As children are heading back to school, parents of children with type 1 diabetes (T1D) must deal with additional concerns—especially if their little ones are going to school for the first time.
School-going children spend more than 30 hours a week outside their home. Parents of children with T1D can find it hard to put their trust into the hands of other people, especially when diabetes-related care is involved.
More often than not, children adjust really well, in part because of ongoing collaboration with school staff.
Here are a few key points to keep in mind to ensure a smooth start to the school year.
Most children wish to be accepted for who they are outside of T1D. They might not want to be treated any differently than other children and might wish to participate in activities as much as possible. Therefore, it is best not to ask for any special privileges and follow the school’s schedule (e.g., snack time).
Depending on their age and maturity level, your child may be able to manage their blood sugar on their own to a certain degree. The more they know about their illness, the better they will be at managing it on their own without help from school staff.
School staff and environment
Any and all people who will be around your child (teaching staff, lunch time staff, bus drivers, etc.) should receive information about T1D from you (the parent), an association, or your child’s healthcare team. The school nurse may even be able to help train the staff. However, in Quebec, school nurses often work in several schools at once and may not be there to supervise or administer bolus injections at lunch time, for example.
Know that there is a wealth of resources on the Internet that are very useful for training school staff.
Based on their level of interaction with your child, school staff should be able to do the following:
- know how to prevent, detect and treat any hypoglycemic episode (low blood sugar);
- help your child to monitor their blood sugar and administer insulin;
- ensure your child eats their snacks and meals as planned (especially for younger and inexperienced children);
- know how to manage physical activity (e.g., the need for a snack before or after doing physical activity);
- report any diabetes-related issue;
- keep in touch with the parents.
Parents are probably worried mostly about hypoglycemia. In order to alleviate any concerns, make sure to let the school staff know what symptoms to look for, how your child might express how they feel when their blood sugar is low, and how to choose the right treatment (e.g., using glucagon in case of severe hypoglycemia).
The same goes for correcting hyperglycemia (high blood sugar). Keep in mind that in some cases, the use of technology may require the staff to pay particular attention (e.g., risk of hyperglycemia in case of insulin pump malfunction).
In any event, it is essential for school staff to notify you promptly if your child presents symptoms such as nausea or vomiting while having high blood sugar, due to the risk of diabetic ketoacidosis.
Also, don’t forget to mention that when their blood sugar levels are optimal, a child with T1D is no different than any other child. They will be as talented and as eager to participate in activities as the other kids in their group.
Positioning yourself as a parent
All parents want the best for their children and hope that they will be cared for in school just as well as they are at home. However, the reality of the school environment must be taken into consideration.
Should any issue arise, an Individual Care Plan (ICP) can be completed in collaboration with the school nurse, the principal and the nurse of your child’s healthcare team.
The code 33 initiative is also in place to support any child with an “organic impairment”—type 1 diabetes is part of the code 33 list.
Also, continuous glucose monitoring (CGM) systems (e.g., Dexcom, Freestyle Libre 2) allow for distance monitoring of the user’s blood sugar levels, meaning that as a parent, you could get an alert whenever your child’s blood sugar is out of range.
It is essential to establish and maintain a relation of trust and collaboration with the school staff to facilitate your child’s adaptation and ensure their safety.
As such, you might have to accept that the school staff may make mistakes (just like you as a parent).
Please note that the BETTER team is testing a simplified way to teach the administration of glucagon in school settings. If you live in the Quebec City area and would like to participate, please contact the head of the project at 418-525-4444, ext. 48729 or firstname.lastname@example.org.
Here are the webinars that will be held this fall. Sign up yourself or your child for the BETTER Registry to be able to attend. Learn more »
- Boucher, C. « À l’école », in Le diabète chez l’enfant et l’adolescent. CHU Sainte Justine, p. 562-574
- Diabète Québec. Le diabète à l’école, accessed on July 6, 2021. https://www.diabete.qc.ca/fr/comprendre-le-diabete/pratique/ecole-et-garderie/le-diabete-a-lecole/
- Gagnon-Le Borgne, D. (Summer 2000). Pour une rentrée scolaire réussie. Plein Soleil, p.21.
- Ministère de la Santé et des Services sociaux du Québec (2011) Protocole d’intervention en milieu scolaire pour les élèves atteints de diabète de type 1. http://msssa4.msss.gouv.qc.ca/fr/document/publication.nsf/4b1768b3f849519c852568fd0061480d/c359dcb1305cd8ca852578af0046dd1a?