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School is starting! If you are freaked out like I am, you are not alone.
Having a child with diabetes, going back to school, and managing diabetes in school means anxiety and maybe even a bit of a panic attack for us T1D parents.
I do not know about you mama, but I get extremely anxious that another person is going to be looking over my daughter for almost the entire day, and not having this control over her diabetes can be very scary.
From my experience, when Amanda started Preschool in the Fall of 2018, I had to train the school nurse and the teachers on how to manage her diabetes. Amanda was the first preschooler with diabetes, so this was a new thing for them.
Although this was a new thing for them, the school was very accommodating to our needs as parents, and the communications between us, was amazing.
Side note: I used to be a special education teacher, so I KNOW how hard it is to be a parent of a child with a disability. I used to see the concerns in parent’s eyes, and now that my own child has a condition, I totally get where they were coming from.
Let’s talk more about how to manage your child’s diabetes at school.
Tips for better blood sugar control while your child is in school.
1. First Visit to the School Nurse or School Personnel
Your nurse will be and has to be your BFF. You need to talk to the school personal, see the school setting, and figure out how is the care to students with type 1 diabetes.
When my daughter started going to Pre-K, I had to go to her school to speak to the nurse and teachers. I had to explain her medical condition, how her participation in school was going to be and how we manage her blood glucose levels at home.
This may come as a shock, but there are some nurses, that even though they have their degree in Science/Medicine, do NOT know how to manage Diabetes. Especially in little kiddos as my child was when she started Pre-K school at 4 years old. Amanda was the first preschooler that had Diabetes in her school, so a lot of training and consfults were done.
On your visit to the school nurse, you need to hand over your child’s supplies. These supplies NEED to stay in the school for the entire year. Your Endo team should always provide duplicate or more quantity of the supplies since one portion needs to be in your home and another goes to the school.
During the entire school, year, your child’s school will need the following:
- Insulin vial(s). Make sure that the nurse knows that these need to be stored in the fridge, and to NOT open one unless needed. If you want, you can have them consult with you before opening one.
- Syringes and/or pen needles. If your child uses a pump, in case of pump failure, you still need this as a backup.
- Glucose Meter. Have the Endo doctor prescribe another one for school.
- Test strips, lancets, lancing device, extra batteries and/or charging cords for the insulin pump. Make sure the test strips are not expired.
- Ketone strips or ketone meter (I LOVE the ketone meter best, it’s more accurate and current)
- Glucagon (be sure to check the expiration date)
- Supplies to treat lows (like glucose tabs, juice boxes, crackers, snacks)
- Continuous glucose monitoring supplies (extra sensors and other CGM supplies that you use. We used the Dexcom G6, and it’s only the sensory that we need)
- Insulin Pump Supplies (extra cartridges, and infusion sites)
- Alcohol wipes, and adhesive wipes
2. What To Do If There Is No School Nurse
I know, you might think this cannot happen, but yes, it can. If this is the case for your child’s school, you would need to either consider moving your child to another school or just have a designated person inside the school to manage their Diabetes.
Things that you can do:
- Meet with the school principal and stress about the importance of having a school nurse. Diabetes is a serious illness, and should not be taken lightly.
- Meet up with other T1D moms from other students in the school and talk to the School Department and/or School Principal about the importance of having a nurse in the school.
- If there is not going to be a school nurse, designate a person that will be managing your child’s Diabetes.
- Go into the school every month in order to make sure the diabetes supplies are well-stocked, especially snacks since they can run fast.
- For insulin storage, talk to the teacher and/or school principal about the proper storage of the insulin vials. If they do not have a safe place, then a backup plan is for you to get a small refrigerator, with the only intention that your child will use it to store the insulin, only. No other person or student is allowed to use if for their personal use.
3. Blood Sugar Checks In School
If your child checks their blood sugar by themselves, inquire if this can be done in the classroom, or do they need to head over to the nurse’s office.
Some kids do not mind checking in public, but others do. You know your child best, think of how you manage your child’s diabetes while out in public, like when in a mall or restaurant, and replicate those same strategies for school.
In our case, the nurse is constantly checking Amanda’s sugar levels, because she wears her Dexcom G6 CGM. The nurse has an iPad that follows Amanda’s iPhone, and the teacher has at all times Amanda’s iPhone and checks from her end as well.
These accommodations (i.e the iPad) were already in place when Amanda started Preschool. This was because a group of moms in my town advocated for this in the School Department because they wanted their children to be safe. So now, when Amanda starts school every year, every nurse that is going to be overseeing her blood sugars, they need to have the iPad (provided by the School Department) with them or in their office and follow the protocol established on her 504 Plan.
