New Diabetes Book v6 Nov 14:Layout 1... · 2017-09-18 · Diabetes is monitored by blood glucose...

FOREWORD

Partnership working between Health and Education services is essential to

ensuring that all children with diabetes reach their full potential and participate

fully in academic and other school activities. The needs of children with

diabetes within school hours are wide-ranging and vary according to age.

A diagnosis of diabetes in a child brings with it many changes and challenges

to the child’s life and also to their family. With appropriate support, children

and their families adjust and adapt to diabetes.

It is vital that educational services support families in managing their child’s

diabetes. Older children from about the age of 9 years are increasingly

independent with their diabetes care but may still require supervision. In

the absence of their parents or carers, younger children will need support

and assistance from school staff during the school day to manage their

diabetes. It is important that all school staff have an awareness of diabetes

and that training is available.

This booklet describes what diabetes care parents can expect when their

child attends school. Information is provided on the roles of parents / carers

and school staff in relation to individual healthcare plans, school staff training,

eating, physical activity, school trips, insulin administration and blood glucose

testing and what to do in an emergency.

There is no cure for diabetes yet but there is a lot of evidence of what works

in diabetes and how we can support children and their families in managing

their condition and live life well.

I endorse the content of this booklet produced by the Education and Library

Boards in association with Diabetes UK and the Health and Social Care Trusts.

This booklet will be beneficial to families and carers of children with Type 1

diabetes and will enhance the support they will receive during their school

years.

Dr Brid FarrellChair, Northern Ireland Paediatric Diabetes Network

Consultant in Public Health, Public Health Agency

3

This booklet informs parents of theprocesses that will enable school staffto support children with diabetes inschools in Northern Ireland. Thisguidance document is intended to beused in conjunction with and not as asubstitute for the joint DHSSPS/DEguidance “Supporting pupils withMedication Needs”.

Type 1 diabetes is a lifelong and lifechanging condition where due to acomplete lack of the hormone calledinsulin, the blood glucose level risesabove normal levels. The cause isunknown but is not related to poor dietor being overweight. Type 1 diabetescan be treated effectively with insulinwhich is injected or infused via an insulinpump, and with regular mealscontaining carbohydrates.

Diabetes is monitored by blood glucosetesting which alerts the child and his/her parent or carer if the blood glucoseis too low, (hypoglycaemia) or too high(hyperglycaemia). Physical activity isalso an important factor in diabetesmanagement as it helps to keep bloodglucose levels closer to the normalrange.

Diabetes needs to be managed well.When a child is cared for in a supportive

environment, they should feel healthyand will be able to concentrate andperform as normal and achieve theirtrue academic potential.

All school staff should be made awarethat your child has a diagnosis ofdiabetes and also be aware of whichmembers of school staff have beentrained by the PDSN to manage yourchild’s condition. Training will be givento school staff by the PaediatricDiabetes Specialist Nurse (PDSN) toensure that they know how to manageyour child’s condition.

W H A T D I A B E T E S C A R E T O E X P E C T I N S C H O O L S

Introduction

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The ultimate aim of diabetesmanagement is to keep your child’sblood glucose levels as close to normalas possible using regular blood glucosemonitoring to balance insulin,carbohydrate intake and exercise.

All children attending school who havediabetes will have an IndividualHealthcare Plan (IHP) which remains inschool and can be accessed at all times.1

The IHP supports and guides the schoolstaff to know about all aspects of yourchild’s diabetes management and thoseinvolved in his or her diabetes care.

The IHP is drawn-up in consultation withthe parents / carers, child or youngperson, the PDSN, Principal, teacher andschool staff including relevant teachers,classroom assistants, dinner supervisors

and school office staff to ensure thatyour child is fully supported. The planis then agreed and signed by a parentor carer and all appropriate staff whowill be involved with your child inrelation to his/her diabetes care. Theplan should include information on howand when to contact parents and keyhealth professionals. The plan could alsoinclude a photograph of your child. Itshould also detail care requirementsincluding blood glucose monitoring, thesafe storage of insulin and otherequipment kept in school.

All facts in the IHP will be updated,under the guidance of the PDSN, on aregular basis, e.g. updated annually orif the medical needs of your childchanges.

Individual Healthcare Plans

Starting a new School or returning to School following diagnosis

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The diagnosis of diabetes and start oftreatment begins in hospital. If detectedearly the child may continue treatmenton an outpatient basis or in the child’shome. Following discharge and whenyour child feels well, a rapid return toall normal routines is encouraged. Thiscan be an anxious time for you as aparent as your child starts or returns toschool.

