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Information for Teachers and Childcare Providers

Teachers and childcare providers are likely to have a child with type 1 diabetes in their care at some point in their career. This page provides basic information about diabetes, offer suggestions for how to care for children with diabetes, and refers you to other sources of information.

What is type 1 diabetes?

Type 1 diabetes, previously called juvenile diabetes or insulin-dependent diabetes, is an autoimmune disease in which the body destroys insulin-producing beta cells in the pancreas. Insulin is required by the body to use glucose, the simple sugar into which foods are broken down by our digestive system. Without insulin, the body starves to death. It’s important to note that everyone is insulin-dependent. People without diabetes make insulin in their pancreas. People with type 1 diabetes must inject insulin.

Implications for School
Diabetes is not contagious. And though there is no cure, diabetes can be managed with insulin injections, blood sugar monitoring, proper diet and exercise.

High and Low Blood Sugars

Children with diabetes face two specific problems that teachers need to understand: hypoglycemia and hyperglycemia. Knowing the specific signs and symptoms of hypoglycemia and hyperglycemia and how to treat each situation helps to protect your student with diabetes.

Hypoglycemia, or low blood sugar, occurs when the blood sugar level is too low, due to too much insulin, too little food, or too much exercise. Children with low blood sugar sometimes behave erratically or act sleepy, and are often very hungry and shaky. Low blood sugar must be treated immediately by giving the child foods with simple sugars, such as glucose tablets, fruit juice or regular (NOT diet) soda. If you suspect that a child has low blood sugar, do not leave the child unattended because the child can lose consciousness. Never send a child who you suspect has a low blood sugar to the nurse or clinic alone.

Hyperglycemia, or high blood sugar, occurs when the blood sugar level is too high, due to too little insulin or too much food. Children with high blood sugar sometimes act lethargic and sleepy, and are often very thirsty and need to go to the bathroom a lot. High blood sugar is treated by giving additional insulin and sugar-free drinks, such as water or diet (NOT regular) soda. Children with diabetes must be given free access to water and the bathroom whenever they feel the need. Prolonged hyperglycemia due to insufficient insulin can lead to a very serious condition called diabetic ketoacidosis, which can lead to coma and death.

Implications for School
Some teachers think that kids with diabetes sometimes pretend to feel low or high to get out of the classroom, or to get out of an activity that they do not like. This is very unlikely. Most kids with diabetes don’t want to be different, and they don’t want their diabetes to cause them to be treated differently. If you think this is a problem, speak with the child’s parents, but do not deny the child’s request for water or a blood sugar test.

How is Diabetes Treated?

Children with type 1 diabetes are treated with insulin taken via injections or using an insulin pump, blood sugar monitoring, a carefully managed diet and exercise. Frequent blood glucose tests help determine the correct amount of insulin to take and help identify low and high blood sugars. Children must be allowed to test their blood sugar at school. Testing in the classroom is preferred by many parents, since it minimizes time away from the classroom. Other parents prefer testing in a clinic. Children should be permitted to check their blood sugar whenever and wherever they want.

Insulin Injections

Insulin must be injected because it is broken down by the digestive system and is rendered ineffective. There have been experiments with insulin nasal sprays and eye drops, but the results have not been encouraging. Insulin syringes have thinner and smaller needles than most people realize and the injections are not as uncomfortable as vaccinations. Many kids now use an insulin pump, which uses a small, thin catheter placed under the skin to deliver insulin.Most children with type 1 diabetes take insulin several times a day. Very few kids take two shots, one before breakfast and one before dinner. They use two different kinds of insulin: one short acting and one long acting. Most kids who use injections take three or more injections per day, with one shot of short acting insulin taken before each meal, and long acting taken with the pre-breakfast and pre-dinner shots.

Many kids with diabetes use an insulin pump instead of taking injections. An insulin pump is about the size of a pager. Kids can wear it on their belt or carry it in their pocket. A thin tube connects the pump to a small cannula (thin tube) inserted under the skin that delivers insulin continuously. Kids who use an insulin pump give extra insulin to cover each meal that they eat.

