Diabetes Tier Training Instructor Guide



|TIER I TRAINING |

|(All School Staff Members) |

|Recommended ratio 1RN Instructor to30 UAPs |

|American Diabetes Association Diabetes Care Tasks At Schools: What Key Personnel Need to Know Modules |

|Power Point, DVD, & Video stream from |

| Use paper handouts |

|or slides of Power Point when presentation technology is unavailable |

|National Diabetes Education Program Helping the Student with Diabetes Succeed: A Guide for School Personnel |

|CONTENT |Type of Activity |Materials |Time needed |

| | |NDEP GuidePg 9-10 | |

|Overview of Diabetes |Slides / DVD / Video stream | | |

|What is diabetes | |Diabetes Care Tasks at | |

|Type I - Type II diabetes | |School Training Modules: | |

| | |Diabetes Basics (PPT) & DVD | |

| | |(4:39) | |

| | |Diabetes Care Tasks at | |

|Recognition of signs/symptoms of : |Slides / DVD / Video stream |School Training Modules: | |

|Hypoglycemia | |Hypoglycemia (PPT) & DVD | |

|Hyperglycemia |Handouts |(3:12) | |

| | |NDEP Guide Pg 23-25 | |

| | |Hyperglycemia (PPT) & Video | |

| | |(1:53) | |

| | |NDEP Guide Pg 26-27 | |

| | |#720 Low-High BS Hands | |

| | |#303 Hypo-Hyper Flowsheet | |

| | |Plan | |

| | |NDEP Guide Pg 14-17 | |

|Typical needs of a student with diabetes: |Discussion | | |

|Bathroom privileges as requested |Slides / DVD / Video stream |Diabetes Care Tasks at | |

|Access to snacks, water, and blood glucose testing in classroom | |School Training Modules: | |

|Field trip considerations | |Legal Considerations (PPT) & | |

|504 and DDMP (individualized health plan) | |DVD (3:00) | |

| | | | |

|Section 504 of the Rehabilitation Act of 1973 prohibits | | | |

|discrimination of an individual with a disability. Disability is | | | |

|defined as a “physical or mental impairment that substantially limits| | | |

|one or more of major life activities.” An amendment was passed in | | | |

|2008 broadening the definition of major life activities. Included in| | | |

|the amendment is abnormal functioning of the endocrine system, thus | | | |

|diabetes can be considered a disability and any facility receiving | | | |

|federal funding or open to the public must reasonably accommodate the| | | |

|needs of people with diabetes. A formal determination process | | | |

|should be completed using many sources of information to determine a | | | |

|student’s eligibility including a medical diagnosis. | | | |

|Who to contact for assistance: |Discussion |Diabetes Care Tasks at | |

|School/Program specific delegated personnel | |School Training Modules: | |

|Emergency response for lockdown or evacuation. |Slides / DVD / Video stream |Diabetes Medical Management | |

| | |Plan (PPT) & DVD (2:27) | |

| |School specific emergency response |NDEP Guide Pg 11-12 | |

| |plan | | |

| |

|TIER II TRAINING |

|(Staff members directly involved with a student with diabetes i.e. teachers, coaches, etc.) |

|Recommended ratio 1RN Instructor to15 UAPs |

| |

|Includes all content from Tier I in addition to the following: |

|CONTENT |Type of Activity |Materials |Time needed |

| | | | |

|Review of Student Specific IHP |Review/Discussion |Copy of Student’s IHP | |

| |Discussion |Diabetes Care Tasks at | |

|Recognition and treatment of: | |School Training Modules: | |

|Mild-Moderate Hypoglycemia |Slides / DVD / Video stream |Hypoglycemia (PPT) & DVD | |

