Middle schoolers and high schoolers may be able to monitor and manage their blood glucose levels mostly on their own, especially if they’ve had diabetes for a long time, but younger children, in preschool, kindergarten, and elementary school, will need more help with their diabetes care. Here’s how to manage your child’s condition while they’re away at school.
How to Build Your Child’s School Diabetes Care Dream Team
The first step to keeping your child safe and healthy at school is to establish good communication with the school’s staff and your child’s medical team, says Kristina Cossen, MD, a pediatric endocrinologist at Children’s Healthcare of Atlanta. “Remember that you’re working in partnership as a team to take care of the child,” says Dr. Cossen. That partnership should include not only your child’s teachers but also other adults at school who may play a role in the care of your child, such as their school bus driver, coaches, school counselors, and cafeteria staff. For instance, a school bus driver may need to know what to do if your child becomes sick or has low blood sugar en route to school or home, says Cossen. “The adult should have basic information about what to do in that situation for that child, whether it’s checking blood sugar levels or treating low blood sugar,” says Cossen. Consider sharing this training resources guide from the American Diabetes Association (ADA), which provides information to school staff members about how to care for students with diabetes. Another way to foster good communication is to set up a visit with your child’s teacher and/or school before the first day of classes if possible. Some things you may want to discuss: How your child can manage their diabetes in class What can teachers do to help your child monitor their blood glucose levels, take insulin, or visit the nurse without disrupting the class or their schoolwork? Will your child be allowed to leave class if needed? Talk to your child’s teacher about where and how they can test your child’s glucose, suggests Anastasia Albanese-O’Neill, PhD, a clinical assistant professor and the director of diabetes education and clinic operations in the department of pediatrics at the University of Florida. She is also a member of the board of directors of the North Florida chapter of JDRF. Signs that your child needs help If your child is shy or feels uncomfortable talking to teachers, the school’s staff should be able to spot the symptoms of low blood sugar, including irritability, dizziness, nervousness, or hunger, advises the Centers for Disease Control and Prevention (CDC). And you can do your part by encouraging your child to see their teacher as someone who can be counted on to help out, says Albanese-O’Neill. What type of food is served in the cafeteria What types of food might be beneficial or problematic for your child? Can you see a few months of sample menus before your child goes to school, or should your child bring lunch from home? Find out what options may be available for your child. How the physical education teachers can help your child manage diabetes Exercise is important for health, and for children with type 1 diabetes, it can be especially beneficial, because it helps lower blood sugar and reduces the need for insulin, according to the CDC. But children with diabetes may need to check their blood sugar levels before and after exercise, and some may need an extra snack before doing any physical activity, to prevent hypoglycemia (low blood sugar). Talk with their teachers about precautions and ways to help your child participate safely in physical education classes. What the diabetes management plan will be during a lockdown drill Albanese-O’Neill suggests parents ask about what the plan might be during school-wide events like lockdown drills. “How will you connect a child with diabetes with their supplies in the event of a school-wide crisis of some sort?” Albanese-O’Neill suggests asking. “Even during a drill where kids end up evacuating the school, how are [they] going to connect that child with care?” How familiar the staff is with the latest diabetes management technology Many children today wear a continuous glucose monitor (CGM), which is a device that works through a tiny sensor inserted under the skin of the belly or arm and can test blood glucose every few minutes. This data can be sent to the school nurse and the teacher as well as you, says Albanese-O’Neill. Consider asking if the school nurse has been trained on your child’s device and how they can provide support to your child or monitor the data throughout the day. Ask, too, if your child will be able to charge their devices or smartphones as part of their care, such as using an app to manage their blood sugar.
Why You Need a School Medical Management Plan
Another important way parents and educators can work together to make sure they meet the child’s medical and educational needs is by developing a Diabetes Medical Management Plan (DMMP). This document, which is filled out by you and your child’s diabetes healthcare team, outlines specific instructions and facts, such as how much insulin the child takes, when the insulin should be administered, what types of technology they use, and more, says Albanese-O’Neill. According to the CDC’s National Diabetes Education Program (NDEP), it should include the following information:
Blood sugar target range and usual testing timesInsulin schedule, either by injection or insulin pumpList of diabetes suppliesMeal and snack planInformation on the student’s ability to perform self-careInstructions on what to do in case of low blood sugar (hypoglycemia) or high blood sugar (hyperglycemia)Emergency contact numbers
Parents should meet with administrators and teachers to go over the DMMP before the start of every school year and agree on how it will be implemented and what medical accommodations, educational aids, and services your child needs. “Get it out to school early, at minimum a week before school starts,” advises Albanese-O’Neill.
