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.