|Hyperglycemia | |(3:12) | |

| |Handouts |NDEP Guide Pg 23-25 | |

| | |Hyperglycemia | |

| | |NDPE Guide Pg 26-27 | |

| | | | |

| | |#720 Low-High BS Hands | |

| | |#303 Hypo-Hyper Flowsheet | |

| | |Plan | |

|Additional required accommodations: |Discussion | | |

|Blood glucose testing in classroom if appropriate | | | |

|Field trip accommodations/plan | | | |

|After-school/extracurricular activities | | | |

|TIER III TRAINING |

|(Staff members who will be performing delegated procedures such as |

|blood glucose testing, insulin administration, glucagon administration, etc.) |

|Recommended ratio 1RN Instructor to5 UAPs |

|Colorado Kids with Diabetes Care and Prevention Collaborative |

|School Nurse Toolkit – Training and Delegation |

|If using this instructor guide for training and delegation use individual student IHP. |

|If providing general skills training use sample IHP. |

|Includes all content from Tier I and Tier II in addition to the following: |

|CONTENT |Type of Activity |Materials |Time needed |

|Blood Glucose Monitoring | | | |

| |Discussion |NDEP Guide Pg 21 | |

| | | | |

| |Slides / DVD / Video stream |Diabetes Care Tasks at School | |

| | |Training Modules: | |

| |Handout |Blood Glucose Monitoring (PPT) | |

| | |& Video (2:22) | |

| |Practice and Return Demonstration | | |

| | |#610 Diabetes Skills – Blood | |

| | |Glucose Monitoring | |

| | |Hypo-NDEP Guide Pg 23-24 | |

|Recognition and treatment of Mild-Moderate Hypoglycemia |Discussion |Diabetes Care Tasks at School | |

| | |Training Modules: | |

|Hyperglycemia |Slides / DVD / Video stream |Hypoglycemia (PPT) & Video | |

| | |(3:12) | |

| | | | |

| |Handouts |#611 Diabetes Skills – | |

| | |Hypoglycemia | |

| |Discussion |NDEP Guide Pg 25-26 | |

|Recognition and treatment of severe low blood sugar – Glucagon | |Diabetes Care Tasks at School | |

|Administration |Slides / DVD / Video stream |Training Modules: | |

| | |Glucagon Administration (PPT) &| |

| | |DVD (1:53) | |

| |Handouts | | |

| | |#613 Diabetes Skills – Glucagon | |

| |Practice and Return Demonstration | | |

|Recognition and treatment of Hyperglycemia |Discussion |Hyper-NDEP Guide Pg 26 | |

| | | | |

| |Slides / DVD / Video stream |Diabetes Care Tasks at School | |

| | |Training Modules: | |

| | |Hyperglycemia (PPT) & Video | |

| | |(1:53) | |

| | | | |

| |Handouts |#612 Diabetes Skills – | |

| | |Hyperglycemia | |

| | | | |

| |Practice and Return Demonstration | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

|CONTENT |Type of Activity |Materials |Time needed |

|Urine/Blood Ketone Monitoring |Discussion |NDEP Guide Pg 27 | |

| | |#618 Diabetes Skills – Urine | |

| |Slides / DVD / Video stream |Ketone Monitoring | |

| | | | |

| | |#619 Diabetes Skills – Blood | |

| |Handouts |Ketone Monitoring | |

| |Practice and Return Demonstration | | |

|Insulin Basics |Discussion |NDEP Guide Pg 28-30 | |

|Participants will be able to understand: | |Diabetes Care Tasks at School | |

|What insulin does |Slides / DVD / Video stream |Training Modules: | |

|Types of insulin | |Insulin Basics (PPT) & Video | |

|Insulin delivery methods |Handouts |(3:39) | |

|Storing insulin | | | |

|Factors that influence insulin dosing |Draw insulin activity curves for |24 hour Insulin Activity Graph | |

