Management of Diabetes in Schools (May 2017)

MARYLAND STATE SCHOOL HEALTH SERVICES GUIDELINE

MANAGEMENT OF DIABETES IN SCHOOLS

MAY 2017

(DMMP Revised June 2019)

Maryland State Department of Education Division of Student Support, Academic Enrichment, and Educational Policy 200 West Baltimore Street Baltimore, Maryland 21201 Phone: 410-767-0311 TTY/TDD: 410-333-6442

Maryland Department of Health Office of Population Health Improvement 201 West Preston Street Baltimore, Maryland 21201 Phone: 1-877-463-3464 TTY/TDD: 1-800-735-2258

Maryland State School Health Services Guideline ? Management of Diabetes in Schools ? 2017

TABLE OF CONTENTS

MARYLAND SCHOOL HEALTH SERVICES PRACTICE ISSUES COMMITTEE (2016-2017)......i EXTERNAL CONTRIBUTORS AND REVIEWERS (2016-2017).......................................................ii FOREWORD .......................................................................................................................................... iv APPLICABLE LEGAL AUTHORITIES ................................................................................................ v EXECUTIVE SUMMARY.....................................................................................................................vi

SECTION I: BACKGROUND ....................................................................................................... 1 INTRODUCTION ................................................................................................................................... 1 PURPOSE ................................................................................................................................................ 2

SECTION II: MANAGEMENT OF DIABETES .......................................................................... 3 DEFINITION OF DIABETES................................................................................................................. 3 ROUTINE DIABETES MANAGEMENT .............................................................................................. 3 BLOOD GLUCOSE MONITORING...................................................................................................... 3 CONTINUOUS GLUCOSE MONITORING (CGM)............................................................................. 4 KETONE MONITORING ....................................................................................................................... 5 CLINICAL LABORATORIES IMPROVEMENT ACT REQUIREMENTS......................................... 6 INSULIN ADMINISTRATION .............................................................................................................. 6 INSULIN PUMP MANAGEMENT ........................................................................................................ 6 SELF-MANAGEMENT .......................................................................................................................... 7

SECTION III: RECOGNITION AND MANAGEMENT OF HYPOGLYCEMIA AND HYPERGLYCEMIA ...................................................................................................................... 8

MANAGEMENT OF HYPOGLYCEMIA.............................................................................................. 8 MILD OR MODERATE HYPOGLYCEMIA......................................................................................... 9 SEVERE HYPOGLYCEMIA.................................................................................................................. 9 MANAGEMENT OF HYPERGLYCEMIA.......................................................................................... 12

SECTION IV: THE NURSING PROCESS RELATED TO STUDENTS WITH DIABETES... 14 THE NURSING APPRAISAL .............................................................................................................. 14 INFORMATION SOURCES TO GUIDE THE NURSING APPRAISAL ........................................... 14 THE NURSING ASSESSMENT........................................................................................................... 14 IDENTIFYING INFORMATION/CONTACT INFORMATION ........................................................ 15 MEDICAL HISTORY ........................................................................................................................... 15 SELF-MANAGEMENT ASSESSMENT.............................................................................................. 17

Maryland State School Health Services Guideline ? Management of Diabetes in Schools ? 2017

EDUCATIONAL HISTORY/INFORMATION.................................................................................... 18 PSYCHOSOCIAL CONSIDERATIONS .............................................................................................. 18 INDIVIDUALIZED HEALTH PLANS ................................................................................................ 19 EMERGENCY PLANS/PROTOCOLS................................................................................................. 21 DELEGATION OF NURSING TASKS RELATED TO DIABETES MANAGEMENT .................... 22

