Managing Diabetes at School Playbook

Goodbye, summer. Hello, homework. And guess what—the first assignment isn’t for kids. Parents, make a game plan to ensure all the bases are covered for your child’s diabetes care at school.

Getting back into the routine of school takes a little more preparation for kids with diabetes, but it pays off over and over as the weeks and months go by. And since kids spend nearly half their waking hours in school, reliable diabetes care during the school day really matters.

Some older students will be comfortable testing their blood sugar, injecting insulin, and adjusting levels if they use an insulin pump. Younger students and those who just found out they have diabetes will need help with everyday diabetes care.

In a perfect world, all teachers and other school staff would understand how to manage diabetes so they could support your child as needed. But here in the real world, you’ll want to provide information to the school and work with staff to keep your son or daughter safe and healthy, no matter what the school day brings.

Put it in Writing

No two kids handle their diabetes exactly the same way. Before the year begins, meet with your child’s health care team to develop a personalized Diabetes Medical Management Plan (DMMP). Then visit the school and review the DMMP with the principal, office secretary, school nurse, nutrition service manager, teachers, and other staff who may have responsibility for your son or daughter during the day and after school.

The DMMP explains everything about diabetes management and treatment, including:

• Target blood sugar range and whether your child needs help checking his or her blood sugar
• Your child’s specific hypoglycemia (low blood sugar, or “low”) symptoms (see the list on this page) and how to treat hypoglycemia
• Insulin or other medication used
• Meal and snack plans, including for special events
• How to manage physical activity/sports

The DMMP works with your child’s daily needs and routine. Make sure to update it every year or more often if treatment changes.

You may want to work with the school to set up a 504 plan that explains what the school will do to make sure your son or daughter is safe and has the same education opportunities as other students. The 504 plan makes the school’s responsibilities clear and helps avoid misunderstandings. A new plan should be set up each school year.

Making the Team

Team up with school staff to make sure all the bases are covered for a safe and successful year.

The school nurse is usually the main staff member in charge of your student’s diabetes care, but may not always be available when needed. One or more backup school employees should be trained in diabetes care tasks and should be on site at all times during the day, including after-school activities. The 504 plan explains how this works.

Make sure to visit the classroom(s). Some teachers may have had kids with diabetes in class before, but there’s still a learning curve because every student is unique—and so is every teacher.

This is a great time to talk about class rules. Are students allowed to leave the room without asking? Should they raise their hand? The more your child and teacher understand each other’s needs, the less disruptive and awkward self-care activities will be. You may want to ask if the teacher could talk to the class about diabetes—what it is and isn’t, what happens, and what needs to be done every day—without pointing out that your child has diabetes.

Also let the teacher know specific signs to look for if your son or daughter’s blood sugar is too low. Does he or she get irritable or nervous? Hungry or dizzy? The teacher may notice the signs before your child does and can alert him or her to eat an appropriate snack or get help.

Check in with nutrition services (school cafeteria) to get menus and nutritional information to help your child plan insulin use. Some students bring lunch from home because it’s easier to stick to their meal plan.

Kids with diabetes need to be physically active just like other kids. In fact, physical activity can help them use less insulin because it lowers blood sugar. Talk with the physical education instructor about what your  kid needs to participate fully and safely.

And as the school year gets into full swing, get familiar with the daily school schedule, including any after-school activities. You’ll want to know where and when you can find your child if needed. Some parents use a smartphone app (several free ones are available) to help them stay informed and in touch with their child.

The First Day and Beyond

• Create a backpack checklist you and/or your child can use every day to be sure all necessary supplies are packed:
  • Blood sugar meter and extra batteries, testing strips, lancets
  • Ketone testing supplies
  • Insulin and syringes/pens (include for backup even if an insulin pump is used)
  • Antiseptic wipes
  • Water
  • Glucose tablets or other fast-acting carbs like fruit juice or hard candy (about 10 to 15 grams) that will raise blood sugar levels quickly
• Put together a “hypo” box (see sidebar) with your child’s name on it for the school office in case of hypoglycemia.

Also make sure your child:

• Wears a medical ID necklace or bracelet every day. Many options are available.
• Tests blood sugar according to schedule; older students can set phone reminders.
• Knows where and when to go for blood sugar testing if help is needed.
• Knows who to go to for help with hypoglycemia.

Important: Treating Hypoglycemia

Hypoglycemia can happen quickly and needs to be treated immediately. It’s most often caused by too much insulin, waiting too long for a meal or snack, not eating enough, or getting extra physical activity. Hypoglycemia symptoms vary, so school staff should be familiar with your child’s specific symptoms (see the DMMP), which could include:

• Shakiness
• Nervousness or anxiety
• Sweating, chills, or clamminess
• Irritability or impatience
• Dizziness and difficulty concentrating
• Hunger or nausea
• Blurred vision
• Weakness or fatigue
• Anger, stubbornness, or sadness

If your child has hypoglycemia several times a week, visit his or her health care provider to see if the treatment plan needs to be adjusted. 

Staying Well Basics

• Make sure your child has had all recommended shots, including the flu shot. Kids with diabetes can get sicker from the flu and stay sick longer. Being sick can make blood sugar monitoring harder.
• Regular hand washing, especially before eating and after using the bathroom, is one of the best ways to avoid getting sick and spreading germs to others.