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Diabetes at school

You are probably reading this resource because you have a child with diabetes at your school or in your class.

This resource offers a guide to Type 1 diabetes and how to manage it in school. Most children with diabetes have Type 1 diabetes which is managed by taking insulin, following a healthy, balanced diet and getting regular physical activity.

The information is however general information and it is important you meet with the child’s parents and carers and paediatric specialist nurse (PDSN) to discuss a child’s particular needs.

All children with diabetes should have an individual diabetes healthcare plan which is developed with the child when appropriate, their parents and carers, their paediatric specialist nurse (PDSN) and school staff. The plan should be updated at least once a year, or whenever treatment changes.

Information:

All children with diabetes are covered by the Equality Act (2010). For more information visit the Equality and Human Rights Commission.

What is diabetes?

Diabetes is a common life-long condition where the amount of glucose in the blood is too high because the body cannot use it properly. This is because the pancreas (near the stomach) does not produce sufficient insulin, or the insulin that is produced does not work properly (known as insulin resistance).

Insulin is necessary to help glucose enter the body’s cells, where it is used for energy. Glucose comes from digesting carbohydrate and is also produced by the liver. Carbohydrate comes from many different kinds of food and drink like fruit, sugar, other sweet foods and some diary products. It can also come from starchy foods such as bread, potatoes and chapatis.

The 2 main types of diabetes

Type 1 diabetes

Type 1 diabetes develops if the body is unable to produce any insulin and usually appears before the age of 40. It is the most common type of diabetes found in children. It is treated with insulin (either by injection or pump), following a healthy, balanced diet and getting regular physical activity.

This resource is about children with Type 1 diabetes.

Type 2 diabetes

Type 2 diabetes develops when the body can still make some insulin, but not enough, or when the insulin that is produced does not work properly. It usually appears in people over the age of 40, though in South Asian and Black people it often appears from the age of 25. It is also becoming more common in children and young people of all ethnicities.

Type 2 diabetes is treated with a healthy, balanced diet and increased physical activity, but medication or insulin is often required.

Both Type 1 and Type 2 diabetes are serious conditions which can lead to complications in later life, such as damage to the eyes, kidneys, nerves, heart and major arteries.

To reduce the chances of developing these complications all people with diabetes, including children, need to keep their blood glucose levels close to the target levels agreed with their diabetes healthcare team and they may need support in this.

Symptoms of diabetes

Schools staff may be in a position to notice signs that a child may be developing diabetes.

The main symptoms are:

  • increased thirst
  • passing urine frequently
  • extreme tiredness
  • unexplained weight loss
  • blurred vision

If these symptoms are seen in a child, their parent or carer should be contacted as soon as possible and advised to see their GP.

Diabetes is diagnosed by a simple blood test and once treated the symptoms are usually quickly relieved.

Managing Type 1 diabetes

The following are required to manage Type 1 diabetes:

  • testing blood glucose levels
  • taking insulin
  • eating a healthy, balanced diet
  • being physically active

All children with diabetes need to test their blood glucose levels on a regular basis, so need their testing kits to hand.

Testing blood glucose levels involves pricking the finger, using a special finger-pricking device, to obtain a small drop of blood.

This is then placed on a reagent strip, which is read by a small, electronic blood glucose meter. A test generally takes less than a minute in total.

Younger children, those newly diagnosed or with learning difficulties may need help with blood glucose testing.

Blood glucose testing

Blood glucose testing is likely to be needed:

  • before meals
  • before, during and after physical activity (see physical activity section)
  • if the child is unwell (see Hyperglycaemia section)

Any time the child or school staff feel that their blood glucose level is falling too low or climbing too high read the section about hypoglycaemia.

Taking insulin

Insulin cannot be swallowed like a medicine as it is a protein and would be broken down in the stomach. Therefore it either needs to be injected, or given via a pump.

Multiple daily injections (MDI)

Most children will be started on multiple daily injections from diagnosis. This is because medical research has shown that multiple daily injections (MDI) can control blood glucose levels better than 2 daily injections.

