12. School and Diabetes
Diabetes management at preschool and school
Preparing for your child with diabetes to return back to school after diagnosis can be a very stressful experience for families.
Careful planning and open, regular and ongoing communication between parents and school staff will assist in making this transition back to school a positive experience for everybody involved.
School staff may not always have a clear understanding of what diabetes is or what the specific care requirements are to manage diabetes within the school environment. However with the help and support of you and the diabetes team, school staff will become skilled and confident in caring for your child at school.
Before returning to school
Prior to your child returning to school it is recommended that you organise a meeting with the key staff. Key staff may include any of the following:
nominated first aider
school nurse (if available)
head of year/ syndicate/dean
deputy principal or principal
Public Health Nurse.
SENCO (Special educational needs co-ordinators)
In some cases the diabetes nurse educator/ specialist may also attend to provide extra support with education.
Some important points to cover at this meeting include:
A description of what diabetes is, especially in relation to hypoglycaemia, hyperglycaemia and safety in sport.
Identify some key staff who will take overall responsibility of supporting your child with their diabetes management at school.
Identify times, location of testing and level of supervision required for blood glucose testing. Identify who will do/ supervise testing and ensure that these key people know how to do a blood glucose test. School staff needs to know how to test the blood glucose level even if the young person is competent in doing their own, so they can offer the correct support and help in the event of the child not being able to carry out their own testing due to sickness or injury.
Ensure staff know how to safely identify and treat a hypo (low). Discuss plan of where testing kit and supplies are kept. Where possible the testing kit and supplies should be kept with the child. Children with type 1 diabetes should never be left alone when having a hypoglycaemic episode. If supplies are to be kept in a central location that is positioned significantly far away from the classroom, hypo treatment and testing kit must be made available within the classroom. Children with diabetes must always be permitted to treat or prevent a hypo with appropriate glucose containing foods or drinks.
Identify if there is a need for insulin at school. If insulin is required at school discuss the location of where this will happen and the level of supervision required. Children with diabetes should never be sent to the bathrooms to inject insulin.
Discuss the need for your child to wear medic-alert identification at school.
Ensure that staff understand the potential for hypoglycaemia during or after sport and have a plan to prevent this.
Starship Child Health have developed a video that is aimed at schools, to increase their knowledge and understanding of diabetes. If you would like school staff to watch the video, you can share this with them via this link: (www.starship.org.nz/diabetes-for-schools)
School action/ management plan
All children/young people attending school should have a school action and management plan.
A school action and management plan is an agreed written plan between the family, diabetes team and the school outlining:
The specific care required for the child/young person with diabetes.
Details describing how this level of care will be achieved.
It should include information about how often testing needs to occur, where testing / insulin administration or hypo treatment should occur, and the level of supervision needed.
The key people who will have responsibility for supporting the child/young person with diabetes.
Describe the specific roles of the school staff and the family to ensure that the child receives the support they need at school.
The management plan should be reviewed annually or whenever a significant change to the treatment plan has occurred.
On the first day of school you need to make sure that you have supplied the school with everything they need to safely manage your child's diabetes at school. The location of where these supplies are kept should be clearly written in the school management plan.
The school will need the following supplies:
Blood glucose meter with finger pricker and strips
Ketone testing meter / urine ketone test strips (if on pump or if available)
Hypo kit - This includes items that would be used in the event of a 'hypo' or low blood sugar episode and clear instructions on how to administer. Items could include glucose tablets, juice drinks as well as carbohydrate snacks.
Glucagon hypo kit - in case of severe hypo. School staff will not administer but it is available for ambulance / family who arrive.
Spare insulin, sites, lines, tape (if required for injected insulin or pump therapy)
It is also useful to prepare a civil defence plan with spare supplies for use in the event of a civil defence emergency. Families should discuss this with their diabetes team.
It is helpful to have a plan in place that identifies who at school is responsible for making sure there are enough supplies and that parents are notified to replace any expired items.
