)

​

Hemoglobin A1C

• Lab test that provides an estimate of what the average amount of blood sugar stuck to red blood cells over the last 2-3 months
• This helps us understand an average of what your blood sugars have been recently
• The goal A1C for most kids is an A1C <7% without many low blood sugars
• This goal is HARD!
• Why does it matter??
• Studies have shown that higher A1Cs put people at more risk for developing complications related to high blood sugar

21

Complications

• Some complications from diabetes can be seen quickly:
• Severe low blood sugar or Seizure
• Usually from too much insulin
• Diabetic Ketoacidosis (DKA)
• Not enough insulin for the body to use sugar for energy

​

Complications

• Other complications can develop over months and years from too much sugar in the blood/high A1C
• Damage to the tiny blood vessels is usually seen in the kidneys, eyes, circulation to your fingers/toes, and gum disease
• Damage to the tiny blood vessels can lead to nerve damage that can cause numbness/burning/pain (usually in hands and feet) or slowing of the way your stomach and intestines move food (gastroparesis)
• Large blood vessels can also be damaged and can cause abnormal cholesterol levels, heart attacks, and strokes

​

​

www.endocrine.org

Preventing Complications

• Some of the best ways to prevent complications from high blood sugars are to:
• Monitor blood sugar and give insulin doses as prescribed
• See your diabetes doctor regularly
• Complete blood and urine tests that your doctor orders to monitor your health

Low Blood Sugar

Resources for Staff

• High and Low Blood Sugar (Handout)

Low Blood Sugar

• Sugar is the fuel for the body and brain
• If sugar levels in the blood get too low you may have symptoms of a low blood sugar
• It is important to treat low blood sugars quickly
• If left untreated a low blood sugar can cause confusion, “passing out”, seizures, and even brain damage
• 70 mg/dL is usually a low blood sugar in someone with diabetes
• Sometimes people will use a slightly higher number, like less than 80 mg/dL– especially at school, in younger children, or in situations where low blood sugar is more risky (sleepovers, away from parents, etc.)

27

Causes of Low Blood Sugar

• Too much insulin
• Not enough carbohydrates
• Exercise (makes the body use sugar more efficiently)
• Drinking alcohol (effect can last up to 24 hours)
• Early pregnancy

Symptoms of Low Blood Sugar

• Shaking
• Sweating
• Weakness/Fatigue
• Hunger
• Dizziness
• Irritability
• Anxiety
• Blurred Vision
• SEVERE: change in level of consciousness, loss of consciousness, seizure

​

29

*Some people using a CGM may find that they need <15 grams to treat low blood sugar. 15 grams is a safe place to start and should be personalized working with the diabetes provider.

Food to Treat a Low Blood Sugar

• It is best to use foods that are primarily made of sugar to treat low blood sugar
• These are absorbed quickly into the blood stream and raise sugar levels

Examples

• Glucose Tabs
• Juice
• Sugary Candy
• Skittles
• Smarties
• Airheads

​

Avoid using foods that have fat or protein in them as this will slow down the glucose from getting into your blood.

Severe Low Blood Sugar

• Rarely, people with diabetes will not be able to take food by mouth to treat a low blood sugar
• This happens when the glucose is so low that the person “passes out” or cannot safely eat or drink
• Glucagon, a medicine that tells the liver to release sugar stores should be given in emergency situations to raise the low blood sugar
• Once glucagon is given 911 should be called immediately

Glucagon

• Glucagon is available in an injectable kit that you mix, an autoinjector (like an Epi-Pen), or a powder that is sprayed in the nose
• Each form works in a similar way, with the same speed
• Anyone you spend time with should know which glucagon you use and how to give it
• You can share this handout with links to videos

Glucagon Emergency Kit

Gvoke™ Premixed Injectable

Baqsimi™ Nasal Glucagon Powder

Click on the photo of each product to be taken to training video/materials or use the Glucagon HFFY QR codes to scan to training materials.

Insulin Pumps

Resources for Training Others on Insulin Pump Use

• Local pump trainers are an excellent resource
• Medtronic
• Medtronic webinar for school staff
• https://www.medtronic.com/us-en/healthcare-professionals/therapies-procedures/diabetes/education/webinars.html.html
• Tandem
• Simulator App
• Omnipod
• Simulator App
• Omnipod 5 Caregiver Guide

​

Omnipod5®Simulator

Tandem T-Simulator App

What are some problems that may occur with an insulin pump?

How Urgent is the Pump Failure?

Less Urgent

• Timing of failure known (infusion set was pulled out) and bolus had been recently administered
• Blood glucose high, but ketones negative to trace
• Child able to tolerate PO intake

​

May be appropriate to attempt bolus through pump x1, monitor for reduction in glucose following insulin dose

More Urgent

• Ketones moderate to large
• Child with symptoms of DKA
• Suspect that pump has not been working for long-period of time
• Child unable to tolerate PO intake

​

True diabetes emergency. Insulin should be given by injection and then pump site replaced.

Use caution if manual injection is given and patient is using an Automated Insulin Delivery System.

Driving and Diabetes

Driving Safely

If you drive it is important to keep your blood sugar in a safe range for you, your passengers, and those around you safe

​

​

Work and Diabetes

The Diabetes Link

Resource Hub (Can access videos and links)

​

Off to Work Guide

​