What to Know About the Law and Your Child’s Rights
The JDRF advises parents to create a formal legal plan to make sure your child’s educational rights are protected and medical needs are met. If your child attends a public school or a private school that receives federal dollars, you are entitled to set up a Section 504 plan. This plan is based on a 1973 civil rights law that protects disabled people from discrimination. Under the law, type 1 diabetes is a medical disability. Children attending schools that don’t take federal funds can set up similar plans under the Americans with Disabilities Act or the Individuals with Disabilities Education Act. The plan enacted for your child needs to address specific needs but will likely include these typical accommodations:
Identifying where and when blood testing and treatment will take placeNaming all people — school nurses, coaches, teachers — trained to help your child and treat high and low blood sugarProviding ready access to the bathroom and the water fountainEating whenever and wherever necessaryPermitting extra absences for sick days or doctor visitsAllowing test taking at a different time if your child is experiencing hypoglycemia or hyperglycemia at exam timeEnsuring full participation in sports, extracurricular activities, and field trips with trained diabetes care personnel on hand
Section 504 and similar plans can guard against a school saying things like “Ellie can’t go on the field trip unless her mom or dad comes, too,” says Albanese-O’Neill. It’s especially important to have the 504 plan in place in middle and high school so your student is guaranteed accommodations during standardized testing, including the SATs. Visit the American Diabetes Association’s website for more information on the 504 plan and the Americans with Disabilities Act. The organization also has information about state laws and other resources that can help protect students with diabetes, says Albanese-O’Neill. Some states provide kids with more protections or give helpful advice on how to provide diabetes care in schools.
Lessons Learned About Type 1 Diabetes and School: Advice from a Mom
Even if you write up a 504 plan, you may need to take additional steps to help your child manage their condition at school. That’s something that Natalie Stanback, of Dallas, learned firsthand when she sent her then 5-year-old daughter, Nadia, who has type 1 diabetes, to kindergarten. Stanback poured her energy into writing a comprehensive 504 plan that would “cover every aspect” of her daughter’s care at school. But after giving the plan to the school district, things changed. Nadia had to go to the school nurse each time she had to check her blood sugar or get treatment (which was sometimes a couple of Smarties candies), and she was ultimately leaving the classroom too much for Stanback’s liking. “It was an impediment to her education,” Stanback says. The next year, Stanback and her husband decided to send Nadia to a charter school. “It has been awesome,” says Stanback of the change. “The first-grade teacher wanted to know what we wanted from her. She had the 504 plan in front of her and asked us directly, ‘What can I do?’” says Stanback. The teacher even turned a desk into a testing station, complete with Nadia’s blood sugar monitors and candy and juice boxes, and moved it next to her own desk, says Stanback. Nadia has a CGM and an insulin pump, and Stanback and Nadia’s teacher can monitor her levels on a smart watch or smartphone. The teacher even knows when Nadia’s parents have struggled to get her levels in check at home during the evenings and weekends. Here are some of the lessons Stanback has learned. Acknowledge the anxiety, fear, and discomfort. Sending a child with type 1 diabetes to school can be a scary thing for parents as well as teachers and other staff. Recognize that these feelings and concerns exist as you work together to make a plan for your child. Build an alliance with your child’s teachers. Before school starts, try to meet the teachers face-to-face and share your story. “That is a big icebreaker,” says Stanback. Give them your cell phone number and maintain an open-door policy. “It will let them know that you are on their side,” says Stanback. Empower your child to take charge of their health. Build up your child’s sense of accountability, suggests Stanback. “One of the things we have done is encourage Nadia to take responsibility and not rely on us or her teachers for her own care,” says Stanback. “At the end of the day, my child being able to take care of herself is the goal.” Today, Nadia is a confident third grader who, having been diagnosed with type 1 diabetes at age 3, is an old hand at managing her condition. She is very in tune with her body and will raise her hand and tell her teacher she feels her blood sugar dropping, says Stanback. Her teacher then gives her permission to do what she needs to regulate her blood sugar. “She is a participant in her own care,” says Stanback.
