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managing type 1 diabetes at school: 'not every child will be on the same system or regimen'
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“not every child will be on the same system or regimen, but the advent of remote monitoring has been very nice, too. so if a parent does want to take a peek at what glucose levels are while their child is away from them at any time, if they are able to use a sensor, they can do that."
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for kids with type 1 diabetes and their families, going back to school can be especially worrisome because of their health. the condition, in which your pancreas doesn’t produce insulin to fuel body processes, demands constant attention to keep blood sugar levels in the normal range.
in other words, insulin dosing comes with a lot of responsibility. staying in range helps students stay engaged in school and get the most out of the learning and social activities.
ciara stevens, a registered nurse and certified diabetes educator in nova scotia, works with people of all ages living with the condition and understands from personal experience the challenges that come with the diagnosis for school-aged kids. she was diagnosed with type 1 diabetes when she was 11.
“i took it and ran with it,” she says of tackling the learning curve and later adopting technology devices and new insulin formulations as they advanced. living with the condition also influenced her career as a health-care provider.
“but i know that’s not the experience that everyone has because we’re all so individual.”
she emphasizes that diabetes affects people differently and the management required also changes over time.
how to keep blood sugar levels in range
“there are many factors that influence glucose [blood sugar], not just what we eat, but our medications and how much we move. we say there’s like 42-plus factors. so, the changes in the trends of glucose and trying to sort that out and what should be adjusted is probably the most challenging thing and that can be day-by-day.”
for success at school, she recommends developing an individual care plan (icp) for students that outlines daily management — blood glucose checks, insulin, meals, activity — and emergency procedures, following
diabetes canada’s national guidelines.
diabetes at schoolalso has detailed information on icps along with templates to follow.
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“the plan of care for returning to school or perhaps even going to school for the first time if they received a diagnosis over christmas break or summer break, it really does look individual based on the child or teen, because i always like to talk about how diabetes can’t be put in a box. it’s individualized,” stevens says.
“whether you’re the school or the nurses involved, in nova scotia, we have eas or tas [educational assistants or teaching assistants], the most important thing is that open communication happens in order to have a plan set for that child or teen so they and their family can feel safe sending them back to school.” the icp is a collaborative plan with input from students, parents and educators.
technology advancements have helped with management at school, she adds. continuous glucose monitoring systems, wearable insulin pumps and the changes in insulins, like long-acting basal insulin that helps maintain steady blood glucose levels around the clock, have made a difference.
“not every child will be on the same system or regimen, but the advent of remote monitoring has been very nice, too. so if a parent does want to take a peek at what glucose levels are while their child is away from them at any time, if they are able to use a sensor, they can do that. how that works with the school staff in conjunction depends on the school, the team at the school and the individualized plan.”
watch for signs of low and high blood sugar
as a general rule, what should teachers be on the lookout for that might suggest a student with type 1 diabetes is unwell?
stevens advises watching for any changes where the student is less chatty or more chatty than usual or they’re not partaking when they typically would or if their friends say that they’re not acting like themselves. there are signs and symptoms of glucose levels below or above target. some of them overlap, but noticing a difference is key. often those are differences in behaviours, so if they are quieter, paler or more tired, for example. some children can feel the changes in glucose and some cannot.
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hyperglycemia or hypoglycemia, high and low blood sugar levels, influence those behaviours and can be problematic. knowing what to do in these situations is important.
“when we do our pediatric team visits with children and teens living with diabetes, we always say, do you have friends around you who know about your diabetes and what to look for and what to do? so that’s a really good point to make: having a support system.”
the icp will outline intervention, stevens explains. in some cases at school, there’s one insulin injection per day that can be overseen or given by a particular individual. in some cases, the instructions would be if glucose levels do a or b, then text or call parents. intervention often depends on what the child can do for themselves and what they need support with and what resources are available from the school.
be prepared with fast-acting glucose supplies
students typically carry a belt bag or backpack with a “diabetes kit” containing fast-acting glucose like apple juice or glucose tablets and supplies may be stored at school as well. some students may carry intranasal glucagon, which can be given in the event of severe hypoglycemia, such as unconsciousness.
another factor is planning around physical activity that uses more energy and generally lowers blood sugar. “they might need carbs or a change in their settings on their insulin pump proactively or change in dosing, depending on what they’re able to do and adjust at school,” stevens says, adding that schools are working hard to better support students with diabetes and welcome parents’ input.
what are parents most worried about?
generally, parents and caregivers are concerned about the response to glucose levels that are below target and troubleshooting technology. there’s also the emotional and social impact of what stevens labels as “shame, blame and stigma,” where kids are treated differently because of their diabetes.
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“some children are quite open about talking about their diabetes and if they are, parents can encourage them to talk to their teacher about having them share about it at school to their peers in a class presentation.”
she encourages parents to also talk with kids about experiencing comments that are not accurate and to let them know that that’s something they can chat with you about when they get home and even information they could share when they hear those comments.
we all need to feel a sense of community and belonging, making it important for kids with diabetes to meet other kids with similar challenges.
breakthrough t1dhas virtual sessions to connect people and diabetes canada offers d-camps in summer across the country for kids to connect and make friends. stevens has worked at some of the d-camps and is an advocate for participation.
“one of the biggest takeaways is that community experience and feeling like you’re not the only one. and it’s truly very powerful. that works on helping to diminish any extra diabetes distress,” she says of the distress and stigma that results in people not accessing health care when they need it. they’re also more likely to experience low blood sugar, complications and lower emotional well-being.
“so it’s really hard to quantify the importance and the benefits of camp, even in what happens in one week.” this summer, one child wasn’t talking much or wanting to be open about his type 1 diabetes and then by the end of the week, he was a happier boy.
“he was hanging up his first certificate in a frame when he got home and setting up a little low station [with supplies to remedy low blood sugar] beside his bed and being very excited for next year. so he might not be around all of his new friends, but he knows they exist in the world.”
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