Diabetes at School

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Diabetes care is a 24-hour-a-day job -- and the time your child spends in school is no exception. Thorough education of and regular communication with her principal, teacher(s), school nurse, and other personnel are essential to helping your child stay in good control during the school day. The information included here is also useful if she spends time in a day care center or other after-school care. To learn more about care for your child with diabetes, read our Consensus Statement on Care of Children with Diabetes in the School and Day Care Setting.

It is essential to meet with personnel at your child's school and map out a plan for her diabetes care before she returns to school. Key school personnel should know of and be capable of meeting her diabetes needs from the first day your child returns to school. Also, keep in mind that the initial orientation of school officials will be just the start of ongoing communication to ensure your child's health and well-being at school.

Preparation for the First Meeting

It's a good idea for you and your child to work with a diabetes educator to create a school diabetes plan. You want to enter that first meeting with school officials with a concrete, written plan of action. You may end up making changes to the plan after talking with the school, but having a document to work with will keep you (and the meeting) on track. Your diabetes educator can recommend or supply you with pamphlets or information sheets on the basics of diabetes to give to school officials. You may also wish to ask the diabetes educator to accompany you to the school meeting.

Three Elements of a School Plan

Schools may have different names for the written document(s) that make up a plan for your child's diabetes care at school. Here are the three elements that should be included.

Information packet
You and your diabetes educator should put together a diabetes information packet. This packet may contain various brochures and articles with general information on diabetes. It should include information on what diabetes is and how it’s treated, what hypoglycemia and hyperglycemia are and how they're treated, and anything else that can give the school a better understanding of diabetes.

Diabetes Medical Management Plan (DMMP)
Your child's Diabetes Medical Management Plan should outline your child's diabetes treatment -- her target range, insulin schedule, eating plan, and usual blood glucose testing times. It should also include instructions on what to do in various situations (treatment for hypoglycemia, for example). This information may be included in the Diabetes Care Plan instead of as a separate document, depending on the procedures in your state or school.

Diabetes Care Plan
This plan is often called a "504 Plan" or "IEP" after terminology used in federal laws on disabilities. Your child's diabetes care plan should cover the responsibilities of you and the school in specific detail. It should also list any accommodations the school needs to make for your child.

Roles and Responsibilities

A key part of ensuring good diabetes care at school is a clear understanding of who will be responsible for each task. In general, you are responsible for providing all diabetes equipment and snacks. You also should take an active role in educating and training school personnel in diabetes care. Your diabetes educator or doctor can help you train key school personnel to perform the necessary diabetes tasks. Also, make sure that the school is able to reach you, your spouse, or other responsible adult quickly in case of emergency. Carrying a beeper or a cellular phone can give both you and school officials a little more peace of mind.

The school should be willing and able to do the following, as needed by your child.

• An adult and a back-up adult should be trained to test blood sugar, know what to do if the blood sugar is out of the target range, know when and how to test for ketones, and know what to do if your child’s ketone level is abnormal.
  

• An adult and a back-up adult should know how to recognize and treat hypoglycemia and hyperglycemia. If your child is mature enough to treat herself, she should be allowed to do so -- but she should remain under the supervision of an adult at all times during a hypoglycemic reaction and should not be required to walk alone to another part of the school to test blood glucose or get treatment.
  

• If your child needs an insulin injection(s) during school hours, an adult and back-up adult should be trained to give her insulin injections (and/or supervise her as she administers her own injection).
  

• An adult and back-up adult should be trained to give a glucagon injection.
  

• If you and/or your child desire it, the school should provide a location in which she can check her blood glucose or take insulin privately (but still with adult supervision, if needed).
  

• An adult and back-up adult should know your child’s meal plan and work with you to coordinate it with the schedule of the other children in the class, if possible. This person should also notify you whenever special events come up that would affect the meal plan.
  

• All adults who have responsibility for the immediate custodial supervision or care of your child at school should be trained to recognize hypoglycemia and hyperglycemia and know emergency procedures.
  

• Allow your child to see the school nurse or other school medical personnel whenever needed.
  

• Allow her to eat a snack anywhere and to use the restroom and drink water at any time.
  

• Allow her to miss school for doctor’s appointments to monitor diabetes without negative consequences.
  

• Provide a safe location for storage of insulin and glucagon, and allow your child immediate access to her diabetes supplies at any time.
  

• Ensure her full participation in all sports, extracurricular activities, and field trips, with any necessary supervision provided.
  

• Provide aids to help your child academically, if needed. Examples of situations in which this might be necessary include making up for class time missed due to diabetes care or academic problems that can be traced to frequent hypo- or hyperglycemia.

Your Child's Diabetes Care Plan

The main goal of the initial meeting(s) with school officials is to agree on a clear, detailed diabetes care plan for your child. It's a good idea to ask school officials to evaluate your child under Section 504 of the Rehabilitation Act of 1973 (Section 504 for short) or the Individuals with Disabilities Education Act (IDEA).  These laws give you and the school a procedure for evaluating your child's needs and agreeing on accommodations.

Begin discussing the diabetes care plan by going over the health care plan that you, your doctor, and your diabetes educator created. Answer any questions the school officials may have about diabetes and your child's care. If other students with diabetes attend or recently attended the school, you may find that school officials take her diabetes care in stride. If she is the first student with diabetes to attend the school, school officials will probably need more detailed explanations and training.

Using the health care plan, list all of the diabetes tasks to be performed at school. In addition, let the school officials know which tasks your child can perform without supervision, which ones need supervision, and which tasks must be done for her. (This will depend on her age and experience with diabetes.) Together with school officials, decide who at the school will be responsible for doing/supervising each diabetes task.

Then discuss any necessary accommodations. These accommodations will vary according to the needs of each child with diabetes.