• Print This
• Select Text Size:
• Comments
• 

Some 176,500 American children — or one out of every 400 to 600 — have diabetes, according to the American Diabetes Association.

To manage diabetes, children are increasingly using insulin pumps as an alternative to multiple daily injections. The pump delivers insulin in precise amounts throughout the day, plus extra doses to cover high carb meals, exercise, and episodes of hyperglycemia.
Helping students manage these pumps is increasingly becoming a task of the school nurse.

“Once they hit adolescence, they do like the pumps,” says Y.Diane Tasev, RN, BSN, school nurse coordinator for the Arizona Department of Education. “Most elementary school students don’t use the pump.”

Today’s inslulin pumps, which also are called continuous subcutaneous insulin infusion therapy or CSII, are about the size of a beeper. The pumps are mostly used by children with type 1 diabetes.

Insulin pumps deliver a continuous dose of rapid acting insulin (basal rate) to cover insulin needs between meals and at night. A needle guides the insertion of a small cannula into the subcutaneous tissue of the thigh, arm abdomen, or buttocks. The cannula is replaced every two to three days. In addition, based on blood glucose readings, planned food intake or exercise, bolus doses are administered throughout the day.

“The pumps are very sophisticated,” says Belinda P. Childs, ARNP, MN, CDE, BC-ADM, with the American Diabetes Association. “The parent, child, school nurse, or other trained personnel would enter the number of carbohydrates that were going to be eaten by the child, then the pump, which is programmed for the specific child, would calculate the dose to be given.”

Blood glucose levels are taken regularly with a meter to help determine the right doses. Some children are now wearing continuous glucose sensors to measure the level, she added.

School nurses need to keep up-to-date with the newer pumps as the technology changes, Childs says. A Website that lists the features of many types of insulin pumps is www.diabetesnet.com.

Tasev says diabetes management for students was added last year to the state’s annual professional development day for school nurses and other health care professionals on campus. But such training can be challenging because of the different levels of education of the group, she says. Only about half of Arizona schools have nurses on staff, with the rest using nurses on-call or other health care workers.

Another challenge facing school nurses is knowing who in the student body is diabetic.
“There are probably a bunch we don’t know about,” Tasev says. “By junior high, students are more aware of their self-image. It’s a 24-hour disease and it becomes routine to them.”

Students and parents often don’t share physician orders, management plans or supplies with the school nurse such as snacks and back-up insulin, Taseve says.

Adolescence can be an age of experimentation as well, Tasev says. Some girls change their treatment plan and let the pumps run higher doses to cut their appetites so they will lose weight.

There are a number of steps school nurses should take to prepare for a diabetic child using an insulin pump at school, Childs says.

“School nurses need to know how to treat hypoglycemia and how to support children as they give their boluses based on insulin-to-carbohydrate ratios,” she says. “They need to have back-up supplies should the child need to change the needle site.”

Also, school nurses need to know how and when to check for urine ketones, Childs says.
School nurses also need to train school staff to recognize problems and assist the child in managing their diabetes if the nurse is absent.

Students on insulin pumps need ongoing support and education, writes Judy Laver Bierschbach, RN, MSN, c-ANP, who along with two colleagues wrote a 2004 article for The Journal of School Nursing.

“School nurses can help students problem solve in situations such as school dances, field trips, or classroom parties,” Bierschbach writes. “Be receptive to student input; they will probably be able to tell you how they adjust their bolus doses based on activities and carbohydrate counting for meals and snacks.”

Bierschbach recommends developing a written plan that includes when to check blood sugars and begin urine ketone testing, how to treat low and high blood sugars and what the parents would like you to do in these situations. The plan should also include the manufacturer’s customer support phone number.

Finally, the school nurse should know each child’s symptoms of hypo- or hyperglycemia, according to Bierschbach.

“These can be very subtle, such as inattentiveness or more overt such as acting out in class,” she writes. “Should the child need a snack bolus for hypoglycemia, have a written plan from the parents about what works best for the child.”

And remember that insulin needs change as a child grows. Increased stress, changes in activity and growth hormone secretions will affect insulin needs, Bierschbach writes.

---

Teresa McUsic is a freelance writer. To comment on this article e-mail editorsw@nurseweek.com.

Reader Comments

You must adhere to the Terms of Service and Community Rules for Nurse.com when posting comments. Please do not post disparaging or offensive remarks. You may use links in your post.

Be the first to comment!