Managing a Child's Diabetes at School

Children spend much of their day at school, so dependable diabetes care there matters, and going back to school takes a little more preparation. Some students can check their own blood sugar, inject insulin and adjust an insulin pump. Younger children and those recently diagnosed need help with everyday care.

Make a Diabetes Medical Management Plan

No two children manage diabetes in exactly the same way. Before the year starts, work with your child's health care team on a personal Diabetes Medical Management Plan (DMMP), then go over it with the school's staff. Everyone responsible for your child during the day and after school should know it. It covers:

• the target blood sugar range;
• whether your child needs help checking blood sugar;
• your child's own symptoms of low blood sugar (hypoglycemia), and how to treat it;
• insulin and any other medicines;
• meal and snack plans, including for special events;
• how to handle physical activity and sports.

Update the plan every year, or sooner if treatment changes.

Consider a 504 plan

A 504 plan, set up with the school, says what the school will do to keep your child safe and give them the same educational opportunities as other students. It makes the school's responsibilities clear and helps avoid misunderstandings. Set up a new one each school year.

Work with the school's staff

• School nurse. Usually the main person in charge of your child's diabetes care. One or more backup staff should also be trained, and someone trained should be on site all day, including during after-school activities; the 504 plan explains how.
• Teachers. Visit the classroom. Even teachers who have taught children with diabetes face a learning curve, because every student and every teacher is different. Agree the class rules: can your child leave the room without asking, or should they raise a hand? Ask whether the teacher could explain diabetes to the class, without singling your child out. Tell the teacher the signs of low blood sugar in your child, such as irritability, nervousness, hunger or dizziness; a teacher may notice them first and prompt your child to eat a snack or get help.
• Physical education. Children with diabetes need exercise like any others, and activity lowers blood sugar, which can mean using less insulin. Talk with the instructor about what your child needs to take part fully and safely.
• Cafeteria. Get menus and nutrition information from the school's nutrition services to help plan insulin. Some students bring lunch from home because it is easier to stick to their meal plan.
• After school. Know the daily schedule and any after-school activities, so you know where to find your child. Some parents use a free smartphone app to stay in touch.

Pack a daily checklist

A backpack checklist you or your child can use every day:

• blood sugar meter with spare batteries, test strips and lancets
• ketone testing supplies
• insulin and syringes or pens, even if your child uses a pump
• antiseptic wipes
• water
• glucose tablets or other fast-acting carbohydrates, such as juice or hard candy

Also make sure your child wears a medical ID necklace or bracelet every day, checks blood sugar on schedule, and knows where to go for a blood sugar check and whom to ask for help with low blood sugar.

Make a "hypo" box

For low blood sugar, leave a labelled box of supplies at the school office or nurse's office, and another in the classroom if you can. Keep it stocked with glucagon, test strips, lancets, a blood sugar monitor, glucose tablets, juice boxes and crackers.

Stay well all year

Make sure your child has had all recommended vaccinations, including the flu shot: children with diabetes can get sicker from flu and stay sick longer, and illness makes blood sugar harder to manage. Remind them to wash their hands often, especially before eating and after using the bathroom.

Sources

• Centers for Disease Control and Prevention, "Managing Diabetes at School." https://www.cdc.gov/diabetes/caring/managing-diabetes-at-school.html
• A stock photograph of children in a classroom is not reproduced here.