Taking more injections can also give greater flexibility in when to eat and how much. Children taking multiple daily injections (MDI) will need an injection with each meal or snack as well as an injection at bedtime or in the morning. This will mean that they have to have injections at school with lunch and most snacks.

2 injections a day

Occasionally children are on just 2 injections a day.

Children who take 2 injections a day usually take them at breakfast and the evening meal, and so will not usually need to inject during the school day.

Injecting at school

Children who need to have an insulin injection at school will need to bring insulin and their injecting equipment to school.

In most cases the equipment will be an insulin ‘pen’ device.

If the child and parents wish, the school should create a private area where the injections can be taken. If not, the child should be allowed to inject where they and the paediatric specialist nurse (PDSN) feel is most appropriate.

Younger children, those newly diagnosed or with learning difficulties may need help with injecting.

Insulin pumps

An insulin pump delivers a small amount of insulin around the clock via a thin flexible tube.

The tube is connected to a cannula, which is inserted just under the skin. The cannula will usually stay in place for 2–3 days so should not need changing at school unless it becomes dislodged or blocked.

When the child eats, or if their blood glucose level is high, they will need to take extra insulin and will do this by pressing a combination of buttons on the pump or a handset.

Younger children, those new to a pump or those with learning difficulties may need help with using their pump.

While insulin pumps are fairly robust and many are showerproof, they are expensive pieces of equipment and need to be looked after. Pumps may need to be removed for contact sports and swimming, for more information on diabetes and physical activity, please see physical activity section.

Photograph of person with diabetes pump connected to their tummy, with wires to a machine

Image from Diabetes UK

Food

Following a healthy balanced diet is an important part of diabetes management. A child with diabetes can have the usual school meals and carbohydrate counted menus are available from the dietitians.

After diagnosis, the child will have been seen by a dietitian, and their parent or carer or paediatric dietitian will be able to explain any particular needs to staff.

We do not recommend special diabetic foods.

A healthy balance

Foods can be divided into 5 main groups. For a balanced diet, the child should aim to eat foods from all of these groups in the right proportions. All main meals should include starchy foods such as bread, potatoes, rice or pasta.

The Food Standards Agency (FSA) has created an Eatwell guide which can be found here.

Plate of different food groups

Sugary foods

Children with diabetes can include moderate amounts of high fat, high sugar foods such as cakes and biscuits as part of a healthy, balanced diet, but eating too much will upset the overall balance of the diet and make diabetes control more difficult.

Soft drinks should be sugar-free, or no added sugar drinks, as sugar in liquid form is rapidly absorbed and raises blood glucose levels quickly, see hyperglycaemia section. Sugary drinks are however good treatment for hypoglycaemia.

Snacks

Children who take insulin 2 times per day and younger children in general may need snacks between meals.

Snacks may need to be eaten during class time but if the times can coincide, they are best eaten at break. If you feel the class should understand why the child is having a snack, first ask the child how they feel about having their diabetes explained to the class.

The choice of snack will depend on the individual child but could include:

  • small roll or sandwich
  • portion of fruit
  • dried fruit
  • cereal bar
  • biscuits

Older children who take insulin with meals or who are on a pump may not need snacks between meals. The child’s parent or carer or paediatric specialist nurse (PDSN) will advise you whether snacks are needed. If they chose to snack they will probably require an insulin dose.

Eating times

If a child takes 2 injections of insulin per day, meals and snacks may need to be eaten at regular intervals, following their diabetes plan. This is to maintain stable blood glucose levels.

It is important that if the plan includes specific eating times, you make sure that the child keeps to these times as a missed or delayed meal or snack could lead to a hypo (see Hypoglycaemia section).

Children who take multiple daily injections or who are on a pump usually have more flexibility with their eating times.

To keep meal times regular, the child may need to be near the front of the queue for lunch and at the same sitting each day.

Physical activity

Being physically active is an important part of diabetes management. Children with the condition can take part in any kind of physical activity including being selected to represent school and other teams, providing they have made some preparations beforehand.