You can read a transcript of this video here.
Continue to work with the school
Parents and teachers need to continue to work together to ensure the school environment remains safe.
A system to communicate what's going on at home (for example parents letting school staff know when the blood glucose levels are not stable) and at school (for example where the school let parents know that they are identifying trends in the blood glucose levels during school hours) should be set up.
This type of communication is useful to help keep both parties in the loop and identify issues that may need addressing.
Some ways of communicating may include:
Using a log book - to document blood glucose levels and physical activity that occurred each day with comments as necessary.
Using a communication book - parents note down any issues that may affect diabetes management at school and teachers can give a brief report on management each day.
Having regular meetings - this could be a brief chat when picking up the child or a more formalised meeting at set time periods (e.g. weekly).
Teachers may choose to email or text or phone parents as needed or agreed.
Diabetes shouldn't stop a child from being involved in all parts of school life; however there are some activities which require a little extra planning.
Special conditions for young people living with type 1 diabetes sitting NCEA or Cambridge examinations should be negotiated with the school at the beginning of each academic year. A 'specialist medical report' for each young person confirming special requirements must be submitted to NZQA by the school early each academic year.
Physical activity usually lowers the blood glucose level. The drop in blood glucose level can be immediate or as much as 12-24hrs later.
Extra testing and carbohydrate may be required before moderate or strenuous exercise.
The school management plan should include a plan for what is required during planned sport activities.
It is also helpful if the school is able to let you know in advance of planned sports or changes to school activities. See more information about management of exercise.
Day trips/ Overnight stays or camps
A key person who will have responsibility for the management of the child/young person's diabetes whilst on the trip or camp should be identified. This can be a parent or carer or a member of school staff.
Ensure that all supplies are available such as testing equipment, hypo treatment, extra food or snacks in case of delays, insulin or pump supplies as appropriate and emergency contact numbers. Always take extra hypo supplies.
Children attending camps or active trips require early and careful planning prior to camp. A separate camp plan should be discussed.
There is often a significant reduction in insulin required for camps or active trips. Your diabetes team can support you with any adjustments that need to be made.
Further resources and support
Starship service run School Seminars at Greenlane Clinical Centre to support non -medical school staff with the care required for children at preschool or school.
Public health nurse/ School nurse/ School councillor
The public health nurse/school nurse or school councillor can provide a great first point of contact for support of a child/ young person at school.
School nurses are generally only available in high schools however other valuable resource person at primary school is the Special educational needs co-ordinators (SENCO) who have overall responsibility for ensuring that children with special educational needs at school receive the support they need.
The Diabetes Nurses are available for further support as required
High Health funding
High health funding is provided by the Ministry of Education to assist with teacher aid time to support children with significant health conditions. Eligibility for the allocation of this type of funding is dependent on strict Ministry of Health criteria. Not all children with type 1 diabetes meet this criteria however some children who have other health needs e.g. autism may be eligible for funding. Please liaise with the diabetes team if you feel you child has high health needs (See http://www.education.govt.nz/school/student-support/special-education/school-high-health-needs-fund/for further information).
Ministry of Education
Links to the information on supporting students in schools with health conditions:
Let's go over the main points. Read this one page summary to make sure you have all the main points covered. Ready?
Think you've got it sorted now?
If you have read through the information above and feel confident that you understand this topic, print off and fill in the evaluation form below (you might need to ask someone to print this off for you) and return to the nurse on your ward. If you have any questions, note them down on this form and your diabetes nurse specialist will discuss them with you.
School and Diabetes: Evaluation
After reading this teaching module and watching the videos, I feel confident that I understand and can describe:
|The importance of liaising with the school.
|The key people who should be involved with establishing a care plan for my child at school.
|Understand what a school management plan is and how to make this plan.
|The supplies required to keep my child safe at school
|The importance of ongoing communication with the school
|Where to get further support