In 2008 the Department of Educationand the Department of Health, SocialServices and Public Safety publishedguidance entitled “Supporting Pupilswith Medication Needs”.2

The Department of Education madeavailable funding to the Education andLibrary Boards to provide training to allschool Principals on how to meet theneeds of all pupils with medicationneeds, including those with diabetes.

Staff in all schools where there is achild/ are children with diabetes, shouldhave a general knowledge of diabetesand what to do in an emergency forexample if the child has a hypo-

glycaemic episode. In planning for apupil with diabetes joining or returningto a school, the Principal can requesttraining from the PDSN. Trainingnormally takes place as close as possibleto the date on which the child startsschool. However, it is important to notethat until training has been delivered byhealth professionals the administrationof medication remains the responsibilityof parents/carers.

Your PDSN will discuss this with you inadvance of your child starting school.

School Staff Training

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In agreement with the schoolPrincipal, school staff can volunteerand be trained to take on a varietyof skills including insulin injectionsand blood glucose monitoring. If yourchild is very young and is unable toself-manage their diabetes, in theabsence of volunteers, the schoolPrincipal can consider recruiting staffto undertake these duties. There mayalready be staff within the schoolthat, with appropriate training, wouldbe willing to undertake these duties.Specific training in the skills thatsupport the management of yourchild will be given by the paediatricdiabetes specialist nurse.

Competency based training to injectinsulin is available and delivered byPDSNs.

Action Responsibility

Organise a meeting withthe school principal prior tostarting or when your childfirst develops diabetes

Parents /Carers

Provide the principal withinformation about yourchild’s condition andtreatment including name ofinsulin, doses and timing ofinjections or pump boluses

Parents /Carers

Principal will seekvolunteers from withinexisting staff to administermedication to child

Principal

Principal will arrange ameeting with parents, andappropriate school staff

Principal

Introductory meeting. Parentidentifies child’s needs andprovides PDSN contactdetails. The school principalwill seek two volunteers tobe trained to meet yourchild’s medical needs.

Principal /Parents /Carers /Volunteersfrom schoolstaff

PDSN is contacted andplanning meeting arranged

Principal

Training meeting. PDSNintroduces the IHP, identifiestraining needs and dates fortraining.

Principal /PDSN /Parents /Carers /Volunteersfrom schoolstaff

Training is provided byPDSN until staff arecompetent and confident(up to 5 visits if required)

PDSN /Parents /Carers /Volunteersfrom schoolstaff

Parents will remain responsible for theadministration of their child’s medication

until staff have been fully trained

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Staff Indemnity

What can the School do if no-one is willingto volunteer to administer medication?

In the event that no volunteers comeforward from within the school staff aPrincipal may consider remuneratingexisting staff members to undertakethese duties. The Principal may wishto discuss this option with theirEducation and Library Board.

The person would have to: � be available in school when the

child requires attention� be prepared to undertake any

training necessary to meet theneeds of the child or children as specified on the Individual HealthCare Plan

Training could include;� testing of blood glucose,

interpretation of results andsubsequent actions

� administration of insulin asrequired on a daily basis

� caring for the child in the event ofa difficulty e.g. unwell orhypoglycaemia

� accompany child on non-residentialschool trips when required

.

School staff are indemnified by their employers as long as they meet the conditionsoutlined in the guidance ‘Supporting Pupils with Medication Needs’2.

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School & Eating

The diet for your child is the samehealthy diet that is recommended foreveryone. Most schools have a healthyeating policy. On the rare occasion asweet treat is provided as a reward atyour child’s school your child should notbe excluded unless you requestotherwise.

In most primary schools, menus are senthome in advance so that you can makechoices for your child. In most secondaryschools ‘fast passes’ are available toallow your child to go to the front of thedinner queue to avoid hypoglycaemiafollowing his/ her insulin injection.

If you have a young child he or she willbe supervised at meal times (eatingeither school dinner or packed lunch)to ensure that enough carbohydrate hasbeen taken. This can be a very difficulttask for younger children and a staffvolunteer will be required to support achild with this. In the absence of avolunteer this will be the responsibilityof the lunchtime supervisor.

You and your child may have beentaught to count their carbohydrateintake and match the insulin dose to theamount of food taken. How this ismanaged will be agreed on the IHP andincluded in staff training.

Younger children on insulin injectionsand pumps may need to have theirinsulin dose after food so that if not allfood is eaten then this can be taken intoaccount when administering the insulinand the individual needs of your childwill be documented in the IHP.

SnacksIt is acknowledged that if your childgoes low they may need to eat outsidenormal meal and break times and yourschool will accommodate this.


