Type 1 Diabetes Care at School

One in 300 children has diabetes, so chances are high for most schools with at least one student with diabetes.

Children spend about 35 to 40 hours per week in school, which might be close to half of their wake hours. So, it is crucial to ensure diabetes student’s safety and well-managed diabetes.

Diabetes is a non-static condition, means blood sugar changes from minute to minute. Thus, school personnel requires being educated to support diabetes students.

My child is school going, what do I need to know?

School going type 1 diabetes has a host of challenges. These challenges are blood-glucose monitoring, carb counting, high sugar, low sugar, ketoacidosis, etc.

Your child is in school for one-third of their wake-up time. Thus, how they handle their blood-glucose level in school can make all the difference. Inform teachers and other school staffs that your child has diabetes and educates them regarding the condition (diabetes).

1. Educate your child and school nurse; how to give insulin to your child, how much, and how to store. Your child may get an insulin shot, insulin pen, or an insulin pump.
2. Educate your child and school staffs about the symptoms of hypoglycemia (low blood glucose level) and the treatment options. Also, provide your child with glucose-rich food. Symptoms may vary, so provide information about symptoms particular about your child.
3. Make sure your child's teacher and the school staff know that your child has diabetes and have permission to eat a snack anytime he or she needs it.
4. Educate your child as well as the school nurse, how to handle emergencies such as hypo, hyper, and ketoacidosis.
5. In the case of pump users, educate about the pump usage. And its common problems such as Infusion interruption (cannula can accidentally fall or pulled out), and pump can run out of insulin.
6. Educate your child and school staffs about the symptoms of hyperglycemia (very high blood glucose) and the treatment options. Symptoms may vary, so provide information about symptoms particular about your child.
7. Instruct your child when to eat, what to eat, how much to eat, and what should not eat.
8. Educate your child as well as the school nurse; when, and how often do they test your child's glucose level. Also, if symptoms of low or high blood-glucose appear, immediate have a blood test.
9. Provide information on when and how do they test your child's urine for ketones. The school nurse and staff members are required to know, how to test urine for ketones and know what to do if the results are above normal.
10. Your child should always wear medical I.D so that during emergency outside school, people around them can know he/she has diabetes.
11. Provide contact information for parent(s), caregivers, doctor, and the health care providers.

Students with diabetes need supervision during exercise and meals. Also snakes supervision, especially before a workout. Blood glucose monitor must be in a place easily accessible to the student, and it must not be in the locked cupboard.

Diabetes school supply list

1. Documentation: Management plan, action plan, emergency plan, and contact details.
2. Insulin kid: If you are on insulin injection have Insulin, insulin pen/syringes, sharps container, and pen needles. If you are on an insulin pump, have spare insulin pump consumables, insulin, alcohol wipes, sharps container, extra batteries, insulin syringes.
3. Blood glucose monitoring consists of glucometer, lancing device, test strips, extra batteries, spare lancets, and hand sanitizer or wipes.
4. Hypo emergency kit consists of fast-acting glucose such as snacks, glucose drink, and tablets, and Glucagon kit.
5. Hyper emergency kit: Ketone testing strips, blood glucose monitor, and insulin

Blood glucose monitor, hypo kit, and emergency health plan should always be to the student wherever the student goes. Blood glucose monitor must be in a place easily accessible to the student, and it must not be in the locked cupboard.

Hypoglycemia requires immediate intervention to prevent severity, which involves loss of consciousness or seizure. Learn to prevent and treat hypoglycemia.

In case of mild to moderate hypoglycemia, your kid needs rapid-acting carbohydrates such as glucose drinks, tablets, or snacks. Severe hypoglycemia requires external help with dextrose or glucagon. Glucagon is a counter-regulatory hormone to insulin, it can be administered by subcutaneous (SC) or intramuscular (IM) injection by trained parents or caregivers. Dextrose in the water at a 25% concentration must be administered intravenously by a qualified health care professional.

What do individual permissions diabetes students require?

Children with type 1 diabetes depend on school authorities to ensure their condition is managed properly at the school.

To support students with diabetes, teachers may require providing some individual permissions, such as:

1. Allow adequate time to consume regular scheduled meals and snacks.
2. Around physical activity, learn/teach your kids to adjust either food intake or insulin dose. Your kid requires extra blood glucose test and extra snack before activity.
3. Require clean area for blood glucose test with the facility to clean hands and container to discard glucose test strips and lancets.
4. Easy access to an emergency kit containing glucose meter, lancet, test strips, fast-acting sugar source, snacks, etc.
5. Absent from school is not significantly higher in diabetes compared with non-diabetes kids. However, they require absenting from school for regular medical appointments. Do not pressurize the student regarding absence, because this put them to forego medical appointments, and it affects their well-being.
6. People with diabetes need extra consideration during exams and tests.
7. Also require extra planning for sport, excursions, camps and other activities.
8. Permission to drink water at any time, because they have increased thirst.
9. Permission to eat in class/sport, because they need to treat low sugar.
10. Permission to go to the toilet at any time because they have frequent urination.
11. Privacy while testing blood glucose and injecting insulin.

Can diabetes child participate in school sports?

Regular physical exercise is beneficial for everyone, including children with type 1 diabetes. However, the unplanned activity can lead to a complication, because of an episode of hypoglycemia (low blood glucose).

Your child can overcome these complications by taking proper advice from your healthcare providers. If he/she is receiving enough carb concerning their planned intensity of activity, then they can easily avoid hypoglycemia. Your child can enjoy participating in school or college sports or other physical activities safely and enjoyably.

