Diabetes Medical Management School Plan – Insulin pump
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 TeamLime 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 ketones measuring more than 1.0 mmol/L with or without 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 /
- When student exhibits symptoms of hyperglycemia
- When student exhibits symptoms of hypoglycemia
- 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 insulin pump
Type of blood glucose meter
Type of finger pricker
Uses a continuous glucose monitororflash glucose monitoring / Yes Type: No
If routinely using a continuous glucose sensor/flash glucose monitoring at school, please see the additional management plan regarding this.
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:in sports and activities or school trips.
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 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, ‘suspend’ the pump until blood glucose rises above 5.6 mmols/L and call parents.
Resume pump once blood glucose above 5.6 mmols/L
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 programmed into the pump as the child starts to eat, using the blood glucose level from before lunch.
Severe Hypoglycaemia
If drowsy but able to swallow, suspend the pump and then 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
Student abilities/ skills
The young personis able to do the following independently
Count carbohydrates / Yes Yes, with support No
Bolus correct amount for carbohydrates consumed / Yes Yes, with support No
Calculate and administer corrective bolus / Yes Yes, with support No
Calculate and set basal profiles / Yes Yes, with support No
Calculate and set temporary basal rate / Yes Yes, with support No
Disconnect pump / Yes Yes, with support No
Reconnect pump at infusion set / Yes Yes, with support No
Prepare reservoir and tubing / Yes Yes, with support No
Insert infusion set / Yes Yes, with support No
Troubleshoot alarms and malfunctions / Yes Yes, with support No
Make decisions around management of sporting activities / Yes Yes, with support No
Sharps disposal - Please refer to the schools own local sharps policy.
When to give insulin at school by a ‘bolus’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.
1.Please perform a blood glucose test and enter into the pump ( if not already there)
2.Enter the amount of carbohydrate to be eaten into the pump.
3.The appropriate dose of insulin required for both food and correction will be calculated by the bolus calculator within the pump. Deliver this bolus.
- It may be necessary to make reductions to the dose of insulin recommended, if the young person is to take part in planned activities 1-2hours following this bolus.
Please reduce the bolus dose by prior to
Can student make decisions regarding this / Yes Yes, with support No
Instructions on how to use the pump bolus calculator can be found on the webpage.
These ’how to’ leaflets are to support teaching on how to use these devices
Hyperglycemia (high blood glucose) – ‘The ABCC Rule’
The student displays hyper symptoms / Yes Sometimes No
The following symptoms may indicate that the child/young person has a high blood glucose level:
Assess
Blood glucose level above 9 mmols/L
Ensure that it has been at least 90 minutes the last food bolus.
Is the pump connected to the child?
Bolus(see additional note below)
Give a correction dose of insulin, using the pump bolus calculatorto calculate the dose
Check
Check blood glucose level 1 hour after this bolus dose has been given
If blood glucose level is lower than the previous value, no further action is required
If blood glucose level is higher than the previous value,the cannula needs to beChanged
and additional insulin should be given by a pen injection.
Ring parents/ diabetes nurses for further advice
Bolus -Please note, the bolus calculator within the pump 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, use the bolus calculator again to calculate the does required and give the correction dose as advised.
Blood Ketone monitoring
Times to test for blood ketones /
- When student has a blood glucose level that 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.
Sport and PE Lessons
Before commencing PE, test the blood glucose level.
Decide whether the pump should be disconnected (e.g. for swimming, contact sports)
If Blood Glucose before sport/PE lesson is:
- Less than <Enter blood glucose level>3.6mmols/l4.0mmols/l
- Between <Enter blood glucose level>3.6mmols/l4.0mmols/land 6.9 mmols
- Between 7.0 to 10 mmols
- Between10 mmolsand 14 mmols
- Above 14mmols
If blood ketones are below 1mmol/L, follow the ABCC rule giving half the recommended correction amount by the insulin pump calculator. If possible, leave the pump connected for the duration of the activity.
After PE, test blood glucose and reconnect pump (if previously disconnected). If above 10mmol/L give half correction bolus advised by pump.
Temporary Basal rates
The background insulin rate can be overridden by programming a temporary basal rate on the pump. This is an effective method of managing exercise and its impact on the blood glucose levels, by decreasing the amount of basal insulin.
Has the school agreed to set temporary basal rates / Yes No
Times to set a temporary basal rate / Before exercise at for hours
During exercise at for hours
After exercise at for hours
Supplies to be kept at School
- Fast-acting source of glucose
- Glucagel
- Glucagon
- Spare cannula and reservoir
- Spare insulin
- Spare battery for pump
- Blood glucose testing kit
- Blood ketone testing kit
- Insulin pen + needle
- 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 / UCLH Diabetes team / School NurseIndividualised medical management 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 staffto 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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