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Robin Kish: Welcome to the Health Care District of Palm Beach Counties Podcast, Here For Your Health. I'm your host Robin Kish. The Health Care District is a unique healthcare system located in Palm Beach County, Florida. We provide County residents access to primary care, hospital, and school health services, skilled nursing and long-term care and life saving trauma and air ambulance services. Through all of these programs, the Health Care District focuses on filling the gaps in the healthcare delivery system and being the safety net for Palm Beach County. On this edition of Here For Your Health, we'll discuss how a diabetes educator help students stay healthy. Our guest today is Kara Baker school health consultant for the Health Care District School Health Program, which staffs more than 200 registered nurses in nearly all of Palm Beach counties, public schools to keep students healthy and ready to learn. Welcome Kara.

Kara Baker: Thanks. It's good to be here.

Host: Kara, your role in certified diabetes care as the diabetes educator for the school health program specifically targets students when they're in class during the school day, before we dive into your work with students, can you please share with our listeners a little about what a diabetes educator does?

Kara Baker: Sure. A diabetes educator works with individuals affected by diabetes or in danger of developing diabetes to provide information and help develop coping skills and healthy habits. This includes working closely with individuals with diabetes, as well as with their caregivers and families. The diabetes educator may answer questions, offer advice or work with the individual to modify behavior in some other way, to help them better control the diabetes. Diabetes educators do this by providing information about diabetes and its management instructing on how to use and understand diabetes devices and helping the individual develop problem solving strategies and skills to self manage diabetes.

Host: So, Kara, your role is dedicated to helping students in kindergarten through 12th grade in the public schools, how prevalent is diabetes in school aged children?

Kara Baker: The number may vary based on the sources you check, but the CDC identifies that diabetes, both type one and type two affects about 208,000 or 0.25% of all people younger than 20 years of age in the United States. However, the incidents of newly diagnosed diabetes in youth continues to increase.

Host: That's a high number. What are you seeing here in Palm Beach County public schools?

Kara Baker: We see about 400 students in Palm Beach County public schools with diabetes.

Host: School nurses assisting students in checking their blood glucose levels throughout the school day?

Kara Baker: Yes, they are. As well as ketone checks. We see about 110,000 glucose and ketones checks during the school year.

Host: How does that break down by school grade?

Kara Baker: We see the highest number of students with diabetes in high school, but the largest number of glucose and ketones checks occur in elementary school, nearly half about 52,000 occur in elementary schools during the school year,

Host: Kara clearly there's a need for a diabetes educator, especially among the younger students. Can you share how you help educate and assist the students in Palm Beach County public schools?

Kara Baker: Throughout the school year, school nurses will identify signs of diabetes in their students and recommend follow-up exams with the pediatrician. The school nurses will often provide reassurance and guidance to families when they first learn of their diabetes diagnosis for their children, which is very scary for them, for the families and the student and I, along with the school nurse, help families manage this chronic disease. I've been a school nurse with the Health Care District for 14 and a half years. I was certified in diabetes education for the past two and a half years and do understand the unique needs of the school nurses and students as they navigate the school day while trying to manage their diabetes. I provide ongoing diabetes education to the school nurses, including the latest technology advances and medication changes that are available for diabetes management. I also act as a liaison between the physician offices, and the school nurses when requested. As well as offer strategies to the school health team for safe management in school. I also provide education and support to students and the families and often assist with recommending the necessary accommodations that need to occur for the student to remain safe in school. I enjoy educating and supporting my fellow school nurses as well as the students and their families so that they can succeed academically and socially by following the management plan.

Host: There really is a lot involved. Recognizing that this podcast is an opportunity to educate and share information and not medical advice. Can you describe, what's typically involved in diabetic treatment for children?

Kara Baker: Our child's diabetes management team can include their doctor, a diabetes educator, a dietician, the school nurse and the parents. The team works to keep the child's blood sugar level as close to normal as possible. Management typically involves taking insulin carbohydrate, counting, frequent blood sugar, monitoring, eating healthy foods and exercising regularly.

Host: What is involved in a student's blood sugar monitoring?