No two diabetic student manage their diabetes in the precisely same way. Some get their insulin using a syringe, other insulin pens, and still other insulin pumps. Some students are in their "honeymoon" period, while others are not. Some students easily detect lows, while others do not seem able to identify lows.

Encourage diabetic children to be physically active; however, around physical activity, the student must monitor their glucose level and food intake. Parents need to know school activity schedule to help their kids to adjust insulin dose and food to avoid blood glucose extremes. Encourage them to eat snacks before physical activity may help to lower or prevent the risk of hypoglycemia.

Students with diabetes need supervision during exercise and meals. Also snakes supervision, especially before a workout. Blood glucose monitor, hypo kit, and emergency health plan should always be to the student wherever the student goes.

Hyper or Hypoglycemia during Exam

A student with diabetes with stable blood glucose can perform the exams/tests to the best of their ability. However, unstable blood glucose level may cause difficulties to concentrate, and their ability to perform in the examination might be lower. Additionally, an unstable diabetic student requires more frequent toilet visits.

Blood glucose high/low negatively affects the learning ability. Hypoglycemia has a short negative effect on concentration, thought processing, and behavior. Thus, there are increased chances for mistakes on math and verbal tasks.

Similarly, hyperglycemia too can cause cognitive problems. Once the blood sugar is normalized, it takes about 45 minutes for the intellectual functions to resolve. Thus, if hypo or hyper occurs during the exam, the student needs special attention to complete the exam correctly.

Responsibilities of a diabetic student’s parent

To make the school a safer environment for your child, you have to meet the school principal, class teacher, sports teacher, etc. well before the school opening. It will help them understand your child health condition and able to support your child.

1. During student enrollment, inform the principal and school coordinator that your child has diabetes. Additionally, tell them that your child needs to test the blood glucose level and take insulin shots. Also request them to supervise, if your child requires.
2. Discuss with your school authority and health care profession to develop an individual health plan and emergency health plan for your diabetes child. Also prepare a plan for outdoor school activities such as camps, interschool competition, and excursions.
3. Meet all the relevant school staff and if required, provide a written request to assist your child in the administration of insulin and testing of blood glucose. And provide relevant information such as the dosage, method of administration.
4. Provide your child with the necessary equipment (such as blood glucose meter, insulin pen, etc.) and medications (such as insulin, hypo kid, etc.).
5. Daily check all the equipment and medications. Replace the drug, if it is expired or used up. If the machine is in repair, then repair it or replace it with a newer one.

The school staffs, including school health personnel, teachers, and bus drivers should necessarily understand the needs of type 1 diabetes and make the school a safe and healthy place.

It is uncommon for diabetes to be the cause of excessive absenteeism. Even school attendance is not significantly affected by a routine doctor, dietician, or other diabetes healthcare professional visit. However, unwell diabetic student (e.g., viral infection) may require increased blood glucose monitoring and insulin adjustment; this may force them to absent from school.

For providing individualized support to a student with diabetes, the school should essentially have both an individual and emergency health care plans.

Individual health care plan provides a daily guideline with instruction about routine food and insulin and medications regime. The emergency health plan provides emergency guidelines with step by step instruction on how to safely handle the predictable emergency (such as hypo, hyper, and ketoacidosis) along with emergency medication. Appropriately qualified health professionals must provide these health plans. Also, should review these plans annually or when there is any change in treatment.

If the diabetic child requires school staff supervision for the administration of insulin, then parents need to discuss with the staff's concern.

Responsibilities of the Principal

1. Create a suitable school environment for students with diabetes. Provide necessary support to diabetic students who are capable of self-administering insulin.
2. Eliminate discrimination against a diabetic student who requires insulin treatment.
3. Provide support for the development of individual and emergency health plans. Prepare it in collaboration with the student, parents, school staff, and diabetes doctor. Periodically confirm that the plans are current.
4. Allow diabetes student to participate in all school activities such as excursion, camps, sports, etc. At the same time, address the needs of diabetic students with the necessary guideline.
5. Should ensure proper disposal of sharps.
6. Make sure the staff are aware that the student’s personal information is confidential.

Responsibilities of the classroom teacher & support staff

1. Go through, becomes familiar, and adhere to the diabetes guidelines of the schools and the student’s individual & emergency health plans.
2. Take management of diabetic student training.
3. Recognizes and acts promptly to the signs and symptoms of hypoglycemia.
4. Provide special privileges to the diabetic students such as toilet facility, drinking water, foods & snakes if appropriate (hypoglycemia), and to test blood glucose level.
5. Supervise the student’s self-administration of insulin and blood glucose testing, if they require.
6. Encourage the participation of the diabetic student in all school activities. Consult with parents and get necessary guidelines about out of school activities. 

Laws protecting type 1 diabetes student

Parent of type 1 diabetes child should be aware of the federal law that protects your child at school:

1. Section 504 of the Rehabilitation Act of 1973 is a civil rights law that prohibits discrimination by disability. This law applies to public elementary and secondary schools, among other entities.
2. Americans with Disabilities Act of 1990 (ADA) is the nation's first comprehensive civil rights law addressing the needs of people with disabilities. This law prohibits discrimination in employment, public services, public accommodations, and telecommunications.
3. Individuals with Disabilities Education Act (IDEA) is a four-part (A-D) piece of American legislation that ensures students with a disability. This act provides right for free Appropriate Public Education (FAPE) that tailored to their individual needs.
4. Family Education Rights and Privacy Act (FERPA) is a Federal law that protects the privacy of student education records. The rule applies to all schools that receive funds under an applicable program of the U.S. Department of Education.