Diabetes: What Schools Should Know

Diabetes is a disease in which the body is unable to utilize sugar effectively, resulting in high blood sugar levels. In order to maintain a normal blood sugar, the person must balance food intake, exercise and insulin.

• Food raises blood sugar
• Exercise and insulin lower blood sugar

This balance may be difficult to maintain, so it is important to know how to recognize when a child needs help. Please share this information with all teachers, school nurses, principals, lunchroom personnel, playground and hall supervisors, and bus drivers who will be in contact with a student with diabetes.

Low Blood Sugar (Insulin Reaction or Hypoglycemia) is caused by:

• Too much insulin
• Not enough food or delayed meal or snack
• Strenuous activity such as gym class

Symptoms:

• Paleness
• Excessive perspiration
• Lack of coordination
• Hunger
• Irritability
• Shaking
• Headache
• Abnormal behavior
• Drowsiness
• Inability to concentrate
• Confusion
• Dizziness

Treatment:

1. Give a fast-acting source of sugar**. Any one of the following is appropriate:

a. 4 oz. of any type fruit juice or regular soda

b. 2 - 4 glucose tablets or glucose gel (available from pharmacist)

c. 4 sugar cubes

** If the child is unconscious, do not give anything by mouth. An injection of glucagon will need to be given. Call parents and emergency personnel immediately. A child who is feeling low should not be sent unaccompanied to seek treatment.

Insist the student take one of the above if a low blood sugar is suspected. A sugar source should be stored in the classroom (i.e. teacher’s desk) for students too young to carry their own. Speak to the parents about how they would like low blood sugars to be treated.

2. Symptoms should improve in 10 to15 minutes. Check the child’s glucose level in 15 minutes to ensure it has improved. If there is little or no improvement, repeat the treatment. This may need to be done several times if the child is not improving sufficiently. If there is no improvement after that, contact the school nurse, parents and/or emergency personnel.

3. Follow this treatment with a snack or meal if it is time for that and let the student resume normal activity. 

Glucagon Emergency Injection (Glucagon SQ):

A glucagon emergency kit should be available at the school. This is an injection that would need to be given by an adult if the student is unable to take glucose by mouth. Options for giving this injection include:

• Designate one or two people at the school to be trained to give this injection.
• A parent is to be called to give the injection.
• Emergency medical service should be called to come and give the injection or to talk a designated individual through the process.

The best option can only be decided by the individual school in coordination with the parent.

High Blood Sugar (Ketoacidosis)

If the student is not physically showing signs of illness (vomiting, abdominal pain, difficulty breathing), a high blood sugar requires no immediate action by school personnel. High blood sugar readings should be reported to the parent for appropriate follow up or insulin adjustment as needed.

Picture 1 - If a child’s blood sugar is high, he should check his urine for ketones.

The child does not need to be taken out of school if the blood sugar is high unless he or she is showing signs of illness. Ketoacidosis does not occur suddenly. If the student has a high blood sugar and is vomiting or is physically ill, the parent should be contacted immediately for appropriate follow up.

If the student’s blood sugar is ____ (a value to be set up by the child’s endocrinologist), the student should check his or her urine for ketones with ketone test strips (Picture 1). If ketones are present, the child will need to drink plenty of clear fluids, preferably water, and recheck the ketones in about one hour. If ketones are gone, no further action is required. If they are still present, continue to give water and contact the parent immediately. If ketones are present, the child should not participate in physical activity such as gym until the ketones are gone. It should be noted on the child’s log that ketones were checked and whether they were present or absent.

Blood Sugar Testing

Students with diabetes need to test their blood sugar before meals, such as lunch, as well as periodically throughout the day if they are having symptoms of high or low blood sugar. This may be done in the classroom or other place deemed appropriate by the school and parent, and should not take more than a few minutes. A log of these checks should be kept so parents can review how the child is doing at school.

Diet

The diet for people with diabetes is a well-balanced, nutritious diet, with a consistent amount of carbohydrates at each meal or snack. Meals and regularly scheduled snacks need to be eaten at a consistent time daily to prevent insulin reactions.  

Young students may need supervision at meal and snack time as determined by the parent and teacher. Ask the parent about appropriate snack options. Good snacks include:

• ½ sandwich
• Crackers and cheese or peanut butter
• Milk and graham crackers

Students with Lunchtime Injection

Students who get a lunchtime insulin injection should check their blood sugar before they get their insulin. If the blood glucose is <70 mg/dl, treat the low blood sugar as directed by the parents. Once the blood sugar is over 70 mg/dl, give the injection as usual and send the child to lunch right away.

