Many pharmacists need to interact with parents of children living with type 1 diabetes who require support at school.
By Shelley Diamond, BScPhm
Illustration by Martin Bregman
Not only can poor diabetes management affect blood glucose levels, but it can also affect academic performance, so being able to ensure that management routines are continued at school is of utmost importance. As well, children with diabetes need to be protected from stigma and discrimination. In 2015, the Canadian Paediatric Society developed a position statement, “Managing type 1 diabetes in school: recommendations for policy and practice.”
The main recommendations from this are:
- Schools having one or more students with diabetes must have at least two school personnel who are trained to provide support. Staff members do not have to be licensed healthcare professionals to administer insulin or glucagon, or perform blood glucose monitoring.
- Adequate personnel and resources should be available to schools managing diabetes in children.
- Schools must provide all students with a clean, convenient and safe area for diabetes self-care as well as respect students’ personal preference for privacy. Young children will need support for all aspects of glucose monitoring and insulin administration. Older children will likely need supervision only.
- Each student with diabetes must have an individual care plan (ICP), which should be discussed among the parents/guardians as well as teacher, principal and healthcare professionals as needed. An ICP is available through the Canadian Diabetes Association as well as JDRF.
- A designated staff member needs to ensure that meals and snacks are eaten on time and in full.
- Staff must know how to recognize and treat hypoglycemia. If emergency response time is expected to be more than 20 minutes for cases of severe hypoglycemia, school personnel must be trained to administer glucagon.
- Accommodations are recommended for tests and exams. A diabetes emergency kit can be kept at the desk which includes a blood glucose meter, hypoglycemia treatment and a snack. Hypoglycemic events before or during exams should be handled by providing an additional 30 to 60 minutes as needed to allow for cognitive recovery from hypoglycemia.
- Exclusion of any kind should be minimal and only in accordance with the student’s ICP.
- If students with diabetes need to attend medical appointments, they should not be penalized in terms of attendance-incentive policies.
There are several opportunities for you to help ensure parents and children are prepared to manage school days. These may include:
- Educating school staff and students about living with type 1 diabetes.
- Instructing assigned staff on how to administer insulin and glucagon and how to use a blood glucose meter.
- Providing education on how to recognize signs of hypoglycemia and hyperglycemia as well as how to manage them.
- Helping parents complete an Individual Care Plan.
For specific recommendations that outline the roles and responsibilities of parents/guardians or students, school personnel, and healthcare providers, see the Canadian Diabetes Association’s “Guidelines for the Care of Students Living with Diabetes at School,” which provides details on communication and education, daily management, as well as physical activity, sports and extracurricular activities.
JDRF has a School Advisory Toolkit, which “offers collaborative methods for educators and parents of children with diabetes to ensure that every child enjoys the best possible school experience.”
Students need to have a positive sense of self and belonging, participate in school activities and feel empowered to self-manage their diabetes effectively at school. These position statements help to clarify the essential roles of the diabetes care team.