Lafayette Parish School System Diabetic Protocol Background Diabetes is a serious, chronic disease that impairs the body’s ability to use food. Insulin, a hormone produced by the pancreas, helps the body convert food into energy. In people with diabetes, either the pancreas does not make insulin or the body cannot use insulin properly. Without insulin, the body’s main energy source, glucose, cannot be used as fuel. Rather, glucose builds up in the blood vessels. Each student will be cared for on an individual basis according to their diabetic needs and medical status. Health Services P. O. Drawer 2158 Lafayette, LA 70502 Phone: 337-521-7281 Fax: 337.521-7285

Responsibilities of Parent • Provide signed and completed LPSS medication orders, LPSS health plan, and LPSS diet prescription. • Contact nursing office to schedule appointment to meet with the school nurse • Bring all supplies, labeled medications, forms and student when meeting with the school nurse. • Provide all supplies needed for care at school. • Provide operable phone numbers where parent can be reached, and notify the school with any changes to those numbers. • Read and follow all other parent responsibilities as addressed in this diabetic protocol. • Notify nurse of MD order changes and provide those changes from MD in writing. No orders will be changed until the nurse receives written orders from the MD. • The parent will notify teacher of student’s diagnosis, medical needs and dietary concerns (classroom treats, parties, etc.) Health Care Supervision Trained Unlicensed Personnel (TUP) may oversee and assist the following as Indicated by the nurse and IHP: • CBG testing, insulin administration, ketone testing, AM/PM snacks, documentation, responding to hyper/hypoglycemia, administering glucagon and notifying parent and or nurse. Nursing Assessment/Evaluation • The MD orders and the medication assessment must be updated each school year, prior to the first day of school attendance and as needed. • MD orders must be on LPSS Diabetic Forms. • Students with diagnosis of diabetes will be excluded from school until the school nurse receives MD orders, in accordance with LPSS diabetic protocol, and has met with the parent or guardian. Student Self Care The student’s ability to perform various diabetes self-management skills will be assessed by the school nurse each school year. Glucose Testing • Blood Glucose (CBG) tests will be performed by the student as ordered by the MD • Nurse or TUP will perform CBG if student unable. • All results and actions must be documented and abnormals reported to nurse

Students with insulin pumps and or insulin pen/syringe can self administer depending on the age, maturity of the child, and at the discretion of the school nurse. MD and nurse must document competency/compliance of the student’s ability to self-administer insulin. 4th Grade and Younger

5th-8th Grade

Not allowed to selfadminister without the parent or nurse present, unless deemed otherwise by the nurse.

May self-administer with TUP supervision or unsupervised if approved by the school nurse, parent, and MD. The student must use log for documentation to be checked periodically by the school nurse. The student must report CBG outside the normal range, as defined by MD, to the school nurse.

High School May self-administer, unsupervised at the discretion of the nurse, with the approval of the parent and MD. The student must use log for documentation to be checked periodically by nurse. The student must report CBG outside the normal range, as defined by MD, to the school nurse.

Any other pump management issues will be addressed on an individual basis. Meals •

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For school lunch to be provided, the parent will provide completed Diet Prescription to Child Nutrition. School staff will coordinate meal schedule in accordance with IHP. Any lunches sent from home will include itemized carbohydrate (CHO) count provided by the parent. If deemed necessary, parent signature will be required on CHO counts.

Snacks • TUP/school nurse will monitor that the student takes snacks at the specified time(s) each day if ordered by MD. If ordered by the MD, the attached IHP states the regular time(s) for snacks each day based on the number of CHO. • Parent will provide ordered snacks. Snacks must be in original prepackaged container or sent with CHO count labeled and provided by parent. Snacks must be of the specified CHO amount ordered by the MD that requires no insulin dosing i.e. (10-15 gm CHO). • If a classroom treat (parties, special functions)requires insulin dosing, the parent must come to school to provide coverage of insulin. Prior to any treats given to student, the teacher will notify parent. In keeping with Healthy Schools Initiative, schools are discouraged from using food as a reward. Treating High or Low Blood Sugar A student with actual-or suspected-high or low blood sugar will not be sent anywhere alone. • High or low blood sugar levels should be treated as stated in the student’s IHP and MD orders. • The location of supplies for treating high and low blood sugar levels, Including equipment for testing blood glucose levels, ketones, glucagon and snacks will be placed in designated area.

Glucose Testing(CBG) • Blood glucose checks will follow MD order. • School nurse or TUP will perform glucose checks when the student is unable to self-test. Documentation will be kept on all results and actions • All CBG results outside of the normal range, as defined by MD, will then be reported to the parent and/or school nurse. Hypoglycemia Hyperglycemia CBG

<70

>300

Symptoms

Shakiness, headache, hunger, sweating, confusion, restlessness, seizure, pallor

Thirst, headache, blurred vision, hunger, irritability

Treatment

Follow MD orders which may include 15 grams fast acting CHO or 3-4 glucose tablets. Recheck CBG in 15 minutes.

Follow MD order which may include insulin administration

If glucose remains<70 at dismissal, parent pickup is required to ensure student safety.

If CBG remains>300 or insulin has been administered and it is within 1 hour of dismissal, parent pickup is required to ensure student safety.

Special Considerations

Glucagon should be given if the student is unconscious, having a seizure, or unable to swallow. Any staff member who finds a student unconscious will immediately contact the school office. The office will do the following: 1.

Call 911 immediately

2. Administer Glucagon per MD order. 3. Contact nurse and parent.

Recheck CBG in 1-2 hours

If at any time glucose remains>399 after treatment, student must be picked up from school. If there is no insulin order and CBG is: 1. 250-399 – Parent will be notified and follow MD orders for hyperglycemia. 2. CBG>399, student must be picked up from school immediately. If not picked up in a timely manner, then nurse may determine if 911 needed for student transport to hospital.

Field Trips Protocol for Diabetic Care while on Classroom Field Trips – See LPSS Field Trip Policy (JGCE-R) •

The principal or designee will notify the school nurse of scheduled field trip one month in advance. This will allow time for the school nurse to in-service the TUP who will be administering the medications.

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All medication brought on field trip shall be stored in a secure area.

In Parish Same Day Trips: The student will be permitted to participate in all field trips without restrictions and with necessary supervision by parent or designated guardian. •

The parent will accompany students on all field trips and monitor diabetic care. If the parent cannot attend, the TUP, appointed by the principal, will accompany student on field trip and supervise diabetic care according to student’s IHP.

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If the nurse deems it safe and appropriate for the student to self-administer, and the parent cannot attend, the TUP will provide necessary supervision.

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If the student is <5th grade the parent is encouraged to attend. If parent unable to attend and nurse determines that the student is unable to provide self-care, a nurse will be available to administer lunch time insulin dose.

Out of Parish and/or Overnight Field Trips: •

All care for the student is the sole responsibility of the parent.

Lafayette Parish School System – Health Services Department October 25, 2010