Keep open communications with all the school personnel that comes in contact with your child (i.e. nurse, teachers, principal, etc. ), you never know who you might need to contact and help you with your child.
4. What To Tell Other Students About Type 1 Diabetes
The younger your child is, the easier it will be. Little kids do not mind you telling other kids and teachers about their Diabetes.
If you wish to teach other children about Diabetes, you can get some stories, and have a day to read it to them or have the teacher read the story during storytime.
Some of the stories that you can read to the kids are:
If your child is older, things will get a bit harder. There are some kids/teenagers that are private about their Diabetes. Please tell them that the more people know about their condition the better. You never know what could happen in an emergency.
Have a meeting with your child, teachers and other school personnel that are going to be in charge of your child. Your child will not like it due to possible embarrassment, but it needs to be done. This is for their safety, you need to tell them that constantly. They should not be ashamed of their Diabetes, it’s a condition that could not have been prevented.
5. School Bus Ride in the School Year
If your child takes the school bus to and from school, the bus driver and bus monitor need to know about your child’s Diabetes. Most of the drivers and bus monitors are trained to deal with chronic illnesses, but they need to be aware of your child’s medical condition. This way they can have the awareness of any abnormal symptoms, like low blood sugar signs that your child may be exhibiting.
Talk to the school bus company and inquire about the bus route. For Amanda, there was an arrangement made that she needs to be almost the last student to be picked when heading over to the school in the morning, and one of the first ones to be dropped off when school is done.
See if a similar arrangement can be done for your child. If not, then you need to prepare your child for a long bus ride and have the bus driver and bus monitor very closely your child to make sure he/she is okay.
Talk directly to the bus driver and/or bus monitor, and make them realize that if your child needs to eat something, that this is going to be medically necessary due to your child experiencing a low.
Also, tell the bus driver that your child may be testing their sugars on the bus with a lancet device, but this will not be left on the bus, it’s only to confirm low blood sugar in order to treat accordingly.
6. Recess and Lunch in the School Year
We can often forget about recess and lunch aides. Make them part of the school team meeting, if possible. Make sure to voice that they should always have some fast-acting glucose tablets or snacks to treat low blood sugars. Your child should always feel comfortable going to them, especially if he/she feels low.
Lunch aides can assist in making sure that your child if independent in managing their Diabetes, that they bolus correctly for their meal. Lunch Aides are there to ensure kids are eating their foods and for your diabetic child, they need to make sure that they eat their food and bolus correctly for the food they ate.
If your child is going to be taking food from home, make sure to write down the carbs on the lunch box or baggies, so your child, nurse or person in charge of bolusing, can do so correctly.
If buying food from the cafeteria, try to see the menu and inquire with the school cafeteria about the carbs.
Make sure that every teacher and other school personnel know that your child is allowed to eat all foods. He/she is not prohibited from not eating anything, especially if there is a birthday party celebration.
Lastly, inform that taking food away is a big no-no, especially if your child has just been bolused. He/she needs that food in order to cover the insulin already dosed.
7. School Care Plan
On one of your child’s Endo visits, you need to inform the Endo team that your child will be starting school soon. If your child is of school age, they should already have an idea of the paperwork they need to submit to the schools.
The Endo team, parents, and the school staff (teachers, nurses, and other school personnel) need to prepare a written plan on the diabetes management plan.
The diabetes management plan specifies in a very detailed manner every little thing that the school personnel needs to do to manage their diabetes.
If it’s not written on the plan, the school will not be able to act. This is due to a legal issue and to prevent a lawsuit. You will and might get frustrated (I know I did), and common sense things/actions needed to be done, but since it was NOT written on the plan, the nurse could not act.
What is a 504 Plan?
Here is what I found from the American Diabetes Association (ADA) website:
The term “504 Plan” refers to a plan developed to meet the requirements of a federal law that prohibits discrimination against people with disabilities, Section 504 of the Rehabilitation Act of 1973 (commonly referred to as “Section 504”).
A 504 Plan sets out the actions the school will take to make sure the student with diabetes is medically safe, has the same access to education as other children, and is treated fairly. It is a tool that can be used to make sure that students, parents/guardians, and school staff understand their responsibilities and to minimize misunderstandings.
On the ADA website, I found some templates of 504 plans that you can use for the development of your child’s school plan.
Also note, that these are guidelines. You should always refer to your child’s school district and see how they do their own 504 plans, but if they have no idea how to do one, these are good starting places.
There is also the Children with Diabetes website, where parents submit their own redacted 504 plans, and they are categorized by grades, age, and if the child is on multiple injections or on a pump. They are free to download, with no email input.
