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Children with Diabetes: Information for Schools and Child Care Providers

Looking for a great resource to hand to your child’s teacher or care provider? Our recently updated brochure, "Children with Diabetes: Information for School and Child Care Providers" is just the ticket.

This helpful brochure covers diabetes basics for people who don’t live with it every day:

... and much more!

Click here to download "Children with Diabetes" today, or call us at 1-800-DIABETES (342-2383) and we'll mail you a copy. 

Diabetes at School

Diabetes care is a 24-hour-a-day job—and the time your child spends in school is no exception. Thorough education of and regular communication with her principal, teacher(s), school nurse, and other personnel are essential to helping your child stay in good control during the school day. The information included here is also useful if she spends time in a day-care center or other after-school care. To learn more about care for your child with diabetes, read our Consensus Statement on Care of Children with Diabetes in the School and Day Care Setting.

It is essential to meet with personnel at your child’s school and map out a plan for her diabetes care before she returns to school. Key school personnel should know of and be capable of meeting her diabetes needs from the first day your child returns to school. Also, keep in mind that the initial orientation of school officials will be just the start of ongoing communication to ensure your child’s health and well-being at school.

It’s a good idea for you and your child to work with a diabetes educator to create a school diabetes plan. You want to enter that first meeting with school officials with a concrete, written plan of action. You may end up making changes to the plan after talking with the school, but having a document to work with will keep you (and the meeting) on track. Your diabetes educator can recommend or supply you with pamphlets or information sheets on the basics of diabetes to give to school officials. You may also wish to ask the diabetes educator to accompany you to the school meeting.

Schools may have different names for the written document(s) that make up a plan for your child’s diabetes care at school. Here are the three elements that should be included.

• Information packet. You and your diabetes educator should put together a diabetes information packet. This packet may contain various brochures and articles with general information on diabetes. It should include information on what diabetes is and how it’s treated, what hypoglycemia and hyperglycemia are and how they’re treated, and anything else that can give the school a better understanding of diabetes.

• Health Care Plan. This plan should outline your child’s diabetes treatment—her target range, insulin schedule, eating plan, and usual blood sugar testing times. It should also include instructions on what to do in various situations (treatment for hypoglycemia, for example). This information may be included in the Diabetes Care Plan instead of as a separate document, depending on the procedures in your state or school.

• Diabetes Care Plan. This plan is often called a "504 Plan" or "IEP" after terminology used in federal laws on disabilities (see Chapter 11 for more details). Your child’s diabetes care plan should cover the responsibilities of you and the school in specific detail. It should also list any accommodations the school needs to make for your child.

A key part of ensuring good diabetes care at school is a clear understanding of who will be responsible for each task. In general, you are responsible for providing all diabetes equipment and snacks. You also should take an active role in educating and training school personnel in diabetes care. Your diabetes educator or doctor can help you train key school personnel to perform the necessary diabetes tasks. Also, make sure that the school is able to reach you, your spouse, or other responsible adult quickly in case of emergency. Carrying a beeper or a cellular phone can give both you and school officials a little more peace of mind.

The school should be willing and able to do the following, as needed by your child.

• An adult and a back-up adult should be trained to test blood sugar, know what to do if the blood sugar is out of the target range, know when and how to test for ketones, and know what to do if your child’s ketone level is abnormal.

• An adult and a back-up adult should know how to recognize and treat hypoglycemia and hyperglycemia. If your child is mature enough to treat herself, she should be allowed to do so—but she should remain under the supervision of an adult at all times during a hypoglycemic reaction and should not be required to walk alone to another part of the school to test blood sugar or get treatment.

• If your child needs an insulin injection(s) during school hours, an adult and back-up adult should be trained to give her insulin injections (and/or supervise her as she administers her own injection).

• An adult and back-up adult should be trained to give a glucagon injection.

• If you and/or your child desire it, the school should provide a location in which she can check her blood sugar or take insulin privately (but still with adult supervision, if needed).

• An adult and back-up adult should know your child’s meal plan and work with you to coordinate it with the schedule of the other children in the class, if possible. This person should also notify you whenever special events come up that would affect the meal plan.

• All adults who have responsibility for the immediate custodial supervision or care of your child at school should be trained to recognize hypoglycemia and hyperglycemia and know emergency procedures.

• Allow your child to see the school nurse or other school medical personnel whenever needed.

• Allow her to eat a snack anywhere and to use the restroom and drink water at any time.

• Allow her to miss school for doctor’s appointments to monitor diabetes without negative consequences.

• Provide a safe location for storage of insulin and glucagon, and allow your child immediate access to her diabetes supplies at any time.