Important Considerations for Students with Diabetes

• Observe the child carefully in class, particularly before lunch and scheduled snacks, and after physical education and strenuous activity, when they could be low.
• Teachers and school nurses, as well as the student, should carry a source of glucose with them at all times.
• Encourage the student to participate in all activities.
• A student with high blood sugars may need additional bathroom privileges and access to water.
• If the student is willing, encourage him or her to share information about life with diabetes with other students.
• Any questions that the school has should be directed toward the parent.

Remember: The best school plan can only be carried out through communication between the child’s parent and the school administration. This communication must be ongoing to ensure the best possible care for the diabetic child. The school nurse should also notify the child’s physician and health care team of any concerns regarding consistent abnormal blood sugars, non-compliance and lack of parental concern.

School Health Care Plan

Date___________________________

For___________________________________________

(Student’s name)

Grade_________________________

Parents:

Name

Daytime Phone ________________ Evenings______________

Name

Daytime Phone________________ Evenings______________

Emergency numbers: 

Physician (Name)_____________________________________Phone:_________________

Other (Name)_______________________________________ Phone:_________________

Medications:______________________________________________________

School Instructions:

Snacks

• Please allow my child snacks at the following times____________________________
• Please supervise my child at snack/lunch-time, i.e._____________________________
• My child does not require supervision at snack/lunch-time.

Blood Sugar Checks

• Please allow my child to check his/her blood sugar at the following times:
  • Before snack(s)
  • Before lunch
  • Whenever my child feels low/has symptoms of low blood sugar
• Other______________________________________________
• Please supervise my child during blood sugar checks.
• Please assist my child in doing his or her blood glucose check, i.e.__________________________________________________________
• Please record my child’s blood sugar results and send the results home with my child every day.
• Other______________________________________________________________
• Blood sugar testing supplies are kept _____________________________________
• Emergency food is kept_________________________________________________

Insulin Injections

• My child receives an insulin injection before lunch each day (see medications above).
• Please supervise my child while he/she is drawing-up and giving the injection. Be sure to double check the dose.
• Please draw-up my child’s injection and allow my child to give it with supervision.
• Please draw up and inject my child’s pre-lunch insulin.
• Other_________________________________________________

High Blood Sugar Levels (Over__________)

It is possible for my child’s blood sugar to be high. Please follow the guidelines checked below for high blood sugar readings while at school.

• Check urine for ketones if over_______________________________________________.
• Ketone test strips are kept_________________________________________________
• Please call __________________________________ if ketones are__________________
• Please call________________________if my child’s blood sugar is above______________
• Have my child drink____________________________. Recheck ketones in___________
• Other____________________________________________________

Hypoglycemia (Blood Sugar Under__________)

It is possible for my child’s blood sugar to get too low. Low blood sugar must be treated immediately.

Symptoms of Hypoglycemia (Low blood sugar)

MILD – Shaky or lightheaded, nervous or irritable, confused, rapid heart rate, numbness or tingling in lips, hungry.

MODERATE  – (Students in this range usually need help with treatment.) Sleepy, headache, blurry vision, nausea, weakness, poor coordination, slow thinking

SEVERE  – Unresponsive, seizures, unconsciousness, lethargy, mental stupor

Treatment of Hypoglycemia

1. If my child is alert and able to swallow, treat immediately with one of the following:

• 4 oz. fruit juice (Use regular pop only if juice or other treatment is unavailable)
• Glucose gel – Give the equivalent of 15 grams carbohydrate.
• Glucotabs – Give the equivalent of 15 grams carbohydrate (usually 2 – 4 tablets)

2. Recheck the blood glucose in 10 – 15 minutes.  If still low, repeat procedure as above.

3. After the blood sugar has returned to __________, initial treatment should be followed by the scheduled snack or lunch (if it is lunch or snack time).  If it is not within 1 hour of lunch or snack, treatment should be followed by an additional snack such as ½ sandwich or a glass of milk.

For severe hypoglycemia (seizures, unconsciousness), call the emergency squad (911) and___________________________________

Glucagon SQ can be given for immediate treatment by parent, RN or medic as instructed.

Other_________________________________________

Other Considerations

Please call_______________________________________prior to class parties for food approval or substitution.

Please allow my child additional bathroom privileges as needed.

Please supervise my child_________________________________________

Other_________________________________________________________

Other__________________________________________________________

Date:_________ Parent:____________________________________________

Parent:________________________________________________

Date:_________ School representative:_______________________________

Date:_________

Other:___________________________________________

Diabetes: What Schools Should Know (PDF)

HH-I-260 2/08 Copyright 2008, Nationwide Children's Hospital