Supporting Students with Diabetes

Diabetes is a metabolic disease affecting how the body converts food into glucose, or blood sugar. In people with diabetes, the body cannot produce enough insulin to keep the blood sugar within targeted levels. Diabetics often need to take insulin throughout the day to keep the body’s blood sugar regulated. When a diabetic student’s blood sugar becomes either too high or too low the student’s ability to focus and learn is impacted.

Unfortunately, diabetes has no cure. However, a diabetic’s goal is to manage the disease through blood-glucose testing, proper nutrition, exercise, administering proper dosages of insulin (via injections or pumps), and/or prescription medication. If diabetes is not managed effectively, serious health problems may occur.

Students with diabetes can be supported by schools and districts with the implementation of guidelines and procedures that encourage the establishment of diabetes medical management plans (DMMPs) for diabetic students. With such plans in place, schools can increase students’ health, safety, attendance, and academic success.

Two Types of Diabetes that Affect Students

Two forms of diabetes exist:

• If someone has Type 1 Diabetes (T1D), their pancreas has stopped producing insulin, so they must take insulin daily to live. This type occurs most often in children and young adults.
• If a person has Type 2 Diabetes (T2D), their pancreas still produces insulin, but the amount produced is likely inadequate. Also, the cells in their muscles, liver and fat may not be using the insulin properly. The most common form of diabetes, T2D previously impacted adults almost exclusively. However, as inactivity and obesity have increased, the disease has become more common in children and teens.*

* According to the Mayo Clinic, the “increasing number of children with obesity has led to more cases of Type 2 Diabetes in younger people.” Although exact causes remain unknown, risk factors for T2D include weight, inactivity, diet, and family history, to name a few.

DMMPs and Section 504 Plans for Diabetic Students

Keeping blood glucose levels in the target range can help prevent many potential health problems. An official Diabetes Medical Management Plan (DMMP) prescribes the health care provider orders for all diabetes care provided in the school setting. This individually developed plan is developed and signed by the student’s diabetes provider. The DMMP is the basis for all the health care and education plans designed to meet the needs of students with diabetes. The DMMP works in conjunction with a Section 504 Plan, or simply a 504, after Section 504 of the Rehabilitation Act of 1973.

According to the American Diabetes Association (ADA), “A 504 Plan sets out the actions the school will take to make sure the student with diabetes is medically safe, has the same access to education as other children, and is treated fairly.” These plans are important tools used to ensure that students, parents/guardians, and school staff “understand their responsibilities and to minimize misunderstandings.”

A 504 for diabetic students lists a broad range of services and modifications that are often needed by students with diabetes, ranging from kindergarteners to high school seniors. All plans should specify that school staff must be trained to recognize hypoglycemia and hyperglycemia and to respond in accordance with the student’s DMMP.

A sample DMMP can be found here.

A sample 504 Plan for Students with Diabetes can be found here.

Hypoglycemia

Hypoglycemia occurs when blood glucose levels drop too low, usually below 70 mg/dL, and can be potentially life-threatening and must be treated immediately. This can develop within minutes, and therefore, is a diabetic’s greatest danger. Hypoglycemia may be caused by carb-counting errors, exercising too long or intensely without eating extra carbs, skipping, or delaying meals or snacks, too much insulin being administered, or several other factors.

Symptoms of low blood sugar include:

• behavior change (combativeness, irritability, crying)
• confusion
• dizziness
• drowsiness
• lack of focus
• nausea
• pale skin
• shakiness
• slurred speech
• sweating
• weakness, among others.

Hypoglycemia Treatment

Treating hypoglycemia depends on the severity of the symptoms. If a student with low blood sugar is alert and able to swallow, give them a fast-acting glucose product equal to 15 carb grams, such as 4 ounces of juice, 6-8 ounces of regular soda, two, three or four glucose tablets, or five to six pieces of hard candy. After 15 minutes, retest the student’s blood sugar level and if it is still less than the target range, repeat the administration of 15 carb grams.

Severe hypoglycemia is a medical emergency that requires immediate attention. If a student with severe hypoglycemia is unconscious or unable to swallow, do not give them fast acting carbs. Never leave the student alone and direct someone to call 9-1-1 immediately. This may also call for a glucagon injection or nasal spray. Call the school nurse or other medical personnel for assistance and always consult the student’s DMMP for further instructions.

Hyperglycemia

Conversely, hyperglycemia occurs when there is too much glucose in the blood, and over time can lead to serious health problems, including heart disease, stroke, diseases affecting the kidneys, eyes, feet, and gums. The student should test their blood glucose levels to determine how high the blood sugar levels are.

The goal of treating hyperglycemia is to lower the student’s blood sugar. This may include allowing the student to drink water or other non-carbohydrate liquids, or possibly assisting the student with an insulin injection or bolus dose from their insulin pump, if applicable. Consult the school nurse or other medical personnel for assistance.

Research shows, however, that these problems can be greatly reduced and even prevented by maintaining blood glucose levels near normal. Keeping blood sugar levels within certain ranges will also prevent symptoms that can interfere with learning, such as fatigue, blurred vision, and increased hunger and irritability.

The School Health Team

According to the National Institute of Health, the school health team “ensures that students with diabetes receive all the help they need while in the school setting.” The team should include people who understand diabetes, the school environment, and state and federal nursing laws. Members of the school health team usually include students with diabetes, parents or guardians, school nurses, and teachers, administrators, and other school staff members.

Tips and Best Practices to Support Students with Diabetes

According to the ADA, there are a few ways teachers can keep students with diabetes safe at school. Some of these include:

• Learn as much as you can about diabetes. Be aware of essential diabetes care tasks and be prepared to respond in the event of a diabetes emergency.
• Every student with diabetes is different. Students may utilize different strategies to manage their diabetes. While some may need help and some may be more independent, learn the best ways you can support them.
• Collaborate with other school staff members. Teachers, school nurses, and other personnel with supervisory responsibilities should participate in team meetings and understand their roles in supporting the students.
• Understand federal and state legal protections for students with diabetes. Become familiar with your role in the development and implementation of the students’ written plans.
• Always be prepared. A “low blood sugar kit” containing food and other supplies to treat hypoglycemia should always be available in the classroom.
• Don’t draw unnecessary attention to the student’s condition. Allow them to eat a snack in the classroom, or test their blood sugar, or even take insulin without the necessity of leaving the classroom or drawing attention.
• Communicate concerns to parents/guardians, school nurses, or administrators. Provide timely and clear communications about any health issues related to diabetes.
• Treat the students with diabetes the same as other students. Students with diabetes should be treated fairly and have the same access to all school opportunities as their fellow students.

Teachers, school nurses, administrators, and other school staff members play an essential role in ensuring that students with diabetes have the support and opportunity they need to stay healthy and prepare to do their best in school.