Diabetes Medical Management School Plan – Injections and Dexcom 5 Continuous
Effective dates /Student’s name
Date of birth
School
Medical condition / TYPE 1 DIABETES
Contact information
Parents/Guardian
Address
Telephone
Mother’s mobile
Father’s mobile
Other
Diabetes team Contacts
Diabetes consultant / <Select name of consultant here>Dr AminProfessor HindmarshDr PetersProfessor VinerDr White
Diabetes nurse specialist / <Select nursing team here>Orange team Lime team
Address / University College London Hospital, NHS Trust
6th Floor Central, 250 Euston Road, London, NW1 2PQ
Telephone / 020 3447 9364(09:00-12:00)
Emergency mobile 07940 476811(08:00-18:00)
Email / <Select email address here>
Website /
Notify parents/guardian or emergency contact in the following situations:
Severe or sustained Hypoglycaemia
Vomiting
Blood ketonesmeasuring more than 1.0 mmol/L +/- abdominal pain
Other:
Other:
Other:
Blood Glucose monitoring
Target range / <Enter blood glucose level>3.6mmols/l4.0mmols/l – 6.9 mmols/l
Blood glucose levels should be checked at: /
- When student exhibits symptoms of hyperglycemia OR Dexcom sensor shows reading of >14mmol/l
- When student exhibits symptoms of hypoglycemia OR Dexcom shows reading of <4mmol/l
Dexcom sensor should be checked at: /
- Prior to snacks and meals
- Before, (during if 60minutes or longer) and after exercise
Can student perform own blood glucose checks? / Yes Yes, with support No
Results of any tests taken should be recorded in the diary and communicated with the parents at the end of each session. Any blood glucose level that is outside of the target range should be acted upon, following the instructions in this management plan.
Equipment Used
Type of blood glucose meter
Type of finger pricker
Uses a continuous glucose monitor orflash glucose monitoring / Yes Type: No
Instructions on how to use these devices can be found on the UCLH webpage to support face-to-face teaching provided
Sharps disposal - Please refer to the schools own local sharps policy.
Hypoglycaemia (low blood glucose) – ‘The 15 Minute Rule’The student displays hypo symptoms / Yes Sometimes No
The following symptoms may indicate that the child/young person has a low blood glucose level:
IF blood glucose is less than <Enter blood glucose level>3.6mmols/l4.0mmols/land the student is able to eat/ drink
Give grams of glucose (e.g.)
Repeat blood glucose test after 15 minutes
If blood glucose is still less than <Enter blood glucose level>3.6mmols/l4.0mmols/l, give a further grams glucose
Repeat blood glucose test after 15 minutes
If the blood glucose remains less than<Enter blood glucose level>3.6mmols/l4.0mmols/l, give a carbohydrate snack and contact parents
It is generally preferable not to eat anything additional in the 15 minutes between these two blood glucose tests. However, if hypoglycaemia is found immediately before lunch and is not severe, the young person can be allowed to commence eating lunch with their fellow students. The bolus insulin for lunch should be injected after eating.
Severe Hypoglycaemia
If drowsy but able to swallow give GlucaGel /Dextragel
Route: Orally
Dosage: 25 gram tube
Has the school agreed to give Glucagon on the premises / Yes No
If unconscious or having a seizure, call 999 for an ambulance. Glucagon should be administered by a trained member of staff or ambulance crew. Place the young person in the recovery position.
Glucagen Dose:<Enter dose here>0.5ml (half dose)1ml (full dose)
Site for Glucagen injection: Thigh
When to inject insulin at school – before meals and snacks
Insulin needs to be given with all food and drink containing carbohydrate. This is calculated using a ‘carbohydrate ratio’ where one unit of insulin is given to cover a quantity of carbohydrate. Insulin for carbohydrate should always be given.
Additional insulin needs to be given if the blood glucose level is above target range. This is calculated using a ‘correction ratio’ where one unit of insulin will drop the blood glucose level by a certain amount.
- Please perform a blood glucose test/enter Dexcom glucose reading into app
- Enter the amount of carbohydrate to be eaten into the meter/app.
- The appropriate dose of insulin required for both food and correction will be calculated by the bolus calculator within the blood glucose meter/app.
- If the young person is going to be doing planned sport / PE 1-2hours following the snack or meal, reduce the insulin dose with the meal before to help manage the blood glucose levels.
