Diabetes

Diabetes

Diabetes mellitus (MEL-ih-tus), often referred to as diabetes, is characterized by high blood glucose (sugar) levels that result from the body’s inability to produce enough insulin and/or effectively utilize the insulin. Diabetes is a serious, life-long condition and the sixth leading cause of death in the United States. Diabetes is a disorder of metabolism (the body's way of digesting food and converting it into energy). There are three forms of diabetes. Type 1 diabetes is an autoimmune disease that accounts for five- to 10-percent of all diagnosed cases of diabetes. Type 2 diabetes may account for 90- to 95-percent of all diagnosed cases. The third type of diabetes occurs in pregnancy and is referred to as gestational diabetes. Left untreated, gestational diabetes can cause health issues for pregnant women and their babies. People with diabetes can take preventive steps to control this disease and decrease the risk of further complications.

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    Parents are responsible for getting the physician's orders, or completed diabetes medical management plan (DMMP) form for the school.

    The DMMP is developed and signed by the student's personal health care team and parent/guardian with the specific needs of an individual student in mind. It should detail all the elements of care and assistance for that student.

    Once the DMMP has been provided to the school, it is implemented collaboratively by the school diabetes team, which includes the school nurse, student, parent/guardian, and other school personnel.

    The DMMP should be updated annually or whenever the child's regimen, level of self-management, or school circumstances change.

    Some health care practitioners will prefer to use their own forms.
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    Creating a plan for how diabetes will be managed at school should be a team effort that includes school staff, families, and health care providers. It is vitally important that the work of this team is documented in written plans.

    The Diabetes Medical Management Plan (DMMP) or physician's order is the foundation for the development of all school-based care plans. The DMMP is the medical basis for an Individualized Health Plan (IHP), written by the school nurse, which specifies what, where, when, and by whom diabetes care tasks will be provided in school.

    The IHP documents how care should be provided, but does not provide legal protections for either schools, students, or families. Accordingly, the American Diabetes Association recommends that all students with diabetes have either a Section 504 Accommodations Plan or an Individualized Education Plan (IEP), depending on eligibility.

    Both 504 plans and IEPs provide protections and services under federal disability laws, and can address both medical and educational issues. The accommodations and services that are detailed in a 504 accommodations plan or IEP, are those that are needed to ensure that diabetes does not become a barrier to educational opportunities.
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    Section 504 is a federal civil rights law to prohibit discrimination on the basis of disability. The law also prohibits retaliation for asserting the right not to be discriminated against. Public elementary and secondary schools covered by Section 504 must:
    • Identify children with disabilities
    • Provide a "free appropriate public education" (FAPE) to each child with a disability. This means providing regular or special education and related aids and services designed to meet the individual educational needs of students with disabilities as adequately as the needs of students without disabilities are met
    • Educate children with disabilities with other students as much as possible
    • Allow parents/guardians to participate meaningfully in decisions regarding their children
    • Afford children with disabilities an equal opportunity to participate in non-academic and extracurricular services and activities
    Covered schools are required to provide needed aids and services in order to allow students with disabilities to receive an education that is comparable to that provided to students without disabilities. Parents/guardians should document this accommodation in a Section 504 Plan.
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    Section 504 is a federal civil rights law to prohibit discrimination on the basis of disability. The law also prohibits retaliation for asserting the right not to be discriminated against.

    To be protected by Section 504, the student must have a disability defined as: A physical or mental impairment that substantially limits one or more of major life activities; a record of such an impairment, or be regarded as having such an impairment.
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    Call 9-1-1 or the local emergency number if:
    • The person is unconscious or about to lose consciousness. In this situation, do not give the person anything by mouth. After calling 9-1-1 or the local emergency number, care for the person in the same way you would care for an unconscious person. This includes making sure the person’s airway is clear of vomit, checking for breathing, and giving care until advanced medical personnel take over.
    • The person is conscious but unable to swallow. (In this case, do not put anything -- liquid or solid -- into the person’s mouth.)
    • The person does not feel better within about five minutes after taking some form of sugar.
    • You cannot find any form of sugar immediately. Do not spend time looking for it.
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    Islet transplantation is a procedure that involves moving the islets from a donor pancreas into a person whose pancreas has stopped producing insulin. Beta cells in the islets make the insulin that the body needs for using blood glucose.
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    The evidence of a link between exposure to Agent Orange (or dioxin, the problematic contaminant in Agent Orange) and diabetes is modest. Most of the association between Agent Orange and diabetes comes from studies of people who lived near or worked at manufacturing plants that produced large quantities of Agent Orange dioxin. In those cases, there appears to be some relationship between Agent Orange exposure and increased insulin resistance, the precursor to type 2 diabetes.
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    When you finish the blood glucose check, write down your results and review them to see how food, activity and stress affect your blood glucose. Take a close look at your blood glucose record to see if your level is too high or too low several days in a row at about the same time. If the same thing keeps happening, it might be time to change your plan. Work with your doctor or diabetes educator to learn what your results mean for you. This takes time. Ask your doctor or nurse if you should report results out of a certain range at once by phone.
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    Some people with type 1 diabetes experience a brief remission called the "honeymoon period." During this time, their pancreas may still secrete some insulin. Over time, this secretion stops and, as this happens, the child will require more insulin from injections. The honeymoon period can last weeks, months, or even up to a year or more.
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    A fasting blood glucose (FBG) test is a check of a person's blood glucose level after the person has not eaten for 8 to 12 hours (usually overnight). This test is used to diagnose prediabetes and diabetes. It is also used to monitor people with diabetes.