Kara Baker: Well throughout a child's treatment throughout the day, there's ongoing blood sugar monitoring. They need to check and record the sugar at least four times a day. Sometimes more often. This is where the school nurse really becomes a key member of the management team. School nurses help identify trends in the blood sugar and they relay this information to the parents and the physicians. It's common though, that blood sugar does get checked more often. For example, prior to going to PE or recess, or if they have special class parties or if they're feeling symptomatic. Some children may have continuous glucose monitoring devices that measure their sugar level every few minutes using a temporary sensor that's inserted under the skin. Some devices will show their sugar reading at all times on a receiver or on an iPhone. And there's some that require they check it by running a receiver over the implanted device. Frequent testing is the only way to make sure that your child's blood sugar level remains within their target range, which may change as your child grows and changes. Your child's doctor will let you know what your child's blood sugar target range is.

Host: Many of our listeners are aware that the primary treatment for diabetes is insulin. Can you tell us a little bit more about insulin treatment?

Kara Baker: Yes. Insulin is the standard treatment for type one diabetes and increasingly we see it being treated for type two diabetes. There are many types of insulin and your child's doctor will help choose, which is best. There are also several options for insulin delivery, including needle and syringe. This looks like a shot that you might get in a doctor's office, but it's a very thin needle. Insulin pen with the fine needle. This looks like a regular pen, except the cartridge is filled with insulin and an insulin pump. This is a device worn on the outside of the body. That's programmed to deliver specific amounts of insulin throughout the day. And also when you eat, a tube connects the reservoir of insulin to a catheter that's inserted just under the skin, usually of your abdomen. There's also a tubeless pump option that involves wearing a pod containing the insulin, combined with a tiny catheter that's inserted under your skin.

Host: So, the nurses really have to be aware of how all of these tools work and how to support the needs of the students who wear them. What are some of the other tools you use to treat children with diabetes?

Kara Baker: Food is a big component of any diabetes plan, but that doesn't mean that they have to follow a strict diabetes diet. Just like the rest of the family. Your child's diet should regularly include foods that are high in nutrition and low in fat and calories, vegetables, fruits, lean protein, whole grains, your child's dietician can help create a meal plan that fits your child's food preferences and health goals. As well as help you plan for occasional treats. He or she will also teach you how to count carbohydrates and foods so that you can use that information to figure out insulin dosing. Our Health Care District school nurses help students manage their diabetes in school, keeping snacks on hand, reviewing menus and assisting with carb counting to calculate the insulin doses. We also work with the child's teachers to review what signs and symptoms to look for. Should the student need to visit the nurse to check their blood sugar levels. Maintaining adequate hydration is also important.

Encouraging the children to drink water throughout the day. Physical activity is another important piece to your child's management plan. Everyone needs regular aerobic exercise and children who have diabetes are no exception and encourage a child to get at least 60 minutes of physical activity daily or better yet exercise with your child, make it a family affair, and that will help incorporate it into their daily routine. But remember, physical activity usually lowers blood sugar and can affect the blood sugar for several hours after exercising, possibly even overnight. If your child begins a new activity, make sure that you check their blood sugar a little more often than usual until you learn how that particular exercise affects their sugars. You might need to adjust your child's meal plan or insulin doses to compensate for the increased activity.

Host: You just mentioned signs and symptoms. Are there any signs that parents, teachers, and others should look for in children that might indicate a problem?

Kara Baker: Yeah. Despite some of the best efforts to monitor them, sometimes problems do arise. Certain short term complications of diabetes require more immediate care, or they could become very serious. This could include low blood sugar or hypoglycemia, high blood sugar, which is hyperglycemia and diabetic ketoacidosis. Low blood sugar is a blood sugar level that's below your child's target range. Blood sugar levels can drop for many reasons, including skipping a meal, getting more physical activity than normal or taking too much insulin. Low blood sugar is not uncommon in people with diabetes, but if it isn't treated quickly, symptoms can get worse. Signs and symptoms of low blood sugar can include shakiness, hunger, sweating, irritability, some other mood changes, difficulty concentrating or confusion, some dizziness, lightheadedness, loss of coordination.

