What is Type 1 Diabetes at School — A Practical Guide?

What schools need to know about T1D: care plans, hypo/hyper treatment, exams, sports, trips, and legal basics.

Diabetes

Type 1 Diabetes at School — A Practical Guide

2025-08-30 • Updated 2025-09-13

Intro

Children with type 1 diabetes (T1D) can thrive at school when staff understand a few essentials:

Monitoring glucose and supporting insulin/meal routines.
Treating lows fast without delay.
Knowing what to do for highs/ketones and when to escalate.
Having a clear, shared Diabetes Care Plan (DCP).

The goal is equal participation in learning, sports, and social activities while keeping the student safe.

Key Points

Every student with T1D needs a written DCP on file.
Never delay urgent treatment — treat hypos where the student is.
Staff must be trained to recognize and act on hypos/hypers immediately.
Allow free access to glucose checks, snacks, water, and toilets.
Plan ahead for PE, exams, and school trips.

Diabetes Care Plan (DCP) — What to Include

Student details, parent/guardian contacts, clinician info.
Target ranges, CGM use, meter/strips location.
Insulin regimen: MDI (doses/timing) or pump (basal/bolus/temp basal).
Hypo treatment protocol (15–20 g fast carbs, recheck in 15 min).
Severe hypo plan: glucagon (nasal/injectable), who can give, when to call emergency.
Hyperglycaemia/ketone protocol: when to test, correction doses, fluids.
Permissions: self-managing vs. staff-assisted.
Storage: snacks, spare supplies, backup pen/syringes, infusion sets/sensors.

Daily Routines at School

Supplies on-site: meter/CGM reader, hypo kit, spare sensors/sets.
Meals/snacks: allow time for carb counting and bolusing.
Free access to water and restrooms.
Where to treat: student may treat in class or nearby safe space —
⚠️ Do not send a hypoglycaemic student alone.

Recognising & Treating Lows

Symptoms: shakiness, sweats, pallor, irritability, fatigue, trouble concentrating.

Action:

Give 15–20 g fast carbs immediately (glucose tabs/gel/juice).
Recheck after 15 minutes.
If unconscious or unable to swallow: give glucagon and call emergency services.

Highs & Ketones

If glucose >13.9 mmol/L (250 mg/dL) and unwell or pump issue suspected → check ketones.
Encourage water; follow DCP for correction insulin.
Pump users: check site/tubing, give correction by pen/syringe if needed.

Red Flags — Call Emergency Services

Vomiting, abdominal pain, rapid or deep breathing.
Confusion, extreme drowsiness.

PE / Sports

Check glucose before activity; keep fast carbs on hand.
Strenuous/long activity: adjust basal/bolus or give extra carbs.
Watch for delayed lows (can occur hours later, even overnight).

Exams & Tests

Allow meters/CGM/phones (silent/airplane mode if needed) and hypo treatment at desk.
If hypo/hyper occurs, allow pause + treatment, then resume.
Schools should provide extra time if diabetes interrupts testing.

School Trips & Camps

Take double supplies (meters, strips, ketones, infusion sets, chargers, glucagon).
Share DCP with trip leaders; identify nearest medical facility.
Assign a named adult trained in T1D care for the trip.
Plan basal/bolus adjustments for activity; bring plenty of snacks.

Communication & Training

Annual training for staff in contact with the student.
Agree on signals for breaks/treatment; update substitute teachers.
Maintain a log of significant events (severe hypos, ketones, site failures).

Legal & Policy Basics

Students with T1D are entitled to reasonable accommodations (varies by country).
Examples:
- US: 504 Plan or IEP.
- UK: Individual Healthcare Plan under statutory guidance.
- AU: Disability Discrimination Act (DDA) obligations.
Parents should share the DCP and update annually.

FAQ

Can a student treat a low in class?
Yes — treating immediately on the spot is safest. Never send them away alone.

Who can give glucagon?
Staff trained per school policy. Nasal glucagon is often simpler to use.

Are CGMs/phones allowed in exams?
Yes, with accommodations. Must be silent/airplane mode if required.