Preparations are needed because activity, such as swimming, football, running and athletics, uses up glucose. If the child does not eat enough before starting an activity, their blood glucose level may fall too low and they will experience a hypo (see Hypoglycaemia section). Also, if their blood glucose level is high prior to getting active, physical activity may make it rise even higher (see Hyperglycaemia section).

The type of preparation required before physical activity will vary depending on:

  • the type of physical activity
  • the timing of the activity
  • how long it will last
  • when the child last ate
  • when they last injected insulin and where
  • their blood glucose level

Before, during and after activities, the child will need to check their blood glucose level carefully and must make sure they have a good fluid intake.

The child’s parent or carer or paediatric specialist nurse (PDSN) will advise on any specific preparations required for physical activities. These may include:

  • having an extra snack before, during or after physical activity
  • altering the insulin dose
  • injecting in a particular site

Diabetes should not be an excuse for opting out of school activities. If this does happen regularly, speak to their parent or carer or paediatric specialist nurse (PDSN) to find out more about how they are feeling and why they may not want to do physical activity.

A child with diabetes need not to be singled out for special attention during physical activity, this could make them feel different and may lead to embarrassment.

Hypoglycaemia

Hypoglycaemia (or ‘hypo’) is when blood glucose levels are low, falling to below 4mmol/l. This is a common short-term complication of diabetes which needs to be treated quickly.

Some children will know when they are going hypo and will be able to take appropriate action themselves, but others, especially younger ones, those newly diagnosed or with learning difficulties may need help in recognising and treating their hypo.

What causes a hypo?

Blood glucose levels fall and can cause hypos fall because:

  • too much insulin has been taken
  • a meal or snack has been delayed or missed
  • not enough carbohydrate food has been eaten
  • exercise was unplanned or strenuous

How do I recognise a hypo?

Most children will have warning signs of a hypo. These warning signs can include:

  • feeling shaky
  • lack of concentration
  • sweating
  • headaches
  • hunger
  • feeling tearful, stroppy or moody
  • tiredness
  • blurred vision
  • going pale

The signs can be different for each child and the child or their parent or carer or paediatric specialist nurse (PDSN) can tell you what their warning signs are. These should be noted in the child’s individual healthcare plan.

How do I treat a hypo?

It is very important that a hypo is treated quickly, so children should have easy access to their hypo treatments and should be allowed to eat and drink whenever necessary to treat a hypo.

Information:

A child should never be left alone during a hypo nor be sent off to get food to treat it. Recovery treatment must be brought to the child.

If the child is unable to treat themselves, here is what to do:

  1. Check the child’s blood glucose level as soon as possible.
  2. Immediately give something sugary to eat or drink (such as Lucozade, non-diet drink, glucose tablets, fruit juice)
  3. After 10 minutes, check blood glucose level again. If the blood glucose level is still low, repeat the sugary food or drink until the blood glucose level has returned to normal (4mmols and above)
  4. When the blood glucose level has returned to normal, the child may need a follow-on snack (such as for example a piece of fruit, biscuit, cereal bar, small roll or sandwich, or the next meal if it is due)

The child’s parent or carer or Paediatric specialist nurse (PDSN) will tell you if a follow-on snack is required.

The child’s parent or carer or Paediatric specialist nurse (PDSN) will advise you on how much should be given.

If a hypo is left untreated, the blood glucose level will continue to fall and the child could become unconscious or have a seizure. This may resemble an epileptic fit, but it does not mean the child has developed epilepsy.

What do I do if the child becomes unconsciousness?

In the unlikely event of a child losing consciousness, do not give anything by mouth. Place them in the recovery position (lying on their side with the head tilted back). Call a paramedic ambulance, informing them the child has diabetes.

What do I do after I have treated a hypo?

Once you have treated a hypo and the blood glucose has returned to normal levels the child can continue with whatever they were doing, even physical activity.

Hyperglycaemia

Hyperglycaemia is when blood glucose levels are too high (generally greater than 8 mmol/l). This might happen because:

  • an insulin dose has been missed
  • too little insulin has been taken
  • more sugary or starchy foods than usual have been eaten
  • a hypo has been over-treated
  • stress
  • being unwell with an infection

How do I recognise hyperglycaemia?

