Diabetes: School

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KEY POINTS

• Call the school to discuss the best way to inform everyone who needs to know, including teachers, the school nurse, bus driver, gym teacher, lunchroom workers, and others involved with your child at school. It’s usually best to do this in the week before classes start.
• Keep a supply of snacks and equipment needed for blood glucose (sugar) testing at school. Make sure that teachers, bus drivers, and coaches know that your child may need to eat snacks or drink fluids to keep blood glucose under control. If your child's blood glucose is high, your child will have to drink more fluids.

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You may have a young child who is not old enough to manage his or her own diabetes care. Or you may have an older child who still needs some guidance. Either way, you want to feel that your child is safe at school and make sure that your child is not treated differently because he has diabetes. Following these guidelines 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 to discuss the best way to inform everyone who needs to know, including teachers, the school nurse, bus driver, gym teacher, lunchroom workers, and others involved with your child at school. It’s usually best to do this in the week before classes start.

You can get training materials about diabetes care for the nurse, teachers, and others who will be working with your child. A video can be a good starting place to learn how to handle low blood glucose, which might happen while your child is at school.

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

Make sure your child knows who will help with testing, shots, and treatment of high or low blood glucose at school.

What supplies do I need to give the school?

State and federal laws require that schools keep information about your child’s care that may include these forms and others:

• A School Health Plan that spells out when and where your child needs to have food, medicine, or tests done
• Individualized Education Plan (IEP)
• A Section 504 Plan
• An Individualized Health Care Plan with your child’s photo
• A Diabetes Medical Management Plan (DMMP)
• A School Medication Form
• A Hypoglycemia Emergency Care Plan
• An Emergency Response Plan outlines what to do in case of an emergency

Keep a supply of snacks and equipment needed for blood glucose testing at school. You should give these supplies to the school:

• A box with your child's name and photo to store food and drink items
• Meter, glucose and ketone strips, lancets for finger sticks
• Logbook for recording blood glucose levels
• Insulin and insulin syringes, prefilled insulin pens, or extra insulin pump supplies if your child is using a pump
• A container for used lancets and needles, if needed, as the school may already have containers
• Ketone testing strips
• Supplies to treat low blood glucose such as glucose tablets, instant glucose, cake decorating gel, juice, a can of full-sugar soda, or a glucagon emergency kit if someone at the school knows how to give the shot
• Snacks to prevent or treat low blood glucose such as crackers with peanut butter or cheese, fruit roll-ups, dried fruit, and other snacks

Tape a set of instructions and your phone numbers to the box of snacks as well as to the glucose meter. Make sure that you replace supplies that get used.

Your child should wear a medical ID necklace or bracelet every day.

Should my child have blood glucose tests at school?

Your child's blood glucose levels may need to be checked before and after eating snacks and meals, with physical activity, or when there are symptoms of high or low blood glucose. Each time a blood test is done, the result, day, and time should be recorded on a record sheet or in a logbook.

It’s best if your child is allowed to do blood tests in the classroom. If your child is testing himself in the classroom, an adult may need to check the result. If your child must go to the school nurse for testing, another person should always go along. If your child's blood glucose is low, the low blood glucose may make him confused, and he may not make it to the office alone. If your child doesn’t wash his hands before the test, a trace of sugar on the finger can cause a high reading. Often children carry a meter in their backpack. A meter can also be stored in the nurse's office or with a teacher. A glucose meter should NOT be kept in your child's locker because it’s hard to reach in an emergency.

How does my child get insulin at school?

If your child needs to be given insulin at school, you and your child's healthcare provider must sign a school medication form. It must specifically say when the insulin is to be given and the dosage. If your child is not on an insulin pump, ask your healthcare provider about using insulin pens at school. They are very convenient, more accurate, and leave less room for error when drawing up the dose at school.

The school nurse or another trained person should always be able to give or supervise the shot. Your child may be able to give his own shot, but if your child is drawing up the insulin and giving himself the shot, it’s a good idea to have an adult check the amount. Or you may need to come in and give the injection.

Follow the DMMP. 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. Your child may need help remembering to take 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 need to check ketones at school if:

• Ketones were present earlier at home.
• The blood glucose level is higher than recommended by your child's healthcare provider.
• Your child is not feeling well.

You should be notified if a urine or blood ketone test is moderate or high. Your child will need extra insulin and need to be treated by adults who can provide constant supervision, usually at home.

What other arrangements should I make?

• 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 glucose under control. If your child's blood glucose is high, your child will have to drink more fluids. If your child has signs or symptoms of low blood glucose, 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 increase the chance that your child’s blood glucose will get too low. Ask the school to let you know about these events ahead of time, so that you can adjust your child's insulin dose. You may also want to give your child extra snacks to take along.
• Gym class: It’s very important for your child’s gym teacher or coach to have a copy of your child’s health plan. Low blood glucose may happen during exercise and a source of quick glucose should be close by. Your healthcare provider may want your child to have a snack before gym. Exercise is even more important for children with diabetes than for other children. Make sure that your child doesn’t miss gym or sports activities.
• Class parties: If the class is having a special snack, your child should also be given a snack. It’s best if you know about this ahead of time. Your child may be able to eat the same snack as the other students, or you may want to provide a different snack.
• Substitute teachers: Ask to have a copy of your child's School Health Plan put in the substitute teacher's folder and the attendance register. Attach a picture of your child to the School Health Plan so teachers will know which student has diabetes. The School 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.
• Staying late after school: If your child needs to stay after school for a longer time than usual, the teacher should give your child an extra snack at noon or in the afternoon. This is a common time of the day for the morning or afternoon insulin to peak. If your child doesn’t have a snack, he could have a low blood sugar reaction.
• Bathroom privileges: If your child's blood glucose is high, your child will have to drink more and urinate more often. It’s important for teachers to let your child use the bathroom as needed. Ask teachers to let you know if your child is going to the bathroom often over a period of several days. Your healthcare provider may need to adjust the insulin dose.

For resources to help teach school staff, see:

• The American Diabetes Association Training Resources
  http://www.diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-at-school/school-staff-trainings/training-resources.html