Type 1 Diabetes at School — A Practical Guide

Intro

Children with type 1 diabetes (T1D) can participate fully in school when staff understand the basics: monitoring glucose, treating lows fast, supporting meals/insulin, and knowing who to call.

Key Points

Every student should have a written Diabetes Care Plan (DCP) on file.
Staff must know how to recognize and treat hypos immediately.
Allow access to glucose checks, snacks, water, and toilets without delay.
Plan ahead for PE/sports, exams, and trips.

Diabetes Care Plan (DCP) — What to Include

Student details, parent/guardian contacts, clinician info.
Typical targets, CGM use, meter/strips location.
Insulin method: MDI (doses, timing) or pump (basal, bolus, temp basal).
Hypoglycaemia treatment protocol (15–20 g fast carbs; repeat after 15 min).
Severe hypo plan: glucagon (brand/dose), who can administer, when to call emergency services.
Hyperglycaemia and ketone guidance (when to test, correction doses, fluids).
Permissions: student self-managing vs. staff assistance.
Storage: snacks, spare supplies, backup pen/syringes, spare infusion sets/sensors.

Daily Routines at School

Before class: ensure supplies are on-site (meter/CGM reader, hypo kit, spare sensors/sets).
Meals/snacks: allow time for carb counting and bolusing.
Free access to water and restroom for highs.
Where to treat: student may treat in class or a nearby safe space—don’t send alone when hypo.

Recognising & Treating Lows

Symptoms: shakiness, sweats, pallor, irritability, difficulty concentrating, sudden fatigue.
Action: give 15–20 g fast carbs (glucose tabs/gel/juice). Recheck after 15 min.
If unconscious or unable to swallow: give glucagon (nasal or injectable) and call emergency services.

Highs & Ketones

If glucose >13.9 mmol/L (250 mg/dL) and unwell or pump issues suspected → check ketones.
Encourage water; follow the DCP for correction insulin and recheck timing.
For pump users with unexpected highs, inspect site/tubing; consider a pen/syringe correction per plan.

PE / Sports

Check glucose before activity; have fast carbs on hand.
For long/strenuous activity: consider temp basal reduction (pump) or extra carbs per DCP.
Watch for delayed lows after afternoon sports.

Exams & Tests

Allow meters/CGM/phones (in airplane/silent mode if required) and hypo treatment at desk.
If hypo/hyper occurs during an exam, pause and treat; offer extra time as per policy.

School Trips & Camps

Take two of everything: meters, strips, ketone strips, infusion sets/sensors, batteries/chargers, glucagon.
Share the DCP with trip leaders; identify the nearest medical facility.
Consider activity-related basal/bolus adjustments; bring plenty of snacks.

Communication & Training

Annual training for staff who work with the student.
Agree on signals for the student to leave class to treat; update substitutes.
Maintain a log of significant events (severe hypos, ketones, site failures).

Legal & Policy Basics

Students with T1D are typically entitled to reasonable accommodations to ensure equal access to education (varies by country). Keep the DCP on file and review annually.

FAQ

Can a student treat a low in class?
Yes—fast treatment where they are is safest. Do not send a hypoglycaemic student alone.

Who can give glucagon?
Staff trained per school policy/DCP. Nasal glucagon is simple to use.

Phones/CGMs in exams?
Allowed with accommodations—confirm with exam board/school policy and set to silent/airplane mode if needed.