And if it gets a little more serious, it would be slurred speech and loss of consciousness. Teach your child symptoms of low blood sugar. When in doubt, he or she should always check their blood sugar level. If a meter isn't readily available and your child feels like they're having symptoms of low blood sugar, treat for the low blood sugar, and then test as soon as you're able, I encourage everyone to speak with their child's doctor about how to handle low blood sugar levels. But typically if a child's low blood sugar is low, have the child consume 15 grams of fast acting carb, such as fruit juice, glucose tablets, hard candy, regular soda, not diet soda, or any other source of sugar. And then retest your blood sugar in about 15 minutes to make sure it's within normal range and repeat this as necessary until you get that normal reading. If a low blood sugar causes your child to lose consciousness, glucagon, which is a hormone that stimulates the release of sugar into the blood may be necessary.

This can be given as an injection or intranasally, depending on which type is prescribed by the physician. High blood sugar or hyperglycemia is a sugar level above your child's target range. Blood sugar levels can rise for many reasons, including illness, eating too much, eating the wrong types of foods or not taking enough insulin to cover the foods that you ate. Signs and symptoms of high blood sugar may include frequent urination, increased thirst, dry mouth, blurry vision, fatigue, or nausea. If you suspect a high blood sugar test your child's blood sugar. If the sugar level is higher than target range, follow your child's diabetes plan or check with your child's doctor. High blood sugar levels don't come down quickly, ask your doctor how long to wait until checking your child's blood sugar. Again, if your child has a blood sugar reading above 240, your child should use a urine test stick to test for ketones. Don't allow your child to exercise if his or her blood sugar level is high, or if ketones are present.

A severe lack of insulin can cause your child's body to break down for fat or energy, this causes the body to produce a substance called ketones. Excess ketones build up in your child's blood, creating a potentially life threatening condition known as diabetic ketoacidosis. Some signs and symptoms of DKA, which is diabetic. Ketoacidosis can be thirst or a very dry mouth, increased urination, dry or flushed skin, nausea, vomiting, and abdominal pain, shortness of breath, difficulty breathing, a sweet fruity smell on your child's breath and confusion. If you suspect diabetic ketoacidosis, check your child's urine for excess ketones and then contact your physician or seek emergency care.

Host: Such good advice for all of these different situations. Earlier in the podcast, I mentioned that the healthcare district school nurses keep students in Palm Beach County, public school system, healthy and ready to learn. Kara what's one top tip that you'd like to share that you feel helps keep students healthy.

Kara Baker: I would have to say encourage them maintain a healthy lifestyle. This can include healthy food choices, adequate hydration, daily exercise, or activity, and a full night of sleep. It's most effective. If the entire family participates and practices these guidelines. In addition for our students with diabetes, following their diabetes management plan, while they're at school, I would also like to add that during this time of COVID-19 continue to maintain a healthy lifestyle and adhere to the management plan, as well as follow the safety guidelines set forth by your child's physician CDC and the Health Department.

Host: Kara, thanks so much for your time and expertise as a diabetes educator, for more information on diabetes, as well as the latest on diabetes and COVID-19 visit the American Diabetes Associations website, www.diabetes.org and the centers for disease control and prevention or CDC’s website at www.cdc.gov/diabetes. And thanks to all of our listeners. If you find this podcast helpful, share it on your social channel and check out our full podcast library for topics of interest to you at healthcaredistrictpodcasts.org. Let us know what you think, your review helps us reach more people just like you. And if you have a suggestion about a future podcast, topic, have questions or some feedback, call (561) 804-4111 today's podcast is brought to you by the Health Care District of Palm Beach County School Health Program. This program places a school nurse in nearly all of Palm Beach County's public schools to assist children with their healthcare needs during the school day, including diabetes education. Today's podcast is also brought to you by the Health Care Districts, federally qualified health centers, the CL Brumback Primary Care Clinics. If you were so many, you know, could benefit from having a medical home call the Brownback clinics at 561- 642-1000 to make an appointment for an in person or telemedicine visit. COVID-19 testing, school physicals, medication assisted treatment, or other services, or you can visit www.brownbackclinics.org.