Managing Type 1 Diabetes at School

‘When Divya (11) requested her class teacher permission to use the restroom for the third time in an hour, the older woman warned her against playing the fool. Embarrassed the child returned to her seat. Divya is not alone. Several children with Type 1 diabetes suffer in silence without proper support in school and among peers.’

   - The Times of India 

Children with diabetes gradually learn to become more independent in self managing activities as they progress through childhood and adolescence. However, they may need help to carry out their regular diabetes management tasks in school. So, ideally a school should provide amenities for

• Maintaining good blood glucose control, 
• Helping the student with diabetes care tasks, and 
• Having trained diabetes personnel for effectively managing  diabetes .

Diabetes management involves checking blood glucose levels throughout the day, following a specially made meal plan, getting regular physical activity, maintaining a healthy weight and taking insulin or other medications to keep blood glucose levels in the target range and to prevent hypoglycemia or hyperglycemia. 

Planning for school events, special events, field trips, and extracurricular activities, correct disposal of sharps and materials that come in contact with blood, dealing with emergencies, and with the emotional and social aspects of living with diabetes are other issues of managing diabetes. 

Low blood glucose or hypoglycemia can happen suddenly and is dangerous for the child with diabetes. It is more likely to occur before lunch, at the end of the school day, during or after physical education classes, or as the result of unexpected physical activities. When the level of blood glucose falls, the child may not be able to manage on their own Sometimes, its symptoms are mistaken for misbehaviour. 

If a child experiences hypoglycemia:

• Never leave them alone 
• Never send them anywhere alone
• The  class teacher or any responsible school staff should be around to help the student, and
• The remedy for hypoglycemia should be readily available in the classroom and administered immediately. 

What is Hyperglycemia?

High blood glucose or Hyperglycemia can develop over a period of time, usually as a result of too much insulin, missing or delaying meals or snacks, not eating enough food (carbohydrates).  Trained staff should be available for quick, safe and appropriate care for students with diabetes. 

Checking Blood Glucose

At school, children with diabetes usually check their blood glucose– 

• Before and after eating snacks and meals
• Before physical activity, or
• When there are symptoms of hypoglycemia or hyperglycemia. 

Many children can check their own blood glucose level. Others need supervision. Still others need to have this task performed by trained diabetes personnel. All students, even those who can independently perform blood glucose monitoring, may need to be helped when experiencing low blood glucose. Blood glucose levels should also be checked whenever the teacher observes symptoms because some children may not recognize the symptoms.

Children must be allowed to check their blood glucose levels and take the necessary actions if the levels are too high or too low as quickly as possible, wherever they are and whatever activity they are doing. Taking immediate action is important to prevent symptoms of severe hypoglycemia such as coma or seizures.

Another important factor is a safe method for disposal of sharps and materials that come into contact with blood.

A specific plan for proper disposal of lancets and other materials that come into contact with blood protects other students and staff members.

Lancets and needles can be disposed of in a plastic or metal container with a tight-fitting lid. Some students may leave the lancet in their lancet device and take it home for disposal. 

Diabetes management in the school

The basic facilities a school should have are:

• Health care support ,
• A record of each student’s diabetes care plan prepared by the student’s   own health care team,
• Emergency care plans in case of Hypoglycemia and Hyperglycemia, and
• Training school personnel about diabetes and its management.

Responsibilities of the Teacher:

Health : the teacher should …

• Be aware of the student’s needs 
• Allow students to monitor blood glucose, inject insulin and take other medications, eat snacks for routine diabetes management and for treatment of low blood glucose levels, have easy access to the bathroom, and to drinking water,
• Know that a child with diabetes needs to eat meals and snacks on time. 
• Learn what to do in an emergency
• Recognize changes in the student’s behaviour that could be a symptom of changes in blood glucose levels 
• Know when and how to contact trained diabetes personnel.
• Know where supplies to treat low blood glucose are kept and where students with diabetes normally keep their supplies. 
• Provide information for substitute teachers about the day-to-day and emergency needs of the student. 
• Communicate with the school authority and the parents/guardian regarding the student’s progress or any concerns about the student.
• Inform the parents/guardian in advance of  class parties, field trips, and other special events. 

Education: The teacher should…

• Provide a supportive learning environment such as  extra classes or make up missed classroom assignments for students with diabetes.  
• Provide permission for doctor appointments and sick days.
• Treat the student with diabetes the same as other students, except when acting in response to their medical needs.

Responsibilities of Parents/Guardian :

The parents should…

• Inform the school principal as well as the teacher that the child has diabetes at the time the student joins the school .
• Submit documents of  the diabetes management plan issued by their child’s diabetologist to the school …
• soon after the child has been diagnosed with diabetes,
• at the beginning of each school year, and
• when there are changes in the child’s diabetes care plan.
• Give correct emergency contact information to the school and update the school about any changes.
• Learn what facilities the school provides for health care and emergency.
• Inform the school authorities about the diabetes care the child can manage at home.
• Inform the school about any changes in the child’s health or in doctor’s orders.
• Provide all supplies and equipment such as blood glucose monitoring equipment, supplies for insulin administration and urine and blood ketone testing, snacks, quick-acting glucose products, and a glucagon emergency kit necessary for the child’s health care. 
• Keep a tab on supplies and restock them, as needed and also replace supplies that have expired (if they are stored in school).
• Inform school authorities when the child plans to participate in school activities before or after school .

Responsibilities of the Student with Diabetes

They should know:

• When they should monitor their blood glucose levels, take insulin or other medication, have a snack or eat a meal.
• What to do when blood glucose level is too low or too high.
• Who to contact if they are not feeling well.
• Where the daily and emergency diabetes supplies are stored.
• Who to contact when they need to use the supplies.

The child with diabetes should: 

• Learn how to contact people who will help them in school.
• Always carry a quick-acting source of glucose.
• Communicate with teachers or other school staff members if they feel symptoms of low or high blood glucose.

(reference:  http://ndep.nih.gov/publications)