Considerations to Have on your 504 Plan
Most of the things listed here have already been addressed above, but these need to be on the 504 Plan in order to make it formal and legal. If the Diabetes management that you want is not written on the 504 Plan, the school will be unable to act, since they are not legally protected. So make sure to revise the 504 Plan as many times as necessary during the year, and make sure that everything listed there is updated.
Make sure you have the following on your child’s 504 Plan:
1. Train school staff to treat the Diabetes
You with the school will identify the personnel that will be managing the Diabetes. This person needs to:
- know how to test blood sugar levels and interpret the results
- know how to measure and administer insulin, (either by syringe or insulin pump)
- know how to respond to hypoglycemia (low sugar) events, this includes the use of the Glucagon kit.
2. Location and time for testing
The school needs to provide an appropriate location for daily blood sugar testing (i.e. it can be in the nurse’s office or in the same classroom). For times, these can be in the morning at snack time, pre-lunch, before recess, after recess, etc.
3. Access to restrooms and water
Your child needs to be allowed unrestricted access to the restroom, water bottle and/or water fountain, snacks, and the nurse’s office when he/she is not feeling well. Your child can carry a bottle of water and extra snacks.
4. Insulin delivery
A nurse or a designated person will supervise daily glucose monitoring and administer insulin via injection or insulin pump.
If there is a substitute school personnel, who is not aware of how to administer insulin and read glucose readings, the school needs to call the parents to inform, so they can take the next action they feel most comfortable with.
5. Blood sugar testing
Having extreme highs and lows can have an effect on your child’s testing, therefore the following needs to be added to the 504 plan: blood sugar should be tested before important tests. Your child needs to eat his/her snacks regularly on their scheduled snack times even if he/she is during a test. If your child needs to manage their diabetes (correct their glucose and/or eat something) and it takes them 20 mins to do it, these 20 mins needs to be added at the end of the test as an extension.
6. Recognizing low blood sugars:
All school staff in charge of your child should have been trained on how to recognize these symptoms.
A designated person will accompany your child on any trips away from school when you as a parent is unable to attend.
8. Parental notifications
Parents need to be notified when food/snacks supplies need to be replenished when your child has abnormal readings, there are insulin pump problems when there is a significant schedule changed when the nurse is absent, and if the school is going on lockdown. School personnel needs to notify you as soon as possible.
9. Substitute Teacher/Substitute Nurse:
They need to be notified of your child’s diabetes. For the teacher, he/she needs to know who is the person in charge of managing your child’s diabetes. If on a test, the substitute teacher should be notified in the lesson plan of the testing schedule before the test.
10. Lunch Time
Your child can go to the front of the lunch line to get their lunch and/or milk so that he/she has time to get his/her food started before insulin is administered.
11. Going to the Nurse’s Office
Please inform to the teacher, school nurse, and other school personnel, to now allow your child to walk down the hallway with an extreme high and/or low blood sugars. Your child should ALWAYS be accompanied by an adult or a responsible student when going to the office/nurse’s office if he/she is not feeling well.
12. Emergency supplies
Your child needs to have emergency supplies and insulin pump bag (or meter/syringes/insulin), and these need to be listed on the student roster. This is to ensure that it accompanies your child during fire drills, field trips, and any time he/she leaves the school grounds.
13. Lockdown situations
Your child will have his/her blood sugar meter and snacks in an additional location that is accessible during school lockdowns.
Your child should use his/her blood ketone meter (or urine ketone strips) anytime that her blood sugar is over 300 mg/dL.
15. Physical Activity
Make sure that the school personnel take a look into your child’s CGM or do a finger poke before recess and even Physical Education class (PE). I know that Amanda, does tend to go low every time she does some type of strenuous of physical activities.
Concluding Managing Diabetes in School
Every year, you and your child will have new issues that may arise when managing their Diabetes. Always be clear and straightforward with your child’s school staff personnel, especially the nurse.
Make sure that all teachers, physical education teachers, coaches, music teacher, art teachers, and anyone your child is in contact with, to know and recognize the symptoms of low and high blood sugars.
The more people know and are trained in managing your child’s Diabetes, the better you will feel leaving your child in school, and the safer your child will be.
The school is your extended arm in assisting you and your family battling this chronic illness. Teach them about diabetes management, be an advocate, voice your concerns, and let them help you and your family in his journey.
If you think the school nurse needs more education on managing Type 1 Diabetes in children, you can refer them to the Sugar Surfing Training for Nurses website here. Dr. Ponder is a Pediatric Endocrinologist, who has Type 1 Diabetes himself, and he is AMAZING! He has a book called Sugar Surfing and it’s filled with knowledge.