If appropriatecarbohydrate foods inpacked lunches shouldbe labelled withamounts.

Parents /Carers

Ensuring youngchildren eat allcarbohydrate in lunch

LunchtimeSupervisoror Volunteersfrom schoolstaff

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Blood Glucose Monitoring

Blood glucose monitoring (BGM) is avital element of the management ofdiabetes and will often inform theinsulin dose required at lunchtime, or, iftreatment is needed for hypoglycaemia.BGM should be part of your child’s dailymanagement at school.

Normally a child at secondary schoolwill carry his/ her own blood glucosemonitoring kit and should have it withthem at all times. In primary schools,the blood glucose monitoring kit willusually stay in your child’s classroombut moves with your child for curriculumactivities outside the classroom. Part ofthe supervision of a young child withdiabetes will include responsibility forensuring that the kit accompanies thechild.

Younger children may need help withperforming this procedure, interpretationof the result and follow up action ifrequired as detailed in the IHP.

Blood glucose tests may need to beperformed before a snack or lunch, ifthe child feels unwell or has behaviouralchanges or prior to physical activity.Planned use within the classroomshould be discussed.

Some children especially youngerchildren will be unable to distinguish thedifference between high and low bloodglucose so rather than guessing, testingwill always be recommended.

The Individual Healthcare Plan will statetargets of acceptable blood glucoselevels for your child. Further details onstorage of medication in schools can befound in the “Supporting Pupils withMedication Needs“ guidance document.


Carry blood glucosemeter kit (secondaryschool)

Student

Carry blood glucosemeter kit for outsidecurriculum activities(primary schools)

Designatedmember ofschool staffwithinclassroom

Ensuring kit stockedwith strips and lancetsat all times

Parents /Carers

Safe storage of kit inthe classroom(primary schools)

Designatedmember ofschool staffwithinclassroom

Support for youngerchildren withsupervision orperforming BGM

Trained schoolstaff member

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Insulin Therapy

Insulin is required to keep blood glucoselevels within normal levels and isdelivered via an insulin pen injector orvia an insulin pump which gives acontinuous flow of insulin. Someyounger children may not require aninsulin injection at school but themajority of children with diabetes arenow using multiple daily injections andinsulin will be required at lunchtime.

Insulin pumps are becoming morewidely used as research has shown thateither multiple daily injections orboluses of insulin (via an insulin pump)matched to food intake, allows for morestable blood glucose levels. The insulinpump more closely mimics a functioningpancreas.

Using multiple daily injections or aninsulin pump does not mean that yourchild’s diabetes is ‘worse’ than that ofa child on 2 or 3 injections daily but thatthis is the best treatment for your child.

Very occasionally a small dose of insulinmay need to be taken outside meal orsnack times if the blood glucose levelis found to be high. This dose is knownas a ‘correction dose’ and should bringblood glucose levels back to nearnormal levels.

This will be discussed in your child’sindividual IHP.

Many pupils especially those aged 9and over will be able to manage insulininjections at a practical level but maystill require supervision.3 Administrationof insulin via an insulin pen or an insulinpump is quick (less than a minute),discrete and safe and should be enabledwithin the classroom to avoid disruptionand discrimination. Blood glucosemonitoring or injecting insulin in a toiletor in a corridor is not reasonablepractice.

Every effort will be made by a schoolto identify staff willing to undertake theadministration of insulin, but if thiscannot be done it remains theresponsibility of parents/carers toadminister medication until staff areidentified and fully trained to meet theneeds of the pupil.

Spare insulin should be stored in schoolfridge but insulin in current use can bekept at room temperature for 1 month.


Supply of insulin Parents /Carers

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In Northern Ireland over the next 3-5years, it is expected that half of allchildren with Type 1 diabetes will beusing an insulin pump.

One of the advantages of a pump is thatblood glucose levels are often morestable with less hypo andhyperglycaemic episodes. Anotheradvantage is that the infusion set onlyneeds to be changed every 3 days orso, avoiding multiple daily injections.

Children using a pump may need to testblood glucose levels more frequentlyand this may happen at any timethroughout the school day. Insulin viathe pump usually needs to beadministered with meals and snacks.

Younger children unable toindependently care for their diabeteswill require assistance as documentedin the IHP.

SharpsThe school’s Health and Safety policyshould set out safe disposal of fingerprick needles and insulin pen needlesin a sharps bin. The document“Supporting Pupils with MedicationNeeds” provides details on how to storeand dispose of sharps safely. The sharpsbin should be supplied and disposed ofby the parents.

