Returning to School with Diabetes
Provided by: Kellie Rodriguez, MSN, CDE, CPT
Well, the long summer break is over, and the school year has begun!
With that comes excitement about connecting with friends and meeting new teachers, and of course, some anxieties about embracing a new curriculum and getting good grades. For our children with diabetes, we know there are extra factors to consider.
For parents, students and school personnel, these quick tips might calm your concerns:
1. Develop a Written Plan
Created and implemented as a team between the health care provider, the school and the family. The written plan begins with a Diabetes Medical Management Plan (DMMP), which forms the basis for care of the child with diabetes at school. Also ensuring you complete a 504 Accommodations Plan is important to ensure diabetes does not create barriers to opportunities for education. The main focus of the plan is to promote open communication between the child’s team, reduce unnecessary anxiety and create clarity in the diabetes care needs of the child. The American Diabetes Association website has great information pertaining to written plans – www.diabetes.org.Talk to your health care team too!
2. Educating School Personnel and Students
Challenges for children with diabetes at school can often arise because of a lack of accurate and specific information about the safety needs of your child with diabetes. Arranging to meet with school personnel prior to the start of the school year is always best, to identify any learning opportunities early. Informing fellow students is also a smart move because they are the ones who are usually with your child in the classroom and the playground. Diabetes Educators are often open to meeting with school personnel and students to provide education and reduce anxieties. There are many free education materials that can be provided to the school to make diabetes just a part of the school day. Also – what a great project if your child can take the lead on providing helpful information – be an ambassador for the school and other children living with diabetes by giving a classroom presentation! Super cool!
3. Diabetes Supplies
Being prepared at school is really important. Ensure there is room in your child’s school bag or school locker for all the supplies needed to check glucose levels, administer insulin and of course, test for ketones and treat hypoglycemia. If using an insulin pump, placing all the supplies you would need in a ziplock bag makes changing sites much easier in a stressful moment. I always tell children and adults on insulin therapy to ensure they always have 3 things with them at all times to be safe: “Your meter, your insulin and rapid acting glucose (Rule of 15g).” You never want to have to walk somewhere to get these items – always have them by your side (especially your meter and rapid glucose).
4. Carb Counting
Everyone with diabetes needs to learn carb counting. However, if you are determining your insulin dose based on the amount of carbs you are eating, then it is a good idea to be accurate. For school lunches from home, label each food item separately. Your child may not always want to eat all of the wonderful lunch you have prepared, or may want to share with their friends. If the lunch is from the school cafeteria, learn about the foods that the school prepares and identify the weekly food schedule, so your child has a better idea of what to expect to eat for their meal. If math is a challenge, place a small calculator in the lunch box or if they have a smart phone, download an insulin bolus app to assist with accurate insulin dosage determination. Get children involved in carb counting early – we know parents are usually excellent – let’s help the kids be superstars, too!
Sadly, we are seeing less and less formal exercise in schools, but exercise is an important consideration for children with diabetes. The main challenge can be hypoglycemia (low blood glucose levels) with increased physical activity. The opposite challenge can be exercising when experiencing high blood glucose levels. When glucose levels are above 250-300mg/dl, you should always check for ketones in the urine before exercising – never exercise with ketones present. The key to having fun with exercise is to monitor the glucose levels before and after exercise to learn how your child responds to different forms of activity. Perhaps your child could present it as a game for their friends to see which friend can guess the blood glucose change with different types of exercise. Get everyone involved.
Of course – I have to say, join the Parents Empowering Parents/PEP Squad group. The best way to reduce anxieties about the school year is to learn and share with those who know best – other parents and children!