Symptoms include:

  • increased thirst
  • increased passing of urine
  • headaches

If school staff notice these signs, they should inform the child’s parent or carer as adjustments to their insulin may be needed.

How do I treat hyperglycaemia?

If the child’s blood glucose level is high for only a short period of time, treatment may not be necessary. The child, parent or carer or Paediatric specialist nurse (PDSN) will inform you when treatment is required and what to do.

Treatment may include:

  • taking extra insulin
  • drinking plenty of sugar-free fluids
  • resting

What should I do if the child is unwell?

If a child is unwell with high blood glucose levels their parents or carers should be informed immediately, especially if they are sick.

A child with high blood glucose levels should be allowed to leave the class to go to the toilet whenever they need to, and should be allowed to drink in class if they need to.

What do I do after I have treated hyperglycaemia?

Once you have treated hyperglycaemia and the blood glucose has returned to normal levels the child can continue with whatever they were doing, even physical activity.

School trips

School trips are an exciting and important part of school life and there is no reason for a child with diabetes to be excluded.

Day trips

Going on a day trip should not cause any real problems, as the routine will be much like that at school.

The child should take:

  • their insulin and injection kit, for a lunchtime injection or in case of any delays over their usual injection time
  • their blood testing kit
  • hypo remedies
  • pump supplies (if appropriate)
  • extra food and snacks in case of delays

Overnight stays

With overnight stays, the child’s routine will certainly include insulin administration and blood glucose monitoring, even if these are not routinely done in school.

If the child cannot do their own injections or manage their pump or check their own blood glucose levels, this will need to be done by a member of staff. Staff should meet with the child’s parent or carer or PDSN well in advance of the trip to discuss what help is required and who will assist.

While away, if any medical equipment has been lost or forgotten, contact the paediatric department or A&E department at the nearest hospital, who will be able to help.

Going abroad

Contact the Sheffield Children’s hospital diabetes team or the child’s parents or carers for extra information, and please visit our Holiday advice resource.


Diabetes record card

This child has Type 1 diabetes

Name:

Age:

Class:

Class teacher:

Emergency contact 1

Telephone:

Emergency contact 2

Telephone:

Hospital clinic telephone:

GPTtelephone:

Hypo symptoms and treatment for this child

Symptoms:

Treatment:

Information:

Do not leave the child alone or move them until the hypo is over.

Remember you may need to follow the immediate hypo treatment (for example, Lucozade) with some starchy food (like a sandwich or cereal bar), see Hypoglycaemia section.

If they become unconscious

Information:

In the unlikely event of the child losing consciousness, do not give them anything to swallow. Place them in the recovery position (on their side with the head tilted back) and phone 999 for an ambulance and explain that the child has diabetes.


Hypos quick guide

Hypoglycaemia is a blood glucose lower than 4.0

What causes a hypo?

  • too much insulin
  • a delayed or missed meal or snack
  • not enough food, especially carbohydrate
  • unplanned or strenuous exercise
  • sometimes cause is unknown

What does it look like?

  • hunger
  • shaking
  • sweating
  • anxiety, irritability or mood changes
  • tingling
  • palpitations
  • glazed eyes or dark circles
  • colour draining
  • drowsiness
  • lack of concentration

What do I do?

Test the blood glucose levels to confirm low blood glucose levels and immediately give something sugary, a quick acting carbohydrate such as:

  • 2 to 3 glucose tablets or
  • 150 to 200ml fizzy pop (not diet) or
  • 50 or 100ml Lucozade
  • 150ml of fruit juice
  • 5 jelly beans

Wait 10-15 minutes and retest blood glucose.

If below 4.0 re-treat as above.

Once blood sugar is above 4.0 a longer acting carbohydrate is needed to prevent blood glucose from dropping again such as:

  • 1 to 2 biscuits
  • a portion of fruit

Further information

Is something missing from this resource that you think should be included? Please let us know

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Disclaimer

Please note this is a generic information sheet relating to care at Sheffield Children’s. The details in this resource may not necessarily reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If you have specific questions about how this resource relates to your child, please ask your doctor.

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United Kingdom

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