Insulin Pumps


Pump Supplies Parents /Carers


Sharps Box will bedisposed of andreplaced as needed

Parents /Carers

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Physical Activity

Children with diabetes should be ableto participate in all physical activitiesand should be encouraged to do so asbeing active and participating in exerciseand sport is as important for the childwith diabetes as it is for everyone. Thereare a number of elite sportsmen andwomen who have been successful intheir chosen sport with carefulmanagement of their Type 1 diabetes.4

Being active uses up energy andconsequently blood glucose levels canfall. Hypoglycaemia can occur somehours after the activity but planning canavoid this. Exercise is not recommendedif the blood glucose level is too low ortoo high therefore it is important for allchildren to test before participating inany exercise. Guidance about supportingyour child with diabetes during physicalactivity will be in detailed in their IHP.

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Emergencies

Your child’s blood glucose level may be quite variable throughoutthe day. If the level is too high or too low then this needs to beacted upon according to their IHP. Parents will be contacted if schoolstaff are concerned about blood glucose levels.

Low Blood Glucose - Hypoglycaemia

Less than 4Hypoglycaemia is the most commoncomplication for pupils with diabetes.Training on the causes, signs andsymptoms, and management ofhypoglycaemia will be given to staff toensure that they are aware of theimportance of ensuring prompt andappropriate treatment of allhypoglycaemia episodes. Training willalso include understanding thattreatment needs to be taken to the childrather than your child being ‘sent’ fortreatment and that your child will notbe left alone until fully recovered.

Written step by step guidance for schoolstaff will also be included in your child’sIHP. All staff will be informed where theHypo Treatment Box is kept. The boxshould not be locked away but be keptsomewhere that is easily accessible toall staff and your child. The box will

include your child’s name and class,emergency contact numbers andtreatment for any hypoglycaemicepisodes. In large schools there mayneed to be more than one HypoTreatment Box per child. As aparent/carer you are responsible forkeeping the Hypo Treatment Boxstocked. If a child needs to eat a snackthroughout the day to maintain theirblood sugar levels, this should befacilitated by the school.


Hypo Box to be keptstocked

Parents /Carers

Storage of HypoBox(es) in safe butaccessible place

Designatedmember ofschool staff

Awareness of locationof Hypo Box(es)

All schoolstaff and child

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These can vary from child to child- yourchild’s individual signs and symptomswill be documented in the IHP. If yourchild’s signs and symptoms shouldchange please inform the school so thatthese can be documented in the IHP.

Hypo Symptoms and Signs


Inform school if thereare any changes toyour child’s diabetes

Parents /Carers

Severe HypoIt is very rare for a child to experiencea severe hypo where they might loseconsciousness. To help prevent a severehypo occurring, school staff will ensureprompt and appropriate managementof all hypoglycaemic episodes asdetailed in your child’s IHP.

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High Blood Glucose - Hyperglycaemia

When blood glucose levels rise above14 mmols they are classified as high. The most common symptoms of highglucose levels are thirst, passing largeand frequent amounts of urine,tiredness and blurred vision. School staffwill receive training so they are alertedto the symptoms and take actionaccording to the IHP and this includescontacting parents. This may helpprevent a serious condition calleddiabetic ketoacidosis (DKA). DKArequires immediate hospital admission.

Hypoglycaemia andHyperglycaemia - Special CircumstancesFollowing a hypo the brain takes 45minutes to fully recover once the bloodglucose level has returned to normallevels. Similarly, when blood glucoselevels are high your child may take acomparable time for full recovery oncethe blood glucose stabilises. Obviouslythis can impact on everyday life inschool however if your child becomeshypo before or during a test orexamination they may be disadvantagedeither by losing time or by not beingable to concentrate properly.

Your child may be eligible forexaminations concessions and you maywhich to discuss this with school staff.On your request your PDSN or diabetesdoctor can supply a letter in advance oftests or examinations. This letter willoutline the special circumstances thatshould allow your child to manage andfully recover from a hypo or fromhyperglycaemia in relation to examtimes. It is important to discuss with theschool their policies in relation to schoolexamination protocols as each schoolmay have different approaches. Thisshould be done well in advance ofimportant exams. Invigilators must bemade aware of your child’ medicalconditions so that they know whataction to take in the event of an issuearising during an examination aroundhypo or hyperglycaemia.


Parent/carer shouldask the schoolexaminations officerto seek examconcessions for theirchild.

Parents /Carers

Examinationsconcessions to berequested if necessary

SchoolExaminationOfficer

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School Trips including Overnight Stays

All children with diabetes should beable to avail of the full curriculumincluding trips and outings. Schoolsshould make every effort to includechildren with diabetes on schools tripsand take all reasonable steps to do so.

