It’s natural for parents to worry if their child has diabetes. How can you ensure that it is well managed at school?

Type 1 diabetes (T1D) in children

Type 1 diabetes is a chronic auto-immune disease. The affected person’s immune system “attacks” the cells of the pancreas that are responsible for insulin production. This results in a lack of insulin which increases blood glucose (the level of sugar in the blood). Hyperglycemia is at the root of diabetes symptoms and its complications.

The onset of T1D often occurs in childhood (between the ages of 4 and 10), at adolescence or in young adults. A late diagnosis in adulthood is possible, but less common. As yet, this disease cannot be prevented or cured.

Each case of T1D requires a daily insulin treatment that must be administered subcutaneously using a prefilled insulin injection device (insulin pen or pump).

 

The risks related to T1D

Still today, T1D can be life-threatening. Diabetic ketoacidosis is the primary cause of morbidity and mortality in children with diabetes, so it is imperative to prevent it.

It occurs when insulin levels are insufficient to satisfy the body’s basic needs. It is manifested in particular by nausea, vomiting and abdominal pain. It can also lead to brain swelling and coma, which can cause death.

One of the major challenges of T1D management is recognizing and managing hypoglycemic episodes (blood glucose that is too low). It can cause symptoms that can compromise a child’s health, well-being and functioning: decreased energy, weakness, headaches, dizziness, drowsiness, difficulty concentrating, impaired speech, blurred vision, etc.

During an acute episode, a child may lose consciousness. Hypoglycemia should be considered a medical emergency requiring immediate treatment.

 

Empowering your child

Diabetes management requires a great degree of autonomy on the part of your child. Moreover, they will want to fit in with other students without being considered different. It’s important to prepare them well for the numerous challenges this condition involves, so they can meet them successfully!

In order to cope well at school, they must understand the illness and why insulin is so important. They must be familiar, and comfortable, with the following aspects:

• glycemic goals
• delivery device use
• blood glucose and ketones testing
• dose adjustment
• care during sick days
• diabetic ketoacidosis prevention
• hypoglycemic episode recognition and management
• meal plan details
• treatment modification for physical activity
• etc.

 

Involvement of childcare and teaching staff

Informing school staff of your child’s health condition is absolutely necessary. Ideally, organize a meeting with those responsible for your child’s well-being at school (teacher, lunchroom monitor, childcare provider, nurse, etc.).

Here are some points to discuss:

• What is diabetes?
• What is hypoglycemia and what are the primary signs and symptoms?
• What is hyperglycemia and diabetic ketoacidosis, and what are their primary signs and symptoms?
• What are the short-term and long-term consequences of poor diabetes management?
• What purpose does insulin serve and what are the risks related to its use?
• How important is it to monitor blood glucose every day?
• What blood glucose target range should your child aim for? The ones that indicate hypo- or hyperglycemia?
• How often are insulin injections and blood glucose tests with a meter needed?
• What is the dose to be injected?
• How does the insulin pump work?
• What should be done in the event of hypo- or hyperglycemia?
• Etc.

If your child wishes to do so, and is comfortable with the idea, why not consider having them do a presentation about diabetes to the students in the classroom or school? It may take on the format of a talk with visual aids, interactive games or role-playing, or a scientific project. Of course, this type of initiative depends on the child’s age.

If your child is not comfortable with this approach and prefers not to talk about their diabetes, this must be respected. If they do talk about it, some may envy their courage to receive injections and to deal with the illness or even their “privilege” of having access to this high level technology!

For safety reasons, the families of your child’s friends, and anyone who has them under their care temporarily must also be made aware of their condition and of the important aspects listed above.

 

Some advice

Here are some additional tips:

• If your child eats at school, it is important that they eat enough to avoid a blood glucose imbalance. Prepare healthy lunches and snacks.
• Periodically check the expiry date of the insulin.
• Prepare a document (action plan) listing all of the important information, and distribute it to everyone concerned.
• Encourage your child and school staff to contact you at the slightest doubt or if there’s an anomaly. Be sure to indicate your cellphone number or your work number in the action plan and on any useful document. Ideally, your child should know it by heart.  
• Stay attentive to your child and provide support. Above all, applaud your child’s efforts to successfully manage their diabetes!

Speak to your pharmacist is you have any questions related to diabetes management.