| |typical daily dosing | | |

|[pic] | |Create graph on marker board or | |

| | |paper noting glucose rate on | |

| | |vertical axis and 24 hour time | |

| | |span on horizontal axis. Have | |

| | |learner draw lines indicating | |

| | |typical insulin doses. | |

|Insulin administered via pen | |NDEP Guide Pg 29 | |

| |Discussion | | |

| | |Diabetes Care Tasks at School | |

| |Slides / DVD / Video stream |Training Modules: | |

| | |Insulin by Pen (PPT) & Video | |

| |Handouts |(2:01) | |

| | | | |

| |Practice and Return Demonstration |#614 Diabetes Skills – Insulin | |

| | |Pen | |

|Insulin administered via syringe | |NDEP Guide Pg 29 | |

| |Discussion | | |

| | |Diabetes Care Tasks Training | |

| |Slides / DVD / Video stream |Modules: | |

| | |Insulin by Syringe and Vial | |

| |Handouts |(PPT) & Video (3:06) | |

| | | | |

| |Practice and Return Demonstration |#616 Diabetes Skills – Insulin | |

| | |Syringe | |

|Insulin administered via pump |Discussion |NDEP Guide Pg 29-30 | |

| | | | |

| |Slides / DVD / Video stream |Diabetes Care Tasks at School | |

| | |Training Modules: | |

| | |Insulin by Pump (PPT) & Video | |

| |Handouts |(1:50) | |

| | |#615 Diabetes Skills – Insulin | |

| | |Pump | |

| |Practice and Return Demonstration |Checklist – Insulin Pump | |

| | | | |

| | | | |

| | | | |

|CONTENT |Type of Activity |Materials |Time needed |

|Carb Counting |Discussion |NDEP Primer Pgs 31-32 | |

| | |Diabetes Care Tasks at School | |

| |Slides / DVD / Video stream |Training Modules: | |

| | |Nutrition and Physical Activity | |

| |Handouts |(PPT) & Video (2:31) | |

| |Nutrition services reference |#617 Diabetes Skills – Carb | |

| |Food labels |Counting | |

| | | | |

| |Practice and Return Demonstration | | |

|Insulin administered via Threshold Suspend pump |Discussion |NDEP Primer Pg 29-30 | |

| | | | |

| |Slides / DVD / Video stream |Diabetes Care Tasks at School | |

| | |Training Modules: | |

| | |Insulin by Pump (PPT) & Video | |

| |Handouts |(1:50) | |

| | |621 Diabetes Skills-Threshold | |

| |Practice and Return Demonstration |Suspend Pump | |

|Insulin administered via Medtronic 670G |Discussion |Medtronic 670G School RN Final –| |

| | |Guide for School Nurses and | |

| |Handouts |training school staff | |

| | | | |

| |Practice and Return Demonstration | | |

|Continuous Glucose Monitoring – CGM |Discussion |Collaborative Guidelines for | |

|Understanding Insulin Pumps & Continuous Glucose Monitors by H. | |Dexcom G5 Non-Adjunctive Dosing | |

|Peter Chase, MD – online books |Handouts | | |

| |Manufacturer literature |#620 Standard Training Checklist| |

| | |–CGM | |

| |Practice and Return Demonstration | | |

Bibliography

Bobo, N., & Silverstein, J. (2010). Designing Diabetes Management Training for School Personnel Using a Three-level Approach. NASN School Nurse , 216-218.

Bobo, N., Kaup, T., McCarty , P., & Carlson, J. P. (2010). Diabetes Management at School : Application of the Healthy Learner Model. Journal of School Nursing , 27, 171-184.

Bobo, N., Wycoff, L., Patrick, K., White, C., Glass, S., Carlson, J. P., et al. (2011). A Collaborative Approach to Diabetes Management : The Choice Made for Colorado Schools. Journal of School Nursing , 27, 260-281.

Patrick, K, and Wyckoff, L. 2017. Providing Standards for Diabetes Care in the School Setting: A Review of the Colorado Model. 33, 52-56

Resha, C. (2010). Delegation in the School Setting: Is it a safe practice? OJIN: The Online Journal of Issues in Nursing , 15 (2), Manuscript 5.

Sampson, C. A., & Galemore, C. A. (2012). What Every School Nurse Needs to Know About Section 504 Eligibility. NASN School Nurse , 27, 88-93.

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