Type 1 Diabetes at School: What Personnel Need to Know

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Type 1 Diabetes at School: What Personnel Need to Know

It is no secret that young children typically do better when parents are involved in their academic lives, and the advice is no different when your child has type 1 diabetes. In anticipation of the school year starting, take the time to attend school informational sessions to learn what the upcoming months might look like. Scheduling time to see the layout of the school building and grounds can help you visualize your child’s day-to-day activities. Knowing where the cafeteria, gymnasium, administrative offices, school nurse, playgrounds and sports fields are can help you as you devise a plan of diabetes care for your child while at school.  

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In addition to touring the school itself, visit the institution’s website. There you can find helpful resources for parents, such as the school calendar and contact information for your child’s teachers and the administrative staff. Many schools have an online portal or app that provides classroom and scholastic testing dates as well as field-trip days. Your child’s teacher may ask parents to sign up for alerts to stay informed of classroom events or changes to previously scheduled activities both in and out of the classroom. This may help you anticipate your child’s diabetes care needs in advance. 

Conversations with school personnel about type 1 diabetes

While planning ahead for the school year, getting to know the school personnel is a necessary step. Consider these five topics of discussion. 

1) Contact information 

This should include how to get in touch quickly. Legible, accurate contact information — including up-to-date home, work and cell phone numbers — for you and any other family members or guardians for the child should be made available. Detailed information about the child’s diabetes care provider also should be included. It is important that each number has a voicemail option or an alert in place so that the required person can be reached in a timely manner. Review the contact information in advance of field trips and ensure parents and caregivers have updated contact information to exchange with the teacher, nurse or healthcare provider who will accompany your child. 

2) Blood glucose monitoring 

Highlight the importance of day-to-day monitoring of blood glucose. Recommendations from your child’s diabetes care provider regarding target blood glucose ranges should be shared. The school should be aware of details such as the type of blood glucose meter, test strips and lancets that your child uses; why monitoring your child’s blood glucose level is vital to their diabetes health; and how often their glucose should be monitored. Be sure to highlight the situations in which your child’s glucose should be checked, including routine times such as before each meal and perhaps after; whenever your child complains of symptoms of hypoglycemia (low blood glucose) or hyperglycemia (high blood glucose); and any time the child is ill. If your child uses a continuous glucose monitor (CGM), the school will need to understand that the system measures glucose levels on a continuous basis throughout the school day. Your child’s caregivers at school will need to understand that the CGM device must remain intact and know how to access the CGM’s data for decision-making. 

3) Treatment for hypoglycemia and hyperglycemia 

This discussion should include information about how to address a blood glucose level that is either too low or too high. Details about treatment for hypoglycemia and your child’s usual symptoms of hypoglycemia are essential. A source of 15 to 20 grams of pure glucose (three to five glucose tablets or an individual 15-gram tube of glucose gel) — which is the preferred treatment — should be easily available. Make sure teachers, nurses and support staff know where emergency treatment supplies are located within areas such as the classroom, in the child’s diabetes bag and in the nurse’s office. Designated school staff should be trained in the use of glucagon (a hormone that helps raise glucose levels) for severe hypoglycemia and know when to call 911, should the need arise.  

Additionally, also discuss how to identify hyperglycemia, with information about the symptoms your child experiences when their blood glucose is too high, as well as how to manage hyperglycemia with extra doses of insulin, as needed. Clear instruction should be available regarding when to check the urine for ketones (a byproduct of fat breakdown that occurs when the body does not have enough insulin), which can lead to a potentially life-threatening condition known as diabetic ketoacidosis. 

4) Diabetes medications 

Share details about your child’s prescribed insulin, and be sure to maintain communication when dose changes are made. Since children with type 1 diabetes always require insulin, school staff should know specifics about the type of insulin, how often your child takes it, and the device (syringe, pen or pump) used to administer it. Dose amounts needed to correct a blood glucose level that is too high should also be discussed. It should be ensured that each dose is spaced far enough apart to avoid too much insulin at once, which can subsequently cause hypoglycemia. Details regarding when, by whom and any approval needed to adjust insulin doses also should be clear. 

5) Meal plan 

Check to see if the school menus have the nutrition information available. School staff should understand the effect that carbohydrate has on blood glucose and how to estimate the carbohydrate content in particular foods. Your child should not be denied a food due to diabetes. Instructions for when food is provided during special events and how much carbohydrate is included is essential so that your child may participate in these occasions (with any required insulin being administered to cover the food). 

Preparing a Section 504 Plan 

You will want to ensure that your child’s rights are protected, their diabetes-related needs are met, and that you and the school system are all on the same page. Accordingly, your child with diabetes should have a “Section 504 Plan.” The Rehabilitation Act of 1973, Section 504, reads “No otherwise qualified individual with a disability in the United States…shall, solely by reason of her or his disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.” This applies to kids with diabetes.  

The school district should have written procedures regarding the services they are to provide under Section 504. You will want to become familiar — ahead of time — with how your child’s school interprets these responsibilities. The goal is to provide guidance for your child’s safety at school. A key component of the Section 504 Plan is the “Diabetes Medical Management Plan” (DMMP). You, the parent and/or guardian, will design and sign the written plan and incorporate the medical orders from your diabetes care team. The DMMP should be signed by your child’s diabetes care provider (pediatric endocrinologist or pediatric nurse practitioner). The DMMP documents your child’s type 1 diabetes and how long they have had it, and includes the items discussed above specific to your child’s diabetes care needs.  

It is important to include in the plan that if your child is capable of doing so, they can be allowed to perform the diabetes care activities associated with monitoring blood glucose, taking insulin, and counting carbohydrate accurately but emphasizing that they should always be closely supervised by trained staff. It is also important to know that if you are unable to attend events such as sports functions and field trips, that your child cannot be excluded from participating. A trained adult should be available and aware of your child’s diabetes plan, and know how to respond based on the child’s DMMP. 

Have a successful school year 

Keep in mind that that you can request additional meetings with teachers, principals, school counselors or other school staff at any time during the school year. Ongoing communication and a solid plan can help your child with diabetes succeed in the school setting. 

Want to learn more about parenting a child with type 1 diabetes? Read “The Type 1 Diabetes Diagnosis,” “Type 1 Diabetes and Sleepovers or Field Trips,” “Writing a Section 504 Plan for Diabetes” and “Top 10 Tips for Better Blood Glucose Control.”

Laura Hieronymus, DNP, MSEd, RN, MLDE, BC-ADM, CDCES, FADCES

Laura Hieronymus, DNP, MSEd, RN, MLDE, BC-ADM, CDCES, FADCES

Laura Hieronymus, DNP, MSEd, RN, MLDE, BC-ADM, CDCES, FADCES on social media

A doctor of nursing practice, master licensed diabetes educator, and Practical Diabetology editor. Hieronymus is the associate director of education and quality services at the UK HealthCare Barnstable Brown Diabetes Center, University of Kentucky, Lexington, Kentucky.

Amanda Thomas, BSN, RN

Amanda Thomas, BSN, RN on social media

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