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Caring For Students with Diabetes

Children with diabetes often have type 1, or “insulin-dependent” diabetes, in which the pancreas doesn’t make insulin. They must administer insulin daily through multiple injections or an insulin pump. Children can also have type 2 diabetes. Though type 2 diabetes is usually found in older adults, it has been on the rise in children and adolescents. Children with type 2 diabetes are treated with diet and exercise, diabetes pills, and/or insulin.

Children with diabetes pose a challenge to a school. Diabetes requires lifelong dedication to self-care and relies heavily on family support. When children with diabetes are away from home, they will depend on school personnel or caregivers to provide emergency diabetes care. They will also rely on the school doctor, nurse, or other trained school members and caregivers to be available to perform some routine diabetes care tasks when they are unable. Schools have a responsibility to provide aids and related services to meet the needs of children with diabetes.

The American Diabetes Association’s “Safe at School” campaign has two basic goals:

  1. That all children with diabetes are medically safe at school; and
  2. That all children with diabetes have the same educational opportunities as their classmates.

How to achieve these goals? It is truly a team effort, and each member of the team (parent, school, child) has its own responsibilities:

Parents/guardian responsibilities

  1. As soon as a child with diabetes is enrolled, or an existing student is diagnosed with diabetes, the parents/guardian should immediately arrange a meeting with school personnel (principal, teachers, doctor, nurse) to discuss the child’s Diabetes Care Plan, duly written and signed by the child’s physician.

    The Diabetes Care Plan should include:

    • Date of diagnosis
      • Current health status
      • Emergency contact information
      • Student’s willingness and ability to perform self management tasks at school
      • When and how to check blood glucose and take insulin and/or diabetes pills
    • Insulin, glucagon, and other medications to be given at school
      • Details on meal and snack time plan
      • Exercise requirements
      • Usual symptoms of hypo- and hyperglycemia and treatment
      • When and how to notify the child’s parents of problems
      • When and how to contact the child’s doctor
      • When to call for emergency medical assistance
    • This written plan should be reviewed and updated each school year or as necessary.
  2. Parents should provide all materials, equipment, insulin, and other medication necessary for diabetes care tasks, including blood glucose monitoring, insulin administration, and urine or blood ketone monitoring. Parents are responsible for maintenance and cleaning of the blood glucose monitoring equipment, and must provide materials necessary to ensure proper disposal of materials. A logbook for monitoring may be helpful.
  3. Provide supplies to treat hypoglycemia, including a source of glucose and a glucagon emergency kit, if indicated.
  4. Provide information about diabetes and the performance of diabetes-related tasks.
  5. Provide emergency phone number.

School responsibilities

  1. It is the school’s responsibility to provide appropriate training of an adequate number of school staff on diabetes-related tasks and in the treatment of diabetes emergencies. This training should be provided by the school doctor or nurse or another qualified healthcare professional with expertise in diabetes. This may also be accessed through local hospitals, accredited diabetes centers, and diabetes-oriented organizations.
  2. Provide a school nurse or back-up trained personnel responsible for the student who will know the schedule of the student’s meals and snacks, and work with the parent/guardian closely.
  3. Provide school health personnel and back-up trained personnel who can check blood glucose and ketones and administer insulin, glucagon, and other medications.
  4. Provide immediate access to the treatment of hypoglycemia by a knowledgeable adult. The student should remain supervised until appropriate treatment has been administered, and the treatment should be available as close to where the student is as possible.
  5. Provide access to scheduled insulin. That is, the student should be allowed to carry and properly store insulin-related paraphernalia.
  6. Provide a location in the school that gives privacy during blood glucose monitoring and insulin administration, if so desired. The student should also have the permission to check his/her blood sugar inside the classroom or anywhere in the school, and give treatment accordingly.
  7. Permission for the student to eat a snack anywhere, including the classroom or the school bus, if necessary to prevent or treat hypoglycemia.
  8. Permission for the student to see the school nurse and other trained school personnel upon request, and to carry a cellular phone for fast access to his/her parent or doctor during emergencies.
  9. Permission for the student to use the restroom and have access to fluids (i.e., water) as necessary.
  10. Provide a plan for the disposal of sharps based upon an agreement with the student’s family, local regulations, and Universal Precaution Standards.
  11. Provide information on serving size and caloric, carbohydrate, and fat content of foods served in the school.

Student responsibilities
Children should be allowed to participate in their diabetes management, as appropriate, based on their age and experience. The extent to which the student should be allowed to do self-care tasks should be agreed upon by the parents, physician, and the school. This should be clearly written in their personal Diabetes Care Plan.

  1. Toddlers and preschool age. These children are usually unable to perform diabetes tasks independently and will need an adult to provide all aspects of diabetes care. Many of these younger children will have difficulty in recognizing hypoglycemia, so it is very important that school personnel are able to recognize and provide prompt treatment. However, children in this age range can usually determine which finger to prick, or may I choose an injection site.
  2. Elementary school age Depending on the length of diagnosis and level of maturity, these children may be able to perform their own finger pricks and blood glucose checks, but usually may still require supervision. Older elementary school–aged children are generally beginning to self-administer insulin with supervision and understand the effect of insulin, physical activity, and nutrition on blood glucose levels. He or she may usually be able to let an adult know when experiencing hypoglycemia.
  3. High school age. These children are usually able to provide self-care depending on the length of diagnosis and level of maturity but will always need help when experiencing severe hypoglycemia. Independence in older children should be encouraged.

The school life of a child with diabetes need not be unpleasant and can be smooth-sailing if only the whole team works together, and the key people in the team communicate regularly. This will help prevent problems and unnecessary distress, which can affect a child’s ability to reach his or her full potential. It is a child’s basic right to be reared in a healthy environment conducive to learning, and all efforts should be geared toward this one goal.

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