Pen injectors make it easy for kids to do their own injections, either in the classroom or in the clinic. Injecting through clothing is perfectly safe. Bathrooms are not a good place to do injections because they are often not very clean.

Implications for School
Kids who inject insulin before lunch might need a little extra time to accommodate their injection. Kids who use an insulin pump will take insulin as needed to cover food.

Blood Sugar Monitoring

Children with diabetes check their blood sugar many times per day. A blood sugar check involves pricking a finger with a lancet and placing a drop of blood on a special test strip. A blood sugar meter analyzes the test strip and reports the blood sugar level, usually in less than one minute. This process is called blood sugar testing, blood sugar checking or blood sugar monitoring. They all mean the same thing. Some children with diabetes are required to do blood sugar checks during the school day. Many do a blood sugar check before lunch. Doing a blood sugar check is simple enough that most grade school children can be taught how to do it themselves. Younger kids might need some adult supervision.

There is considerable debate about whether children should do blood sugar checks in the classroom or in a school clinic. Older children are sometimes more conscious of their diabetes, especially if newly diagnosed, and may not feel comfortable checking their blood sugar in the classroom in front of their friends. Kids who are diagnosed very young and know only life with diabetes are often more open about diabetes and are comfortable checking their blood sugar in front of friends. Proponents of in-class checking argue that kids who check in the classroom spend more time in the classroom and are not at risk for having problems while walking to the clinic.

Proper education of teachers and school staff by parents prior to school starting can help eliminate the anxiety many teachers feel regarding in-classroom blood sugar checking. For kids who check in the classroom, parents should provide a blood glucose meter that can remain in the classroom, a lancing device and lancets, a sharps disposal container such as the B-D Home Sharps Container for proper disposal of the lancets, and emergency glucose for treatment of hypoglycemia. Lancing devices and blood glucose meters should not be shared, even among kids with diabetes.

Regardless of where a child performs blood sugar checks, they must be allowed to check at school. The Americans with Disabilities Act and the Individuals with Disabilities Education Act established the legal basis for blood sugar monitoring at school.

Implications for School
Children with diabetes must be allowed to check their blood sugar at school. When a child with diabetes has low blood sugar (hypoglycemia), he or she must be given access to emergency glucose to treat the low blood sugar. When a child with diabetes has high blood sugar (hyperglycemia), he or she must be allowed free access to water and the restroom.

Meal Planning

Children with diabetes usually follow a meal plan. Meal plans come in many varieties, and is usually tailored specifically to the needs of each child. Parents should provide teachers and day care providers any specific instructions, such as what foods must be avoided and what to do when food treats are brought in by other students.Parents should also provide morning and afternoon snacks for those children with diabetes who require them. These snacks usually consist of protein and carbohydrates, such as crackers with peanut butter. Children with diabetes who require snacks, but who are not allowed to eat them when required, are at very high risk for hypoglycemia. For these kids, snacks are part of the essential medical care and are not optional.

Implications for School
All children with diabetes must be allowed to have ready access to emergency glucose to counter the effects of hypoglycemia. Left untreated, hypoglycemia can lead to loss of consciousness, convulsions and coma. Also, teachers must allow kids with diabetes to eat snacks when prescribed by their doctor.

Exercise

Exercise is important for all kids, and kids with diabetes are no exception. Diabetes does not prevent a child from participating in any exercise or outdoor activity. Gym class (physical education) and recess can, however, be a challenging time for kids with diabetes since exercise, like insulin, works to lower blood sugar. Teachers should know if a child has diabetes so they can provide help if needed.Children with diabetes often eat an additional snack before participating in strenuous exercise. A good rule of thumb is 15 grams of carbohydrates for each 30 minutes of exercise.If gym or recess is immediately before lunch, for example, kids with diabetes should be allowed to eat a snack before participating. Kids with diabetes should be allowed to carry emergency glucose to treat hypoglycemia, especially if they will be outside, far away from the clinic or classroom.

Implications for School
Physical education teachers and athletic coaches should consider keeping a supply of emergency glucose on hand to treat hypoglycemia. Parents can provide glucose tablets, which work best and will not be confused with candy.

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