Millions of children with T1D go to school every day without any serious problems…but there are a few vital bits of information you can share with your child’s school to help them through each day.
The following information is pulled together from my own personal experience when trying to get my son established in school for the first time. In our case, Noah was 4 years old which presented additional problems because any 4 year old is still fairly highly dependent on adults for a number of things, however a diabetic 4 year old has added dependencies. Furthermore, my experience is limited to the schooling system in The Netherlands where sadly we do not have trained medical staff on site like a School Nurse. This means that not all of the following could apply to your situation but I hope some of it helps.
Before your child starts his or her first day at school make at least one appointment with the following people (preferably all together to save you time and ensure everyone gets the same message and information from you):
1- Your child’s regular teacher(s)
2- The school nurse (if there is one)
3- The school coordinator
4- The Head Teacher
5- The designated backup teacher(s)
Feel free to print the following and give it to your school.
 What is Diabetes Type 1 (T1D)?
Diabetes Type 1 (T1D) is a life-threatening disease in which the body’s ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood. When there is too much insulin or too little glucose in the body there is a risk of a hypo. A hypo requires quick action to prevent immediate and potentially serious health problems. When there is too little insulin or too much glucose in the body there is a risk of a hyper. A hyper requires immediate attention to prevent long term health issues in the patient. Both a hypo and a hyper state in the body make the patient feel extremely horrible. See Cheat Sheet for symptoms here.
 Needles or Pump?
Someone with T1D is unable to make insulin and therefore it needs to be manually administered. There are two ways to do this:
- Using an insulin pen with a small needle at the top which needs changing after every use
- Using an insulin pump which pushes insulin into the blood stream through a cannula inserted into the body (this is done at home)
The insulin pump uses a mixture of the following techniques to provide insulin:
- Basal – this is a continuous, low dosage of insulin into the body to help regulate between meal times.
- Bolus – this is an additional boost of insulin before a meal.
A child who wears a pump might need to deactivate the pump before a gym or sport session.
 Measuring blood glucose levels
To measure the amount of glucose in blood (for example before a meal, or to check if there is too much/too little insulin in the body) a diabetic child (or their teacher if the child is too young) needs to test the blood. To do this a small drop of blood is taken using a finger prick pen. The drop of blood is then placed onto a small strip that has been inserted into a glucose monitor. If the child is using an insulin pump, the result of the blood test will be sent via Bluetooth to the pump automatically.
 What is a good blood glucose level?
Someone who isn’t diabetic will always be between 4.0 and 10.0. A diabetic on the other hand can easily go over or below this.
- Below 4.0 is a hypo
- Above 10.0 is hyper
Both require different actions to fix the glucose level in the blood and try to return it to normal.
 What affects glucose levels in blood?
LOTS of things affect the level of glucose in a diabetic’s body – not just food. Growth hormones which are of course common in children can affect the levels. Also feelings – pay additional attention to diabetic children when they are excited, scared, angry or stressed as their glucose levels will likely be affected by these strong emotions. Adrenalin also affects blood glucose levels so running in the playground, sport lessons, sport days etc. require extra attention too.
 Exchange information daily
When a child arrives in class the teacher and parent should always have a brief exchange of information. Has the child slept well? Are there any concerns about their general health? Have they eaten breakfast well? Likewise when the child goes home, the same kind of information needs to be shared. Did the child eat all their lunch? Was there a sport lesson that day? Are there any remarks to make about the (sometimes temperamental) pump functionality? Teachers and parents who exchange information and work as a team always have better results for the child’s health than those who don’t.
 If you are going to do it – do it RIGHT
Taking a finger prick blood test is incredibly quick and simple. The results of the test will determine the next step in caring for the child so it is also one of the most important parts to get RIGHT.
- ALWAYS wash hands before a test. A single drop of juice or a cookie crumb can give you hugely incorrect results, leading to incorrect treatment.
- BUT if for some reason it is not possible to wash the hands then wipe the first drop of blood away. The next drop of blood will be ‘cleaner’.
 A wise man takes care of his tools
Diabetics need to carry a lot of ‘tools’ every day and everywhere. Kids are prone to throwing school bags around in class or sitting on them in the playground. NOT A GOOD IDEA. Likewise, their ‘tools’ do not like extremely warm or cold conditions. During summer try to keep insulin in the fridge door (not the fridge itself where it is too cold) and in winter do not let insulin sit near the heaters.
 Failing to plan is a plan to fail
During your pre-meetings with the school it is a good idea to decide on important issues like:
- When will you organize training for them to learn how to take finger prick tests and administer insulin?
- How often will you meet to update them on the care of your child?
- Who is in the primary care team? I.e. which group of people have received all the information and training required to keep your child safe during school hours?
- Who is in the secondary care team? I.e. who will look after and teach your child when the usual teacher is sick? Are they fully trained? Do they need regular update training sessions?
- How will the school ensure every teacher knows how to spot when your child is having a hypo and who to contact for help?
- What are the protocols when extra treats are brought into class (like on a birthday)?
- Are there any times during school hours when your child might be unsupervised by a trained adult, and if so, how will this be handled?
- If there is a school emergency (fire etc.) does the primary care team know which diabetes equipment to take to the safety point with them and where to find it quickly?
 And finally….trust
Trust in the child, even if they are only 4 years old to communicate when something is wrong. Hypos and hypers make a child feel terrible and you will either see it or they will tell you how they feel. Listen carefully to the young children especially who still find it difficult to articulate feelings. Trust in your own instincts to be more observant in the class for a diabetic child – and if in any doubt always do a finger prick test.
And never, ever forget: