Diabetes and School

Parents always have some anxiety about their child with diabetes starting school. You may have a young child who is not mature enough to manage his or her own diabetes care. Or you may have an older child who has more responsibility for his care, but still needs guidance. Either way, you want to feel that your child is in safe hands while at school and make sure that your child is not treated differently because of having diabetes. Following the guidelines below will help your child have a safe and healthy year at school.

What do I need to tell the school?

Teach those who will be working with your child at school about diabetes. Call the school nurse, teacher, or principal to discuss the best way to inform all of the necessary people. It is essential that you educate the teachers, school nurse, bus driver, gym teacher, lunchroom workers, and others involved with your child at school. Sometimes the school nurse or the teacher will help educate other staff people. This is usually best to do in the week before classes start. You may want to buy or borrow a copy of a video about diabetes and the school and show it to the nurse, teachers, and others who will be working with your child. A video can be a good starting place for discussing hypoglycemia, the most likely emergency to occur at school.

It is important NOT to leave it up to the child to inform and educate the school. Your child may be self-conscious or embarrassed and not get the job done.

Also you need to make sure your child understands the details of who will help him or her with testing, shots, and treatment of high or low blood sugars at school.

What supplies do I need to give the school?

A supply of snacks and equipment needed for blood sugar testing should be kept at school. You should tape a set of instructions and parents' phone numbers to the box of snacks as well as to the extra meter you send for testing. Make sure that you replace supplies that are used. You should give the following supplies to the school:

• meter, strips, and finger-poker
• lancets
• logbook for recording blood sugar levels
• insulin, insulin syringes, and extra insulin pump supplies (if using a pump)
• biohazard container
• ketone testing strips
• photo of your child to attach to the school health plan
• glucose tablets
• juice cans or juice boxes (approximately 15 grams of carbohydrate each)
• instant glucose or cake decorating gel
• a glucagon emergency kit (if someone at the school can give)
• crackers (peanut butter and/or cheese)
• a can of sugar pop or quarters to buy sugar pop if needed
• fruit-roll ups
• dried fruit and other snacks
• box with the child's name to store food and drink items.

What is a school health plan?

Schools in most states now require a school health plan. A school health plan is a form that is filled out for your child that records the specific time and place your child needs to have food, medicine, or tests done. Along with a health plan is an emergency response plan. This plan outlines what to do in case of an emergency.

Should my child have a blood sugar test at school?

At a minimum a test must be done whenever your child is feeling low. Some healthcare providers or parents ask that a test be done every day before lunch. Each time a blood test is done, the result, day, and time should be recorded on a record sheet or in a logbook.

It is best if your child is allowed to do a blood test in the classroom. Your child will miss less school this way. If the child is testing himself in the classroom, an adult may need to check the result to see if the blood sugar is low. The biggest disadvantage of testing in the classroom is that the hands cannot be washed first (unless there is a sink in the classroom). A trace of sugar on the finger can cause a high reading. If alcohol is used to clean the finger, it needs to dry completely before lancing. If the student must go to the school clinic for testing, another person should always go along. If the child's blood sugar is low, he or she may be confused and not make it to the clinic alone.

Often children carry their own meter in their backpack. A meter can also be stored in the school clinic or with the teacher. A glucose meter should NOT be kept in a child's locker because it is hard to reach in an emergency.

How does my child get insulin at school?

If insulin is to be given at school, the parent and the child's doctor must sign a school medication form. It must specifically say when the insulin is to be given and the dose. The school nurse may not always be available to give or supervise this injection. Under some circumstances the child may give his or her own shot. Sometimes the nurse will train another staff person who is always available. If a child is drawing up the insulin and giving his own dose, it is a good idea to have an adult check the amount. On other occasions the parent may need to come in and give the injection. Insulin pens are very convenient, more accurate, and leave less room for error when drawing up the dose at school.

If your child is using an insulin pump, the school staff needs to learn how to connect and disconnect the pump. Your child may need to disconnect the pump during gym or recess. There must be a safe place to keep the pump when it is disconnected. Some children need help remembering to give themselves a bolus dose, particularly at lunch. Let the school staff know how to calculate the bolus dose and any other important pump operating instructions.

When should ketones be tested at school?

Your child may occasionally need to check ketones at school if:

• ketones were present earlier at home
• the blood sugar level is above 300 mg/dl (16.7 mmol/L)
• your child is not feeling well.

You should be notified if moderate or large urine ketones are present (or a blood ketone test shows more than 1.0 mmol/L). Your child will need extra insulin and need to be treated by adults who can provide constant supervision, usually at home.

What arrangements need to be made for special school situations?

• Snacks and Drinks: Make sure that teachers, bus drivers, and coaches know that your child may need to eat snacks or drink fluids to keep blood sugar under control. If your child's blood sugar is high, your child will have to drink more fluids. If your child feels low, he must be allowed to eat a snack, even in the classroom or on the bus.
• Field days and field trips: Field days or field trips usually involve extra excitement and exercise. Both of these can cause an increased chance of low blood sugars. You should ask to be notified ahead of time so that you can reduce your child's insulin dose. You may also want to send extra snacks.
• Gym class: It is particularly important for the gym teacher or coach to have a copy of the school health plan. Low blood sugars may occur during exercise and a source of instant sugar should be close by. Often a snack is recommended before gym. Your child should start to eat the snack early enough so he does not miss part of gym class. Exercise is even more important for children with diabetes than for other children. They should not be excluded from gym or sports activities.
• Class parties: If the class is having a special snack, your child should also be given a snack. You should be notified ahead of time so you can decide whether your child may eat the same snack as the other students or if you want to provide an alternate snack. If an alternate snack is not available, your child should be given the same snack as the other children.
• Substitute teachers: Ask to have a copy of your child's health plan placed in the substitute teacher's folder and the attendance register. Attach a picture of your child to the health plan so the teacher knows which student has diabetes. The health plan will help the substitute know the symptoms and treatment for an insulin reaction, when your child needs a snack, and where the supplies are kept.
• After school detention: Children with diabetes should not be singled out or treated differently from the rest of the class. However, if required to remain after school (at noon or in the afternoon) for a longer time than usual, the teacher should be asked to give your child an extra snack. Most parents will have packets of cheese and crackers, peanut butter and crackers, or some such snack for the teacher to keep in the drawer. This is a common time of the day for the morning or afternoon insulin to be peaking. If a snack is not eaten, an insulin reaction is likely to occur.
• Bathroom privileges: If your child's blood sugar is high, your child will have to drink more and urinate more often. It is important that the teacher give your child bathroom privileges. If the teacher notices that your child is going to the bathroom frequently over a period of several days, you should be notified. Your diabetes care provider can then adjust the insulin dose.