- Maintaining Optimal Blood Glucose Control
- Assisting the Student with Performing Diabetes Care Tasks
- Designating Trained Diabetes Personnel
Maintaining Optimal Blood Glucose Control
The goal of effective diabetes management is to keep blood glucose levels within a target range determined by the student’s personal diabetes health care team. Optimal blood glucose control helps to promote normal growth and development and to prevent the immediate dangers of blood glucose levels that are too high or too low. Maintaining blood glucose levels within the target range also can help to optimize the student’s ability to learn by avoiding the effects of hypoglycemia and hyperglycemia on cognition, attention, and behavior. In the long term, effective diabetes management helps to prevent or delay the serious complications of diabetes such as heart disease, stroke, blindness, kidney failure, gum disease, nerve disease, and amputations of the foot or leg.
The key to maintaining optimal blood glucose control is to carefully balance food intake, physical activity, insulin, and/or other medication. As a general rule, food makes blood glucose levels go up. Physical activity, insulin, and diabetes medications make blood glucose levels go down. Several other factors, such as growth and puberty, physical and emotional stress, illness, or injury, also can affect blood glucose levels.
Managing blood glucose is a constant juggling act—24 hours a day, 7 days a week.
Many students with diabetes check their blood glucose levels throughout the day using a blood glucose meter. Some students also wear a continuous glucose monitor (CGM). When blood glucose levels are too low (hypoglycemia) or too high (hyperglycemia), corrective actions need to be taken.
Low blood glucose levels, which can be life-threatening, present the greatest immediate danger to students with diabetes.
Assisting the Student with Performing Diabetes Care Tasks
Diabetes management is needed 24 hours a day, 7 days a week. Many students will be able to handle all or almost all of their nonemergency diabetes care tasks by themselves. Others, because of age, developmental level, inexperience, or issues with adherence to their diabetes tasks, will need help from school personnel. (See Understand Why Diabetes Self-Management Is Important)
All students with diabetes will need help during an emergency, which may happen at any time. School personnel need to be prepared to provide diabetes care at school and at all school-sponsored activities in which a student with diabetes participates.
The school nurse is the most appropriate person in the school setting to provide care for a student with diabetes. Many schools, however, do not have a full-time nurse, and sometimes a single nurse must cover more than one school. Moreover, even when a nurse is assigned to a school full time, she or he may not always be available during the school day, during extracurricular activities, or on field trips. In circumstances where a nurse is absent or unavailable, the school remains responsible for arranging and implementing the agreed upon diabetes care that is necessary to enable the child to participate in school and school-related activities. The school nurse or another qualified health care professional plays a major role in selecting and training appropriate staff and providing professional supervision and consultation regarding routine and emergency care of the student with diabetes.
Designating Trained Diabetes Personnel
Nonmedical school personnel—called “trained diabetes personnel” in this guide—can be trained and supervised to perform diabetes care tasks safely in the school setting. School staff who may be trained to provide diabetes care include: health aides, teachers, physical education personnel, school principals, school secretaries, school psychologists or guidance counselors, food service personnel, and other appropriate personnel. Some schools may call these individuals unlicensed assistive personnel, assistive personnel, paraprofessionals, or trained nonmedical personnel. Trained diabetes personnel may be identified from existing school staff who are willing to serve in this role.
Care tasks performed by trained diabetes personnel may include blood glucose monitoring, insulin administration (by syringe, pen, or assistance with a pump), glucagon administration, ketone testing, and basic carbohydrate counting. In addition to learning how to perform general diabetes care tasks, trained diabetes personnel should receive student-specific training and be supervised by the school nurse or another qualified health care professional. (See Train School Personnel)
The school nurse has a critical role in training and supervising trained diabetes personnel to ensure the health and safety of students with diabetes. In addition, a student’s health care provider or a diabetes educator may assist in training nonmedical personnel in diabetes care. Given the rapid changes in diabetes technology, therapies, and evidence-based practice, the school nurse who provides care to students with diabetes and facilitates diabetes management training for school personnel has the professional responsibility to acquire and maintain knowledge and competency related to diabetes management. (See Train School Personnel)
Once it has been determined that a student-specific diabetes care task may be delegated, the school nurse should be involved in the decision-making process to identify which school personnel are most appropriate to be trained. A diabetes-trained health care professional, such as a school nurse or a certified diabetes educator, develops and implements the training program, evaluates the ability of the trained diabetes personnel to perform the task, and establishes a plan for ongoing supervision throughout the school year. Diabetes care must be carried out as specified in the student’s health care plans.