Help to transform our extraordinary hospital into something even better.
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.
All children with diabetes are covered by the Equality Act (2010). For more information visit the Equality and Human Rights Commission.
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.
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 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.
Schools staff may be in a position to notice signs that a child may be developing diabetes.
The main symptoms are:
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.
The following are required to manage Type 1 diabetes:
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 is likely to be needed:
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.
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.
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.
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.
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.
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.
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.
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.
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.
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:
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.
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.
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:
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:
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 (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.
Blood glucose levels fall and can cause hypos fall because:
Most children will have warning signs of a hypo. These warning signs can include:
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.
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.
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:
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.
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.
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 is when blood glucose levels are too high (generally greater than 8 mmol/l). This might happen because:
If school staff notice these signs, they should inform the child’s parent or carer as adjustments to their insulin may be needed.
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:
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.
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 are an exciting and important part of school life and there is no reason for a child with diabetes to be excluded.
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:
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.
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.
Emergency contact 1
Emergency contact 2
Hospital clinic telephone:
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.
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.
Hypoglycaemia is a blood glucose lower than 4.0
Test the blood glucose levels to confirm low blood glucose levels and immediately give something sugary, a quick acting carbohydrate such as:
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:
Diabetes UK website
Diabetes UK helpline: 0345 123 2399
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.
Switchboard: 0114 271 7000
We’ve got a special MRI scanner just for teddies so children can see what it’s like before they have a scan.
Help to transform our extraordinary hospital into something even better.