• Ensure her full participation in all sports, extracurricular activities, and field trips, with any necessary supervision provided.

• Provide aids to help your child academically, if needed. Examples of situations in which this might be necessary include making up for class time missed due to diabetes care or academic problems that can be traced to frequent hypo- or hyperglycemia.

The health care plan for your child should spell out the details of her diabetes treatment, including the following information.

• Your child’s blood sugar target range.

• Blood sugar testing—how to do it, how often your child needs it, and special circumstances when she might need additional testing (like hypoglycemia).

• Your child’s meal schedule and appropriate food choices.

• When and how to give insulin injections (if necessary during the school day).

• Hypoglycemia—symptoms and treatment, including administration of glucagon.

• Hyperglycemia—symptoms and treatment.

• Ketones—what situations warrant testing, how to test, and what to do if the test is abnormal.

• Daytime phone numbers for you and/or your spouse or other adult care-giver.

• Phone number of your child’s doctor.

• Instructions on when to call you (many parents want to be informed about any hypoglycemic episode that occurs at school, not just emergencies).

Consult your child’s doctor and diabetes educator for help in creating a health care plan, or click here for a sample health care plan.

The main goal of the initial meeting(s) with school officials is to agree on a clear, detailed diabetes care plan for your child. It’s a good idea to ask school officials to evaluate your child under Section 504 of the Rehabilitation Act of 1973 (Section 504 for short) or the Individuals with Disabilities Education Act (IDEA).  These laws give you and the school a procedure for evaluating your child’s needs and agreeing on accommodations.

Begin discussing the diabetes care plan by going over the health care plan that you, your doctor, and your diabetes educator created. Answer any questions the school officials may have about diabetes and your child’s care. If other students with diabetes attend or recently attended the school, you may find that school officials take her diabetes care in stride. If she is the first student with diabetes to attend the school, school officials will probably need more detailed explanations and training.

Using the health care plan, list all of the diabetes tasks to be performed at school. In addition, let the school officials know which tasks your child can perform without supervision, which ones need supervision, and which tasks must be done for her. (This will depend on her age and experience with diabetes.) Together with school officials, decide who at the school will be responsible for doing/supervising each diabetes task.

Then discuss any necessary accommodations. These accommodations will vary according to the needs of each child with diabetes. 

Some children with diabetes and their parents face discrimination at school. Don’t allow uncooperative school officials to endanger your child’s health. In many cases, school officials are simply unfamiliar with diabetes and/or with laws concerning children with disabilities. Education may be all that’s needed to resolve the issue. Unfortunately, sometimes education is not enough. If your child is facing discrimination (in school or in some other arena), click here to learn her rights under the law and suggestions for combating diabetes discrimination.

If your child eats snacks and/or checks her blood sugar in the classroom or nurse’s office, her classmates will naturally want to know why. A short statement by your child or her teacher about her diabetes is probably sufficient to allay students’ immediate curiosity.

Of course, many of her classmates will naturally want to know more about diabetes. This is a good opportunity for your child to educate her friends and other students about diabetes. However, the decision of how and when to tell classmates and how many details to include is up to her (with your input). You may wish to encourage her gently to be open about her diabetes. Here are some options that you and/or your child might consider to tell her classmates more about diabetes.

• Your child could talk to her class about diabetes. This could be in the context of a school assignment, such as a science project or a speech class. Or her teacher(s) may allow it as a special educational experience for the class.

• Your child may prefer to invite her diabetes educator to class. Diabetes educators are trained to teach in a variety of settings, and most have experience visiting their clients’ schools.

• She may decide to go with a more low-key option—answering questions from classmates as they come up.

Whatever option your child chooses, provide her with age-appropriate materials to give to friends and classmates as needed. Your diabetes educator can recommend these materials.

Sometimes children with diabetes want to keep their condition a secret from as many people as possible. They may feel that diabetes is something to be ashamed of (especially if they have the mistaken idea that diabetes is their fault). Or they may be afraid of appearing different from their friends and classmates. If your child is newly diagnosed, it just may take some time and encouragement for her to accept her diabetes. But if she remains overly secretive (or if her secrecy becomes a danger to her health), it may be helpful to consult a mental health professional with expertise in children with diabetes (or other chronic diseases).

Finally, keep in mind that every child is different. How open your child is about her diabetes—at school and in the rest of her life—depends on her personality and her attitude toward diabetes. You may also see her attitude change in the coming years, as she grows in both maturity and diabetes experience.

Unfortunately, people with diabetes—of all ages—face discrimination at times. Children with diabetes most often run into discrimination at school or day care. Here are some real-life examples of problems that children with diabetes have faced.

