Managing type 1 diabetes in school: Recommendations for policy and practice

Question 1

What is the prevalence of type 1 diabetes in Canadian children?

Answer 1

1 in 300 children

Question 2

What are some complications?

Answer 2

Short term:

1. Hyperglycemia
2. Hypoglycemia

Long term:

1. Heart attack
2. Stroke
3. Amputation
4. Kidney failure
5. Blindness
6. Learning deficits

Question 3

What are recommendations re: preventing and treating hypoglycemia?

Answer 3

1. Regularly scheduled meals and snacks, and adequate time to consume them.
2. Adjusting either food intake or insulin doses for increased physical activity. In most cases at school, this means an extra blood glucose check and/or extra snack before physical activity.
3. A clean area for blood glucose checks, where hands can be cleaned, with a sharps container to safely discard glucose test strips and lancets.
4. Supervising young children in ways that help them recognize, treat and prevent hypoglycemia.
5. For all children, ready access to their emergency kit (with glucose meter, fast-acting sugar source, extra snacks, etc.).
6. For older children or teens, accommodations for tests, quizzes or exams (eg, extra time), since hypoglycemia is likely to affect test performance even after appropriate treatment of an acute event.

Question 4

What are potential barriers to safe and effective management of hypoglycemia in schools?

Answer 4

1. incomplete training of school personnel;
2. unscheduled activity and inactivity;
3. altered meal or snack times; and
4. lack of rapid access to a glucose meter and emergency and treatment supplies.

Question 5

What are the CPS recommendations re: type 1 DM and the school?

Answer 5

1. Schools having one or more students with diabetes must ensure that at least 2 school personnel are trained to provide support. Staff members may be unlicensed (ie, not regulated by a health-profession college), and will be provided with diabetes education resources and enabled to attend annual diabetes updates.
2. Provinces/territories or regions should establish mechanisms to ensure adequate personnel and resources are available to provide diabetes education to schools, and that the education is specific to managing diabetes in children.
3. Schools must provide all students with a clean, convenient and safe area for diabetes self-care, and respect students’ personal preference for privacy. Self-care tasks include blood glucose monitoring and the administration of insulin via injection or insulin pump. The level of autonomy will vary based on age and the individual child. The youngest children will need school personnel to provide all aspects of glucose monitoring and insulin administration, while older elementary school students are likely to need supervision only. As students mature, they are typically more able to provide self-care. School personnel should be identified and trained within the school to support students as needed.
4. An individual care plan (ICP) must be developed for each student with diabetes and discussed among parents or guardians and the school principal (or designate) and teacher, with input from a health care provider as needed. The ICP should clearly outline roles and responsibilities of school personnel, parents and the child with diabetes. Discussions should occur before the start of the school year. Ideally, provincial authorities would make available a standardized form for this purpose.
5. A designated staff member must supervise students’ meals and snacks to ensure that they are eaten on time and in full. Adequate time must be provided to consume the meal or snack. The level of supervision will vary based on the age and autonomy of the student.
6. Each teacher or supervisor of a child with diabetes must know how to recognize and treat hypoglycemia. Regardless of age, a student must not be left alone when hypoglycemia is suspected. In the event of severe hypoglycemia, school personnel should call 911. Giving intramuscular glucagon is the optimal treatment for a severe hypoglycemic event, but may not be feasible for all schools. However, if the emergency response time is expected to be more than 20 minutes, it is strongly recommended that school personnel be trained to administer glucagon.
7. Accommodations are recommended for examinations, tests and quizzes. Students with diabetes must be allowed to keep a diabetes emergency kit at their desk, including a blood glucose meter, hypoglycemia treatment, and snacks as required. In the event of a hypoglycemic event in the half hour preceding or at any time during an exam, a student should be granted an additional 30 to 60 minutes as needed to allow for cognitive recovery from hypoglycemia.
8. Diabetes care tasks should be integrated into the student’s regular daily routine. To preserve the dignity of the student and to promote normal behavioural and social development, exclusion of any kind should be minimal and only in accordance with the student’s ICP.
9. Students with diabetes may have more frequent medical appointments. Attendance-incentive policies and practices should not be applied to students when they need to attend medical appointments.