As you can imagine, each school will react differently to children that need extra attention. And children with diabetes do need extra attention, especially when they are very young. If your child is recently diagnosed and you are approaching your first school year with diabetes, here’s a list of things you should do before school starts:
Meet with the school principal and determine the school’s specific policies regarding children with diabetes and let them know you would like to prepare a 504 plan to assist them with the care of your child.
Find out at what time your child will be having lunch so you can plan your insulin accordingly. Some kids have lunch at 11:00 while others have lunch at 12:45. That can make a big difference on insulin and morning snack makeup.
Find out the name of your child’s teacher(s) and schedule appointments to see them before school starts. At that meeting, you should:
- Let the teacher(s), including gym, music, art teachers and the librarian, know your child has diabetes (this is especially important for gym teachers).
- Briefly describe what it means to have diabetes. Providing some background information to leave with the teacher is a good idea. Both ADA and JDRF have booklets and pamphlets to assist you. The ADA publication, Caring for Children with Diabetes (not free) covers the basics about diabetes and, at only 14 pages, is short enough to read in less than an hour.
- An extra note for gym teachers: Be clear your child must test before exercise and should not exercise with a blood sugar over 240 mg/dl, since such a high sugar can indicate insufficient insulin and, in this case, exercise can actually cause the blood sugar to rise.
- Explain that your child must eat mid-morning and mid-afternoon snacks, and what time you expect the snacks to be eaten. Regardless of the day’s activities, your child must be allowed to eat these snacks. That might mean bringing food to an assembly or field trip. This sometimes causes problems with other students. It might be necessary to explain to the other students why one child is allowed to “break the rules” about food in the classroom.
- Describe what happens when your child is hypoglycemic or might be having an insulin reaction. Since every child reacts differently, tell the teacher exactly what to look for and how to respond. You might want to provide a one-page instruction sheet.
- Give the teacher a supply of gluco tabs or crackers, graham crackers, peanut butter, granola bars or raisins to keep in her desk in case they are needed. An old lunch box or a plastic container clearly labeled with your child’s name works well as a container. In some schools, these supplies might need to be stored in the clinic.
- Be certain that if the teacher suspects that your child is having an insulin reaction that your child is not to be left alone.
Provide all materials and equipment necessary for diabetes care tasks, including blood glucose testing, insulin administration (if needed), and urine or blood ketone testing, or a glucagon kit. This includes blood glucose meter, testing strips, lancets, and extra batteries for the meter, insulin and syringes/pens, antiseptic wipes, for children who wear an insulin pump, backup insulin and syringes/pens in case of pump failure. These can be kept at school, or brought daily in a regular travel kit.
Parents are responsible for the maintenance of the blood glucose testing equipment and must provide a sharps box or the materials necessary to ensure proper disposal of medical waste.
In some states or school districts, use of insulin pens rather than syringes by unlicensed school health personnel is preferred. Pens often make it easier both for unlicensed staff and the young student to learn to give insulin. Pen needle removers and retractable pen needles alleviate concerns about accidental needle-sticks. Interactive tutorials are also available online for learning to use an insulin pen.
“Smart” insulin pumps make it easier and less intimidating for school health staff to assist a young student with insulin bolus administration. Dose calculations are done by the pump and can be verified by phone with the parent if desired. Insulin pump companies will also send certified pump trainers to schools to assist with staff training. Most also have web-based interactive tutorials, CD ROMs, and videos.
If your child is too young to track their numbers, provide a logbook to keep at school with the diabetes supplies for the staff. Set up a regular schedule for sharing the school blood glucose values.
Your child also needs to have quick sugar emergency supplies with them at all times, such as: Glucose tablets, Lifesavers, Sweet Tarts or a small tube cake icing (gel type). Check with the teacher or health aide weekly to see if items need to be replaced.
Provide an emergency number so your child’s teacher(s) and clinic nurse, if there is one, can send you a text with your child’s blood sugar value whenever it is out of the range that you feel is acceptable.
Written instructions are particularly important when your child has a substitute teacher. Make sure that your instructions are prominently posted in the classroom, preferably close to the teacher’s desk. You might even want to print it on bright yellow or pink paper so that it stands out.