• Not allowed to go on field trips, or not allowed unless a parent comes along.

• Being cut from a sport because the coach thinks people with diabetes can’t be good athletes.

• Not allowed to test blood sugar in class.

• Not allowed to eat snacks in class or on the bus.

• Being punished for being absent from school because of diabetes.

• Not allowed to participate in after-school activities because no one there knows about caring for diabetes.

In many cases, discrimination against children with diabetes can be resolved through education of the parties involved. In some cases, parents may have to file administrative complaints or even a lawsuit to get their concerns addressed. Parents of children of diabetes need to know their child’s rights under the law.

It is illegal to discriminate against a person with a disability. What qualifies as a disability under the law depends on which law you are talking about. There are three federal laws that protect people with disabilities in the school and day care settings. These laws have successfully been used to protect the rights of children with diabetes. 

Section 504 of the Rehabilitation Act of 1973. This law forbids any organization that receives federal funding (including all public schools and some private schools and day-care centers) from discriminating against anyone with a disability. You don’t need to wait until discrimination occurs to seek the protections of this law. The first step is having your child evaluated under Section 504. Parents and school officials then meet and develop a Section 504 Plan. A Section 504 Plan would include the information listed for a "Diabetes Care Plan" discussed in Chapter 10. Often, good schools want to develop a Section 504 Plan so that everyone knows his or her responsibilities.

The Individuals with Disabilities Education Act (IDEA). This law covers children whose disability impairs their school performance. It requires that such children be given a "free, appropriate public education." Your child may or may not qualify, depending on how diabetes affects his academic performance. If he qualifies, you have the right to develop an Individualized Education Plan (IEP) with his school. An IEP is similar to a Section 504 Plan but would include specific measures to address your child’s academic performance.

The Americans with Disabilities Act (ADA). Among other things, this law expressly prohibits all schools and day care centers—except those run by religious institutions—from discriminating against people with disabilities. Its definition of disability is the same as in Section 504.

Basically, these laws say that your child has the right to go to school, play a sport, join a club, and do everything else that kids without diabetes do. They also say that public schools and other covered organizations must make "reasonable accommodations" for his diabetes. Such accommodations are to be spelled out in the diabetes care plan, Section 504 plan, and/or IEP. (See Chapter 11 for suggestions for working with the school on such a plan.) Accommodations may include:

• Assuring that there are staff members trained in testing blood sugar levels, recognizing and treating hypoglycemia and hyperglycemia, and administering insulin and glucagon.

• Allowing your child to self-administer blood glucose tests in the classroom and in other locations, and allowing him to promptly treat hypoglycemia and hyperglycemia.

• Ensuring full participation in all sports, extracurricular activities, and field trips, with the necessary assistance and/or supervision provided.

• Eating whenever and wherever necessary, including eating lunch at an appropriate time with enough time to finish eating.

• Taking extra trips to the bathroom or water fountain.

• Permitting extra absences for medical appointments and sick days when necessary.

For more information on your and your child’s rights, click here.

What You Can Do

Believe it or not, some people who discriminate don’t know it. They may not know enough about diabetes. They may honestly believe that they’re doing what’s best for your child.

Your first step, then, is to educate them about diabetes. Try not to show the anger and hurt you may feel on behalf of your child—that only puts people on the defensive. Instead, explain the reasons for your requests—both in person and in writing. You may wish to ask your doctor or diabetes educator to help explain key points or to back up the information you give about diabetes. In many cases, once people know more about diabetes and your child’s needs, they will stop the discrimination.

If educating people about diabetes doesn’t help, you (and your child, depending on age) may have to make some decisions about what to do next. Some things you can do:

• Call the American Diabetes Association at 1-800-DIABETES and ask to fill out an education discrimination form. 

• Contact officials higher up in the school system. Describe your complaint, your child’s needs, and your rights under the law. Be knowledgeable, calm, and confident about his needs and legal rights—you will be taken more seriously.

• Contact any other people in the community who might be able to help (elected officials, the local newspaper).

• Contact other parents of kids with diabetes or the American Diabetes Association for suggestions and support.

• If the problem is serious, look into involving the legal system.

You and your family and friends can help prevent discrimination against your child and other people with diabetes. Every time you give someone correct information about diabetes, you’re helping to stop discrimination. You may also want to get involved in diabetes organizations—such as the ADA—that fight for the rights of people with diabetes. You and your child could write letters to people in government—the president, your state and national senators and representatives, your governor, and your local school board—to inform them about diabetes and discrimination. For more information on advocacy for people with diabetes, click here.

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