Use ‘Exercise 2’ to reduce the bolus dose by prior to
Can student make decisions regarding this / Yes Yes, with support No
Instructions on how to use the blood glucose meter can be found on the webpage.
These ’how to’ leaflets are to support teaching on how to use these devices
Additional insulin injections- high blood glucose levels in between meals
Can student make decisions regarding this / Yes Yes, with support No
The following symptoms may indicate that the child/young person has a high blood glucose level: in
ABC:
Assess
Blood glucose level/Dexcom reading above 9 mmols/L
Ensure that it has been at least 2 hours since the last injection of quick acting insulin.
Bolus
Give a correction injection of insulin, using the blood glucose meter/app calculator to calculate the insulin dose (see info below)
Check
Check blood glucose level 2 hoursafter this bolus dose has been givenand give another correction if advised by the blood glucose meter calculator
Please note, the bolus calculator within the blood glucose meter/app takes into account ‘active insulin’ or ‘insulin on board’ when calculating any correction bolus. This means that there may be times when blood glucose levels are high and the bolus calculator does not recommend a correction, or only a very small correction bolus.
If this happens, do not give a correction bolus. Wait one hour and check the blood glucose levels again. It the blood glucose level is still high, give the correction dose advised by the bolus calculator.
Blood Ketone monitoring
Times to test for ketones /
- When student has a blood glucose levelthat is 14 mmols/L or above
- If vomiting and/or complaining of abdominal pain
Can student perform own blood ketone checks? / Yes Yes, with support No
Blood Ketone levels under 0.6 mmol/L are normal.
Blood Ketone levels over 3.0 mmol/L indicate that the young person requires immediate medical care. If you are unable to contact the parents, please ring for an ambulance.
Student abilities/ skills
(Child/young person able to do independently)
Count carbohydrates / Yes Yes, with support No
Inject for correct amount for carbohydrates consumed / Yes Yes, with support No
Calculate corrective insulin dose / Yes Yes, with support No
Inject correction insulin dose / Yes Yes, with support No
Dispose of sharps / Yes Yes, with support No
Make decisions around management of sporting activities / Yes Yes, with support No
Sport and PE Lessons
Before commencing PE, check Dexcom sensor glucose level:
If Blood Glucose before sport/PE lesson is:
•Less than <Enter blood glucose level>3.6mmols/l4.0mmols/lFollow ‘15 minute rule’
•Between <Enter blood glucose level>3.6mmols/l4.0mmols/land 6.9 mmols/L
Have a carbohydrate snack without giving any insulin
•Between 7.0 and 10.0 mmols/L
Check Insulin On Board (IOB)/ Active insulin AND Dexcom trend arrows- if IOB present or Dexcom trend arrows trending downwards, will need a snack.
If no IOB and/or rising blood glucose levels - No action
•Between 10.0 and 14 mmols/L
Check Insulin On Board (IOB)/ Active insulin and Dexcom trend arrows- if IOB present or Dexcom trend arrows trending downwards – No action, check Dexcom every 30minutes
If no IOB and rising blood glucose levels - Follow the ABC rule, giving half the recommended correction amount by the blood glucose meter/app, check Dexcom every 30minutes
•Above 14mmols/L
Test for blood ketones and if greater than 1 mmol/L do not exercise, and follow the ABC rule. If blood ketones are below 1mmol/L, follow the ABC rule and give half the correction dose recommended by the blood glucose meter calculator.
After PE, check dexcom glucose within 30 minutes:
If blood glucose above 10mmol/l, check Insulin On Board (IOB)/ Active insulin and Dexcom trend arrows- if IOB present or Dexcom trend arrows trending downwards – No action, check Dexcom every 30minutes
If no IOB and rising blood glucose levels - Follow the ABC rule, giving half the recommended correction amount by the blood glucose meter/app, check Dexcom every 30minutes
Supplies to be kept at School
- Fast-acting source of glucose
- Glucagel
- Glucagon
- Insulin pen & needles
- Spare insulin
- Blood glucose testing kit
- Blood ketone testing kit
- Other
Where to find my supplies:
THIS DIABETES MEDICAL MANAGEMENT PLAN HAS BEEN APPROVED BY:
Student’s Diabetes Nurse Specialist / DateI give permission to the school nurse, trained diabetes personnel and other designated staff members to perform and carry out the diabetes care tasks as outlined by this Medical Management Plan. I also consent to the release of the information contained in this Diabetes Medical Management Plan to all staff members and other adults who have custodial care of my child and who may need to know this information to maintain my child’s health and safety. A copy of this plan will be kept by the parents, school and hospital diabetes team.
