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This page provides basic information for teachers about diabetes, and offer suggestions for how to care for children in school with diabetes.

Type 1 diabetes, previously called juvenile diabetes or insulin-dependent diabetes, is an autoimmune disease in which the body destroys insulin-producing beta-cells in the pancreas. Insulin is required by the body to use glucose, the simple sugar into which foods are broken down by our digestive system. Without insulin, the body starves to death.

Diabetes is not contagious. And though there is no cure, diabetes can be managed with insulin injections, blood sugar monitoring, proper diet and exercise.

Children with diabetes face two problems that teachers need to understand: hypoglycemia and hyperglycemia. You should learn the symptoms and how to treat each.

Hypoglycemia or low blood sugar occurs when the blood sugar level is too low, due to:

• Too much insulin,
• Too little food, or
• Too much exercise.

Children with low blood sugar sometimes behave uneasy or act sleepy, and are often very hungry and shaky. Low blood sugar must be treated immediately by giving the child foods with simple sugars, such as glucose or fruit juice. If you suspect that a child has low blood sugar, do not leave the child unattended because the child can lose consciousness. Never send a child who you suspect has a low blood sugar to the home/clinic alone.

Hyperglycemia or high blood sugar occurs when the blood sugar level is too high due to too little insulin or too much food. Children with high blood sugar sometimes act lethargic and sleepy, and are often very thirsty and need to go to the bathroom a lot. Children with diabetes must be given free access to water and the bathroom whenever they feel the need. Prolonged hyperglycemia due to insufficient insulin can lead to a very serious condition called diabetic Ketoacidosis, which can lead to coma and death.

Some teachers think that children with diabetes sometimes pretend to feel low or high to get out of the classroom, or to get out of an activity that they do not like. This is very unlikely. Most children with diabetes don't want to be different, and they don't want their diabetes to cause them to be treated differently. If you think this is a problem, speak with the child's parents, but do not deny the child's request for water or a blood sugar test.

Children with type 1 diabetes are treated with insulin taken via injections, blood sugar monitoring, a carefully managed diet and exercise. Frequent blood glucose tests help to determine the correct amount of insulin to take and help identify low and high blood sugars. Children must be allowed to test their blood sugar at school. Testing in the classroom is preferred by many parents, since it minimizes time away from the classroom. Other parents prefer testing in a clinic. Children should be permitted to check their blood sugar whenever and wherever they want.

Most children with type 1 diabetes take insulin several times a day. Very few children take two injections, one before breakfast and one before dinner. They use two different kinds of insulin: one short acting and one long acting. Most children take three or more injections per day, with one injection of short acting insulin taken before each meal, and long acting taken with the pre-breakfast and pre-dinner injections.

Bathrooms are not a good place to do injections because they are often not very clean.

Children who inject insulin before lunch might need a little extra time before lunch to accommodate their injection.

Children with diabetes check their blood sugar many times per day. A blood sugar check involves pricking a finger with a lancet and placing a drop of blood on a special test strip. A blood sugar meter analyzes the test strip and reports the blood sugar level, usually in less than one minute. This process is called blood sugar monitoring.

Some children with diabetes are required to do blood sugar checks during the school day. Many do a check before lunch. Doing a blood sugar check is simple enough that most school children can be taught how to do it themselves. Younger children might need some adult supervision.

Proper education of teachers and school staff by parents prior to school starting can help eliminate the anxiety many teachers feel regarding in-classroom blood sugar checking. For children who check in the classroom, parents should provide a blood glucose meter that can remain in the classroom, a lancing device and lancets, a sharps disposal container such as the sharps container for proper disposal of the lancets, and emergency glucose for treatment of hypoglycemia. Lancing devices and blood glucose meters should not be shared, even among children with diabetes.

Regardless of where a child performs blood sugar checks, they must be allowed to check at school.

Children with diabetes must be allowed to check their blood sugar at school. When a child with diabetes has low blood sugar (hypoglycemia), he or she must be given access to emergency glucose to treat the low blood sugar. When a child with diabetes has high blood sugar (hyperglycemia), he or she must be allowed free access to water and the restroom.

Children with diabetes usually follow a meal plan. Meal plans come in many varieties, and is usually tailored specifically to the needs of each child. Parents should provide teachers the instructions, such as what foods must be avoided and what to do when food treats are brought in by other students.

Parents should also provide morning and afternoon snacks for those children with diabetes who require them. These snacks usually consist of carbohydrates, such as crackers, biscuits, cake piece, potato-chips, sandwiches etc. Children with diabetes who require snacks, but who are not allowed to eat them when required, are at very high risk for hypoglycemia. For these children, snacks are part of the essential medical care and are not optional.

All children with diabetes must be allowed to have ready access to emergency glucose to counter the effects of hypoglycemia. Left untreated, hypoglycemia can lead to loss of consciousness, convulsions and coma. Also, teachers must allow children with diabetes to eat snacks when prescribed by their doctor.

Exercise is important for all children, and children with diabetes are no exception. Diabetes does not prevent a child from participating in any exercise or outdoor activity. Physical education, however, be a challenging time for children with diabetes since exercise, like insulin, works to lower blood sugar. Teachers should know if a child has diabetes so they can provide help if needed.

Children with diabetes often eat an additional snack before participating in strenuous exercise. A good rule of thumb is 15 grams of carbohydrates for each 30 minutes of exercise.

If recess is immediately before lunch, for example, children with diabetes should be allowed to eat a snack before participating. Children with diabetes should be allowed to carry emergency glucose to treat hypoglycemia, especially if they will be outside, far away from classroom.

Physical education teachers should consider keeping a supply of emergency glucose or fruit juices on hand to treat hypoglycemia. Parents can provide glucose which work best and will not be confused with candy.