Most children with diabetes have Type 1 diabetes (autoimmune). This is a condition in which the insulin producing cells are destroyed and the pancreas stops making the hormone insulin. Without insulin, the body cannot convert food into energy. The only treatment is to replace the missing insulin by injection. Food and exercise must be balanced with the insulin to maintain normal blood sugar. The child with diabetes can do all the same things as children who do not have diabetes, if the school’s staff understands and cooperates with treatment.
There is not single right way to treat diabetes. Each child’s circumstances are different. Therefore, experienced diabetes team individualize treatment plans based on needs as well as preferences of the child and family.
There are a variety of insulin regimens. Many children will get insulin injections before breakfast and before dinner. However, some children may need to take insulin more frequently and still others may use an insulin pump.
Just as with insulin regimens, there are several methods of meal planning. New information allows diabetes teams to be much more liberal with food. Carbohydrate Counting coupled with recommendations in the Food Guide Pyramid seems to be most popular, although some programs still use the Exchange System.
To help assess how well the treatment plan is working, the child may need to check his/her blood sugar one or more times throughout the school day. This is done using a blood glucose meter that the child must bring to school. Most children can perform blood sugar checks by themselves but may need a private place to do so. Some children may need supervision to see that the procedure is done properly and results are recorded accurately. It is helpful for the child to have a meter at school so the blood can be checked during treatment for a low blood sugar reaction. The parent needs to instruct the health aide (or other designated personnel) on use of the blood sugar meter. This will assure that help will be available to the child if needed. How often the child checks or whether he/she checks at school at school at all are decisions made in conjunction with the child, family, child’s diabetes team and school personnel.
Hypoglycemia (Low Blood Sugar)
Occasionally, a child who takes insulin may have a low blood sugar. This is typically caused by not eating as much as usual, taking too much insulin, or exercising more than usual without having eaten an extra snack. The blood sugar may drop below 70 and result in hypoglycemia (low blood sugar).
If the child is supposed to get snacks, it is essential that he/she eats these snacks every day. Also, if the child does not finish lunch he/she should be given an additional snack later to compensate for what was left uneaten. Parents need to know the times of recess and PE, so that they can be planned for. If a child has symptoms of hypoglycemia, treat immediately and do not leave the child alone. If untreated the blood sugar may continue to drop and the child can lose consciousness. Loss of consciousness due to low blood sugar is a medical emergency and treatment must be administered immediately! (See Acute Emergencies of Diabetes.)
Hyperglycemia (High Blood Sugar)
Sometimes, the blood sugar can go too high. This is usually caused by eating more food than usual, not getting enough insulin, not having as much exercise as usual, being stressed out, or by illness. High blood sugar takes hours to a day or two before it causes problems. This is not an emergency. Parent/guardians need to be informed if the blood sugar at school was over 250 mg/dl, or if the child showed signs of high blood sugar:
- Nausea and vomiting
- Fruity odor to breath
- Rapid, deep breathing
- Lethargy, sluggishness
A child with diabetes may have an unexplained increased or decreased blood sugar from time to time.