Acknowledged and received by:
Student’s Parent/Guardian / DateSchool staff / Date
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Item / Parents Responsibility / Early years/school responsibility / Child/Young persons responsibility when deemed competent / Paediatric Diabetes Specialist Nurse / School NurseIndividualised care plan / A parent or carer who has legal responsibility for the child/ young person will liaise with the Head of the School/establishment and the Paediatric Diabetes Nurse Specialist (PDNS) to complete a medical management plan.
Where volunteers are being trained to supervise or perform any diabetes tasks the parent or carer will sign the plan to show that they have agreed to this arrangement.
The extent of a child or young person’s ability to participate in their own diabetes care should be agreed upon by the parent/carer. / Each school should have an up-to-date medical conditions policy.
All school/setting employees are aware of a child having diabetes, being able to obtain the child’s individual plan in the school setting and know how to assist them when necessary.
The extent of a child or young person’s ability to participate in their own diabetes care should be risk assessed and agreed upon by senior school staff. / Children and young people should be allowed, as much as possible, to manage their own diabetes at school, to the extent that is appropriate for their developmental stage and his or her experience with diabetes.
The child’s capabilities and willingness to provide self-care should be acknowledged in their plan. / Provision of a template medical management plan.
The extent of a child or young person’s ability to participate in their own diabetes care should be risk assessed and agreed upon by the diabetes nurse specialist (PDNS). / Advise on completion of plan and provide some training in order for the information to be disseminated
Provision of support and training / A parent or carer who has legal responsibility for the child/ young person will liaise with the Head of the School/establishment and the Paediatric Diabetes Nurse Specialist (PDNS) to provide the school/establishment/ setting with adequate, up-to-date information about the young person’s diabetes and treatment.
Following training, volunteer member of school staff to observe the parent for one week performing diabetes related tasks. Then the parent observing the volunteer, until both are confident. / A minimum of two staff members to be selected for training in the management of each individual child/young person’s diabetes.
To assess training requirements on an annual basis / To be involved in any additional training on the school site / UCLH to offer structured multidisciplinary training for staff at UCLH on an annual basis.
Additional ad hoc training at UCLH to be provided as required/requested. / Advise on completion of plan and provide some training in order for the information to be disseminated
Emergency Supply Box / To provide box and contents and to ensure contents are in date / Safe storage of diabetes containers (containing, if necessary, insulin injection devices as well as hypoglycaemic treatment) is established, together with the safe disposal of used needles / “sharps” / To make parents aware when supplies low / To provide training as to the appropriate use of emergency supplies. / May provide training as to correct use of box
Blood glucose & ketone testing / To provide supplies of equipment at the start of a school term and replenish whenever necessary.
Undertake regular quality control measures / Provide correct storage for supplies where necessary and request for training when further required. / To make parents aware when supplies low / To train parents to carry out as per local guidelines / To make parents aware when emergency supplies low
Sharps Disposal / To provide sharps bin (refer to local policy) / To provide parents with information as to local policy / To make parents aware when 2/3 full / To provide parents with information about local policy / To provide parents with information about local policy
Extra Food / To provide food for snacks and exercise as required / To make parents aware if running out of snacks and exercise food. To give permission for CYP to eat whenever required. / To make parents aware when requires more food supplies / To provide parents / CYP with recommendations regarding when to have additional carbohydrate / None
Risk Assessment / To provide information to facilitate risk assessment / To initiate and complete risk assessment documentation / To participate in risk assessment where possible / To provide specialist information as required / To provide specialist information as required
Out of school activities & residential trips / To contact the diabetes team if any additional training is required. To meet with school staff to formulate an agreed care plan for the duration of the trip / The school and its employees do not discriminate against children and young people with diabetes, thereby enabling young people with diabetes to participate fully in all aspects of school life, including physical and extra-curricular activities
To contact parents in advance of any trip to enable planning and additional training for staff / To inform parents of any trip planned. To be involved in the formulation of the care plan / To provide additional training/ advice as required. / To support if required.
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