A Guide to Diabetes Management In the school setting

What is diabetes?

Diabetes mellitus (DM) is a complex, multi-system disease affecting the metabolism of fats, proteins and carbohydrates caused by an insufficient production of insulin by the pancreas or by the body’s inability to use and secrete insulin. There are two main types of diabetes: Type 1 and Type 2. With Type 1 diabetes, the pancreas does not produce insulin. It is the most common type of diabetes afflicting school-age children and requires careful monitoring and treatment with insulin. With Type 2 diabetes, the body becomes resistant to the insulin produced by the body and is most often treated with oral medications. Type 2 diabetes has increased dramatically in children and can be associated with obesity.

Do students with diabetes take medications for this condition?

Yes. Most children with a diagnosis of diabetes are insulin-dependent. The student may have to visit the school nurse at scheduled times for blood testing for glucose levels and/or may require insulin injections. The student may require testing of his/her urine for ketones. Some students receive their insulin requirements with an insulin pump that automatically injects calculated amounts of

insulin throughout the school day.

What are the common symptoms observed in a student with diabetes?

The most common symptoms seen in a student diagnosed with diabetes will be associated with hypoglycemia (low blood sugar). This can happen if the student takes his/her insulin and then has an insufficient or delayed meal or increased periods of exercise.

• hunger  
• personality change, irritability, crying
• lethargy, sleepiness, light-headedness
• headache, pale
• shakiness
• inability to follow directions
• fast heart beat, rapid breathing
• cold, clammy skin, profuse sweating
• unconsciousness, convulsions

What should I do if I notice symptoms of hypoglycemia?

The nurse must evaluate the student immediately. Depending on the student’s Individual Health Plan (IHP), blood sugar level, and level of consciousness, the student may be able to be treated at school. If the student needs to go to the clinic, make sure he/she goes with a responsible buddy/adult. Do not send a symptomatic student to the clinic unescorted. This situation can rapidly become a medical emergency and it may be necessary to implement emergency procedures.

What other symptoms may be observed?

Diabetic students can also develop symptoms of hyperglycemia (high blood sugar). This can occur when the body gets too little insulin, too much food, too little exercise or may be caused by stress or an illness.

• Excessive thirst
• Blurry vision
• Frequent urination/trips to the restroom
• Nausea/VomitingFast heart rate, rapid breathing

Hyperglycemia generally requires treatment and the Individualized Health Care Plan (IHP) should be followed.

• Maintain confidentiality.
• Treat students with diabetes as normal as possible, but keep in mind their dietary needs and special accomodations.
• Stay in regular contact with your school nurse and the student’s parent regarding the student’s status and become knowledgeable and familiar with a diabetic student’s Individualized Health Plan (IHP), meal plan and emergency protocol.
• It may be necessary for a student with diabetes to eat a snack in your classroom to maintain adequate blood sugar levels.
• Students with diabetes should have access to water and unlimited bathroom privileges.
• Include information about the student’s special accommodations in your sub folder and make sure that the folder is easily accessible for subs.
• Encourage the student with diabetes to participate fully in physical activities, unless the student is symptomatic.
• Please inform the school nurse at least two weeks in advance of any field trips.
• Familiarize yourself with the trained unlicensed diabetes care assistant(s) on your campus. The school nurse or principal will be able to provide this information to you.
• Encourage independence and diabetes management at home, as well as at school. 

Remember, it is the responsibility of the teacher, student, and nurse to ensure that the student receives the proper care at school during the school day.