Type 1 diabetes in school

Type 1 diabetes is a chronic disease in which the pancreas doesn’t produce insulin, a hormone that allows the body to convert glucose (sugar) into energy or to store it in cells. Without insulin, glucose levels in the blood become dangerously high. Untreated type 1 diabetes is life-threatening. The only treatment is insulin, which is administrated through multiple daily injections or through a pump.

About 1 in 300 children have type 1 diabetes. They need frequent blood sugar checks each day and regular doses of insulin. There are many factors that affect blood sugar levels and the amount of insulin needed, including food, physical activity, illness, and stress

How does type 1 diabetes affect a child in school?

Managing type 1 diabetes at school is important for children’s short- and long-term health. Blood sugars that are too high or too low can affect a child’s ability to learn. Blood sugar levels can change quickly, so it’s important that school staff are educated, equipped and available to support students.

At a minimum, all students have to check their blood sugar throughout the day. If their blood sugar is too low (hypoglycemia), they need to treat it by eating a fast-acting sugar. Many students will also take insulin during the school day, when they eat or to correct a high blood sugar. They’ll do this either by injection or through an insulin pump that they wear on their body. Some students also wear a device to monitor their blood sugar.

While older students may be independent, many younger students will need an adult to help with or supervise these tasks. Even students who are independent may need help if they are unwell.

Some families worry that their child won’t have the proper support to deal with diabetes at school. They wonder:

• Will my child be excluded from activities because there is no one to help with diabetes-related tasks?
• What happens if my teen has low blood sugar just before an exam?
• Can my child go on field trips?
• Is my child safe during the day? What happens if their blood sugar goes low?

These are just some of the situations students with diabetes may face in school.

With support and planning, students with diabetes can participate fully in all school activities. Events involving food, for example, may require extra insulin to keep blood sugar levels in range. Because physical activity lowers blood sugar, changes to the typical routine (like a track meet, for example) need to be communicated to parents so they can either adjust insulin levels or provide an extra snack.

Is there support for students with type 1 diabetes in schools?

Support for students with type 1 diabetes in schools varies across Canada. Resources and policies are different across the country, even among schools in the same city or the same school board.  

Through Diabetes@School – a program developed by the Canadian Paediatric Society, the Canadian Pediatric Endocrine Group, and Diabetes Canada—educators and other school staff can access a number of resources to help them support students with type 1 diabetes. The Diabetes@School website has a list of provincial policies on type 1 diabetes in school.

The Canadian Paediatric Society and the Canadian Pediatric Endocrine Group have established minimum standards for care that will allow schools to create a safe and supportive environment for students with type 1 diabetes.

What are the responsibilities of a parent or guardian and the school?

Both the Canadian Paediatric Society and Diabetes Canada believe that supporting children and youth with diabetes at school should be a shared responsibility between families (including the students), schools, and, as needed, a health care provider.

Although parents or guardians should be responsible for the daily management decisions around their child’s diabetes (e.g., medications and storage, frequency of blood sugar monitoring, carbohydrate counting, determining insulin doses), school staff should be equipped (and trained, as needed) to provide the student with reliable hands-on support and supervision. 

Each school year, parents (with help from their diabetes care team, as needed) should develop a detailed Individual Care Plan (ICP) for their child. This plan should include a daily diabetes management plan and a diabetes emergency plan for school staff. The ICP should also outline roles and responsibilities of everyone involved in the student’s well-being.

Parents should review and finalize their child’s ICP with input from school staff. They may also want to review it with their physician. The school principal should then share it with all staff who are in contact with the student on a regular basis.

What resources are available to school staff?

School staff should be educated, equipped and available to support students with type 1 diabetes. In many cases, parents will be the ones to take the lead on this education. There are many excellent resources to help, including:

• Diabetes at School: A resource for families, schools and caregivers to help school-aged children with type 1 diabetes. Includes a video series that makes it easy to learn about how to support students with type 1 diabetes in school. 
• Diabetes Canada: Guidelines for the Care of Students Living with Diabetes at School
• B.C. Children’s Hospital: Online module for educators: Taking Care of Diabetes at School
• IWK Health Centre Pediatric Diabetes Team in Halifax: Online video training modules for teachers.