In accordance with the SpecialEducational Needs and Disability (NI)Order 2005, schools have a duty tointegrate children with diabetes withinthe life of the school and to makereasonable adjustments so that pupilsare not at a substantial disadvantagecompared to other pupils in theprovision of education and otherassociated services.

Prior to school trips, an assessment willbe carried out by school staff who knowyour child and their needs. Theassessment will take into account theactivities to be undertaken and thelength of the school trip. Your child’sPDSN will be available to provide anyextra training and education for the staff/volunteers who are supervising thetrip.


Risk assessment andmanagement plan tobe prepared

School staff

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Managing Difficult Situations

If you as a parent feel that your child isbeing prevented from participating inschool outings or any school activitiesthese are the steps you as a parent cantake;

You should ask to see a copy of theassessment form confirming this. Theassessment should identify genuine andreal risks that mean it is unsafe for thepupil to go. It is important for you todiscuss these issues with the teacherwho has made this decision

If you as a parent have enduringconcerns about the treatment of yourchild in school you can discuss issueswith the appropriate Education & LibraryBoard. (Contact details below)

If you still feel unhappy, you can contactthe Dispute Avoidance and ResolutionService (DARS). DARS was establishedin 2005 and aims;

� to resolve disagreements betweenvarious parties: Education & LibraryBoards, Boards of Governors ofschools and parents about the wayin which they carry out theirresponsibilities towards children withSpecial Educational Needs and

� to resolve disagreements betweenparents and schools about theprovision being made for childrenwith Special Educational Needs.

DARS is an independent, confidential,voluntary and informal service designedto provide an opportunity for identifyingpoints of disagreement and findingways forward that all parties are willingto accept. There is a DARS contact ineach Education & Library Board area.

The vast majority of children withdiabetes do not require a statement.However there may be circumstanceswhere young children withdiabetes may need additionalassistance to manage theircondition safely. If it isdecided that the child’sneeds cannot reasonablybe met from within theresources normallyavailable to the schoolthen a request forstatutory assessmentcan be made by a school,parent or other agency. This

is done by writing to the SpecialEducational Needs section of the local

education and library board.

The Statement of SpecialEducational Needs follows

a multi-disciplinaryassessment.5 It detailsthe special help the childrequires and is providedby the Education andLibrary Board.

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Statement of Special Educational Needs

The contact addresses of the fiveeducation and library boards inNorthern Ireland are:

www.belb.org.uk40 Academy Street, Belfast, BT1 2NQTelephone 028 9056 4000

www.neelb.org.uk182 Galgorm Road Ballymena, BT421HN Telephone 028 2565 3333

www.selb.org 3 Charlemont Place, The Mall,Armagh, BT 61 9AX Telephone 028 3751 2200

www.seelb.org.ukGrahamsbridge Road, Dundonald,Belfast BT16 2HS Telephone 028 9056 6200

www.welbni.org1 Hospital Road, Omagh, BT79 0AWTelephone 028 8241 1411

Help & Advice

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More Information can be obtained from...

www.diabetes.org.ukDiabetes UK Northern Ireland,Bridgewood House, Newforge Lane,Belfast BT9 5NWTelephone 028 9066 6646

www.deni.gov.ukDepartment of Education, RathgaelHouse, 43 Balloo Road, Bangor, BT19 7PR Telephone 028 9127 9603

www.childrenslawcentre.orgThe Children’s Law Centre.

www.niccy.orgThe Northern Ireland Commissionerfor Children and Young People

www.senac.co.ukThe Special Educational Needs AdviceCentre

These are able to provide parentswith detailed information as to howthe appeals process works as well asgiving them support should they needthis.

1. Specialist nursing services for children and young people with diabetes. Royal Collegeof Nursing 2006.www.rcn.org.uk/__data/assets/pdf_file/0008/267389/003318.pdf

2. Supporting Pupils with Medication Needs. 2008www.deni.gov.uk/support_with_medical_needs.pdf

3. Diabetes Through the Looking Glass: Seeing diabetes from your child’s perspective.Dr Rachel Besser. 2009 Class Publishing, London.

4. www.runsweet.com

5. www.education-support.org.uk/parents/special-education/

The Education and Library Boards are indebted to Diabetes UK and the Paediatric Nurse Specialists for their significant help in the production of this booklet.

Acknowledgements

designed and printed by antrim printers � 028 9442 8053

New Diabetes Book v6 Nov 14:Layout 1... · 2017-09-18 · Diabetes is monitored by blood glucose...

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