SECTION V: MEALS AND SNACKS........................................................................................ 24

SECTION VI: PHYSICAL EDUCATION, EXERCISE, AND PHYSICAL ACTIVITY .......... 25

SECTION VII: SCHOOL-SPONSORED ACTIVITIES AND FIELD TRIPS ........................... 25

SECTION VIII: CARE COORDINATION ................................................................................. 26 CARE COORDINATION ROLES AND RESPONSIBILITIES .......................................................... 26 PARENT/GUARDIAN RESPONSIBILITIES...................................................................................... 27 STUDENT RESPONSIBILITIES ......................................................................................................... 28 SCHOOL RESPONSIBILITIES............................................................................................................ 29 SCHOOL ADMINISTRATOR RESPONSIBILITIES.......................................................................... 30

SECTION IX: SCHOOL STAFF AWARENESS, EDUCATION, TRAINING, AND RESPONSIBILITIES ................................................................................................................... 31

SCHOOL STAFF AWARENESS AND EDUCATION ....................................................................... 31 SCHOOL STAFF TRAINING .............................................................................................................. 32 SCHOOL STAFF RESPONSIBILITIES............................................................................................... 33

SECTION X: DIABETES EDUCATION FOR STUDENTS WITH DIABETES ...................... 35

SECTION XI: EDUCATION PLANNING.................................................................................. 35 INDIVIDUALIZED EDUCATION PROGRAMS (IEP), Section 504 PLANS AND OTHER ACCOMMODATIONS ......................................................................................................................... 35

SECTION XII: DIABETES ACTIVITIES MONITORING AND EVALUATION ................... 37

SECTION XIII: LIABILITY PROTECTIONS............................................................................ 38

SECTION XIV: GLOSSARY, RESOURCES, REFERENCES, AND APPENDICES .............. 39 GLOSSARY .......................................................................................................................................... 39 RESOURCES ........................................................................................................................................ 44 REFERENCES ...................................................................................................................................... 47 APPENDIX A: Glucagon Administration Instructions ......................................................................... 49 APPENDIX B: Sample Maryland Diabetes Self-Management Skills Assessment Checklist ............... 51

Maryland State School Health Services Guideline ? Management of Diabetes in Schools ? 2017

APPENDIX C: Maryland Diabetes Medical Management Plan/ Health Care Provider Order Form and Form Guidance ................................................................................................................................ 55 APPENDIX D: Section 504 Plan and IEP Parent and Educator Brochure ............................................ 61

Maryland State School Health Services Guideline ? Management of Diabetes in Schools ? 2017

MARYLAND SCHOOL HEALTH SERVICES PRACTICE ISSUES COMMITTEE (2016-2017)

Isha Alston, RN, MSN Deputy Director Bureau of School Health and Support Anne Arundel County Department of Health

Karen Bates, RN, BSN, MS Nursing Supervisor School Health Policy, Services, and Innovation Prince George's County Public Schools

Karen Siska Creel, RN, MSN Director of Nursing Bureau of School Health and Support Anne Arundel County Department of Health

Cheryl Duncan De Pinto, MD, MPH (Committee Co-Chair) Director Office of Population Health Improvement Maryland Department of Health

Christine Knode, RN, BSN, NCSN Supervisor of Student Services/School Health Calvert County Public Schools

Tammatha Metcalf, MSN, RN, NCSN School Nurse St. Mary's County Public Schools

Alicia Mezu, MSN/Ed, BSN, BSc, RN (Committee Co-Chair) Health Services Specialist Maryland State Department of Education

Mary Nasuta, RN, BSN, MS, NCSN Nurse Coordinator Harford County Public Schools

Barbara Obst, RN, MS SHNIC Program Coordinator Kennedy Krieger Institute

Jacqueline Doug?, MD, MPH Medical Director, Bureau of Child Health Howard County Health Department

Diane Pellegrino, RN, BSN Health Services Coordinator Wicomico County Board of Education

Filipa Gomes, RN, MSN Supervisor of Health Services Carroll County Public Schools

Marilyn Healy, RN, NCSN Supervisor, Office of Health Services Baltimore County Public Schools

Michal Thornton, RN, BSN Community Health Nurse Supervisor Bureau of School Health Baltimore City Health Department

Kerrie Wagaman, MSN, BSN, RN, NCSN Coordinator of Health Services Howard County Public Schools

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