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Information for Teachers and Day Care Providers

Published:
17-May-2005

Teachers and day care providers are likely to have a child with Type 1 diabetes in their care at some point. We will provide some basic information about diabetes, and offer some suggestions for how to care for a child with diabetes.

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What is Type 1 Diabetes?

Type 1 diabetes, also known as juvenile diabetes is an auto-immune disease where the body destroys insulin-producing islets in the pancreas. The body need insulin to use glucose. Glucose is the sugar into which foods are broken down by our digestive system. Without insulin, the body starves to death. Everyone is insulin-dependent. Children without diabetes make insulin in their pancreas. Children with Type 1 diabetes must inject insulin.

High and Low Blood Sugars

There are two problems that children with diabetes face. Please be aware of the symptoms and how to treat them.

Hypoglycemia, or low blood sugar, occurs when the blood sugar level is too low. This can be from to too much insulin, too much exercise or too little food. 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 carbohydrates, 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. This can be from too little insulin or too much food. Children with high blood sugar sometimes act lethargic and sleepy. They 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.

Treatment of Diabetes

Children with Type 1 diabetes are treated with insulin taken by injection or using an insulin pump. They must also accurately monitor their blood sugar and follow a closely monitored program of 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. Children should be permitted to check their blood sugar whenever and wherever they need.

Insulin Injections Most children with Type 1 diabetes inject insulin several times a day. Some children take two shots, one before breakfast and one before dinner. They use two different kinds of insulin: one short acting and the other long acting. Other children take injections every time they eat anything containing carbohydrates or sugar .

Some children 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 canula (thin tube) inserted under the skin that delivers insulin continuously. Kids who use an insulin pump give themselves extra insulin (bolus) 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.

Monitoring Blood Sugar

Children with diabetes may check their blood sugar many times per day. This check involves pricking a finger or forearm with a lancet and placing a drop of blood on a special test strip. A blood glucose meter analyzes the test strip and reports the blood sugar level, usually very quickly. 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 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 children may need some adult supervision.

Proper education of teachers and school personnel 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 establish the legal basis for blood sugar monitoring at school.

Planning Meals

Children with diabetes usually follow a meal plan. There are many different meal plans. Each plan 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.

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.