The demands of diabetes management may have an impact on school life; therefore, you should inform school personnel that your child has diabetes.
Inform your child’s school
To prevent potential problems, arrange a meeting with your child’s teachers and other school personnel at the beginning of the school year, or soon after diagnosis to discuss your child’s individual needs. Give them the appropriate information about your child’s diabetes.
General health care is the responsibility of the family, with the help of the diabetes team.
Teachers and other school personnel are not health-care professionals but they have a role to play in supporting students and ensuring their safety not only in the classroom but on the playground, on school trips, and during sports activities. Your child may be the first student with diabetes their teacher or school have ever encountered. Despite diabetes care being new to the school staff, it is the school’s responsibility to understand your child’s daily diabetes management and participate in their individual care plan.
What to tell to your child’s school
When a student with a disorder arrives in their classroom, teachers and school personnel should gain the necessary know-how to provide support. How much participation is expected from teachers will depend on the child’s age, stage of development and diabetes routines.
In case of diabetes, teachers should be able to do the following:
- Recognize the symptoms of "low blood glucose (sugar)" (hypoglycemia) and know how to prevent a mild hypoglycemic event from escalating to a more severe one
- Understand that exercise burns off sugar, creating an insulin imbalance in children with diabetes; during gym periods the child with diabetes on insulin may need a reminder to take a snack
- Be aware that meal plans are an important element of diabetes care:
- Children with diabetes who are on insulin have a hard time participating in surprise pizza parties or snacks. Teachers should inform caregivers of any such events so they can adjust the child’s meal plan and insulin dose accordingly
- Children with diabetes need between-meal snacks at regular times and should be allowed to carry snacks and eat according to their routine
- Familiarize themselves with unusual behaviour, such as urinating or drinking more frequently than normal
The Hospital for Sick Children has created a handout for you to bring to school for your child’s teacher. Together with the information you can provide, this resource will help your child’s teachers be a positive partner in their diabetes care.
Partner with the school to ensure your child’s safety
In general, teachers should not be expected or required to perform blood sugar checks, inject insulin or give glucagon. However, school personnel should understand enough about the procedures that they will allow the child privacy to do injections and blood sugar testing, and supply any necessary supervision.
The school should have a plan of action in place in case the child shows symptoms of hypoglycemia.
- If the child is conscious, give sugar to eat or juice to drink
- If the child is unconscious, call an ambulance
If the child vomits, the school should notify the caregivers or some other designated, responsible adult. If they are unavailable, the school staff must call an ambulance to quickly get the child to the nearest emergency room.
Diabetes and disclosure
Young people often worry about how to make this new reality fit into their lives. Plenty of questions arise: What do I tell my friends? How do I tell them? Will they treat me differently? Just as each family has different ways of coping with diabetes in general, children and teens have different styles of telling their friends.
With a little encouragement, most children will choose an open, matter-of-fact approach. Some make a presentation on diabetes to the class as part of “show-and-tell”. Others choose to share their experience and knowledge as part of a speech or science project. Most classmates are curious and admire a friend who is brave enough to endure daily injections and finger pricks. But not all children are comfortable with this approach. Some hesitate to discuss their diabetes with classmates they hardly know. Rather, they prefer to share the information only with school personnel and their closest friends, the ones they rely on for support. For safety’s sake, the families of the child’s friends should also be aware of the diabetes, the need for routines and the signs and symptoms of hypoglycemia.
What if your child does not want to tell anyone about diabetes?
Hiding diabetes is unsafe, may be psychologically unhealthy and may reflect denial or shame. A child who refuses to tell friends about their diabetes may have poor self-esteem and a lack of confidence. While respecting their child’s wish for privacy, parents may have to help their child share the diagnosis with close friends, key school personnel and other caregivers to ensure a safe environment.
The fear of teasing or shunning often prevents children from telling their friends. If teasing is an issue, children may need some special tips and support in handling the situation.
Your family, your child’s school and the diabetes team can support and help your child talk to friends and deal with their different reactions. You can speak to the friends’ parents and help your child feel more self-confident. The school can explain to classmates that diabetes is not contagious, and that the child with diabetes is no different from other children and can continue to enjoy the same games and activities as before.
The social worker or counsellor from the diabetes team is experienced in dealing with these coping issues, recognizing children’s varied backgrounds, personal experience, and family dynamics.
What should your child tell their classmates?
It is often difficult for children to know what and when to tell classmates. Other children may be scared too. Tell them that diabetes is not contagious or cannot be passed on.
If a younger child has type 1 diabetes, and people want more information, they can simply say, “My diabetes means that I do not have enough insulin, so I have to take insulin injections and make sure I eat healthy foods regularly.”
If offered sweets and treats, or foods outside the child’s meal plan, a child can learn to respond, “No thanks, I can only have extra treats when they are worked into my meal plan. Otherwise, they can be bad for my diabetes.” As the child, and their peers, gets older, it will be easier to explain about blood sugar regulation, insulin dosages, and the effects of exercise.
If your child has type 2 diabetes, the response will be similar: “My diabetes means my body does not know how to use insulin and I have to take medications (or inject insulin) and make sure I exercise on a regular basis, and eat healthy foods.”
Your child can involve their friends in their diabetes routines, if they want to learn and if your child is comfortable showing them.
Physical activity and field trips
Children with diabetes should be encouraged to participate in as many school activities as they choose and should not be excluded from school trips. You and your child just have to plan ahead.
If your child is participating in physical activities beyond those they do on a daily basis, pack extra food in their backpack or lunch box. Include a mix of fast-acting carbohydrate snacks (such as juice boxes or dried fruit) to stave off hypoglycemic events, and complex carbohydrate snacks (such as a slice of whole grain bread with peanut butter, carrots and hummus, or dried peas).
Careful preparation for overnight trips or special events will help prevent problems. If your child needs an insulin injection or blood test time, ensure that one of the teachers or chaperoning parents is taking responsibility for either performing or supervising the task.
Your child and accompanying adults should always have supplies on hand to treat symptoms of hypoglycemia, and even a glucagon kit for overnight or longer trips. A responsible adult should be taught how to use it. Teach your child to recognize symptoms of hypoglycemia before you allow them to go on overnight field trips. Before that, consider volunteering as a chaperone yourself.
What to pack on a field trip
On field trips of any type, the child with diabetes must have:
- a source of quick-fix concentrated carbohydrates (fast-acting sugar) to prevent and treat symptoms of hypoglycemia (example of fast-acting sugar are juice boxes and sugar tablets.)
- visible identification that indicates that the student has diabetes, such as a MedicAlert bracelet
- insulin, syringes and blood testing equipment, if the trip overlaps a testing or injection time
- an informed adult companion
- the phone number of caregivers or an alternate, well-informed responsible adult.
