During the school year, children spend 30—35 hours in school each week. It’s therefore essential that their type 1 diabetes (T1D) be managed effectively and supervised, especially in primary and secondary school.
Unfortunately, as the Canadian Paediatric Society highlighted, support for students living with T1D is inconsistent across Canada. In many schools, children have little to no help with blood sugar monitoring or other important diabetes management tasks. In some cases, these children are even denied access to childcare services or after-school activities!
The Individual care plan
In 2015, the Canadian Paediatric Society and the Canadian Pediatric Endocrine Group made recommendations to provincial governments and regional school boards, school administrators and teachers. Youth living with T1D and their families could also use these recommendations during their discussions with the school.
Among other things, the experts recommend that each student have an individual care plan (ICP) that details how diabetes should be managed during the school day. The plan should include the following:
- The times and frequency at which the child or school personnel should check blood sugar levels.
- How to treat hypoglycemia (low blood sugar), for instance the number of DEX 4 (or equivalent) or amount of juice.
- What to do in the event of severe hypoglycemia and how to use glucagon.
- How to correct hyperglycemia (high blood sugar), for instance, drink water, give a bolus with the pump.
- Actions to take during hypoglycemia and hyperglycemia episodes: withdrawal from the classroom, rest, exams in progress on hold.
- The method of insulin administration (pump or pen) and dose calculation, and when and where the child should inject.
- Blood sugar management strategies when doing physical activity, for instance, drinking a set amount of juice beforehand.
Here is an example of a care plan you can fill out for your child. Make sure to review any standards that might apply to your province and to check whether there’s a standard form you should fill out.
In all cases, this plan should be reviewed and discussed with your child’s medical team, the school principal and the lead teacher. It should clearly describe the roles and responsibilities of school personnel, parents and the child. This discussion should take place before the start of the school year.
The rights of children with T1D at school
According to the Canadian Paediatric Society and the Canadian Pediatric Endocrine Group, all schools where there’s at least one student living with T1D should ensure that:
- All school personnel are aware of the symptoms of hypoglycemia and know what to do should there be an emergency.
- The student can check for and treat hypoglycemia or take a snack as soon as needed, regardless of where they are (e.g., in class, at recess).
- The student is allowed enough time to finish the meal or snack to prevent hypoglycemia. Younger children have more supervision if necessary.
- At least two staff members are trained to provide support to the student, whether or not he or she is independent in managing his or her diabetes.
- Teachers understand that low blood sugar can interfere with the thinking process. A young person who has low blood sugar before or during an exam may need to take a break and have more time to finish it.
- The student may go to the bathroom more often if they have hyperglycemia.
Different standards in each province
There are no federal policies to ensure the health of children with diabetes while they’re in school. This falls under the jurisdiction of each province and school board.
Many, but not all, provinces recommend or require that an ICP be developed in collaboration with the parents, school staff and the healthcare team.
Some provinces go further. For example, British Columbia established provincial standards in 2015 that allow trained, unlicensed school personnel (e.g., not regulated by a health professional college) to administer insulin and glucagon. There’s a similar policy in Newfoundland and Labrador.
In Quebec, a child with T1D falls into the category of a difficulty code 33 for organic impairment because he or she needs to integrate care into his or her routine. This code provides schools with additional funding to meet the needs of the child. The child also has more time to do their exams, usually 33% more.
In Alberta, code 30 applies to preschool and code 58 to elementary and secondary levels. This ensures that children have access to appropriate services, accommodations and supports when needed.
Tools to better manage diabetes at school
There are various resources available to guide parents of T1D children.
- Diabetes Canada : Guidelines for the Care of Students Living With Diabetes at School
- FRED foundation : find out how FRED support families
- JDRF: School
- Société canadienne de pédiatrie. Prise en charge du diabète de type 1 à l’école : recommandations de politiques et de pratiques, accessed April 11, 2023. https://cps.ca/fr/documents/position/type-1-a-lecole#ref21
- Le diabète à l’école. Le diabète de type 1 à l’école : les droits et les responsabilités, accessed April 11, 2023. https://diabetealecole.ca/parents/droits-et-responsabilites
- Le diabète à l’école. Plan de soins personnalisé, accessed April 11, 2023. https://diabetealecole.ca/parents/plan-de-soins-personnalise
- Diabetes Canada. Guidelines for the Care of Students Living with Diabetes at School, accessed April 11, 2023. https://www.diabetes.ca/DiabetesCanadaWebsite/media/Learn-About-Diabetes/Your%20Rights/Diabetes_Canada_KWDIS_Guidelines-(ENG).pdf
- Fondation ressources pour les enfants diabétiques (FRED). Quels sont mes droits en tant que diabétique à l’école?, accessed April 11, 2023. https://diabete-enfants.ca/soutien-aux-familles/droits-de-leleve/
- Fondation ressources pour les enfants diabétiques (FRED). Quelles sont les mesures prévues par le MELS?, accessed April 11, 2023. https://diabete-enfants.ca/soutien-aux-familles/mesures-prevues-par-le-ministere-de-leducation/
- Fondation ressources pour les enfants diabétiques (FRED). Quels sont les outils nécessaires à la communication?, accessed April 11, 2023. https://diabete-enfants.ca/soutien-aux-familles/outils-de-communication-parents-ecole/
- Diabetes Advocay. School Policies for Children with Diabetes in Canada, accessed April 12, 2023. https://www.diabetesadvocacy.com/school-policies-for-children-with-diabetes-in-canada/
- Soins de nos enfants, Société canadienne de pédiatrie. Diabète de type 1 à l’école, accessed April 11, 2023. https://soinsdenosenfants.cps.ca/handouts/health-conditions-and-treatments/children-and-youth-with-type-1-diabetes-in-school
Written by: Nathalie Kinnard, scientific writter and research assistant
- Sarah Haag, RN. BSc.
- Jacques Pelletier, Claude Laforest, Andréane Vanasse, patient partners of the BETTER project
Linguistic revision by: Marie-Christine Payette