Information to record includes the following:
- What time does the student eat lunch?
- Does he eat a school lunch or bring lunch from home?
- Is there a plan if the student refuses to eat his lunch?
- Who is responsible for making sure the student eats a snack?
- Does the school restrict where food can be eaten?
- Can snacks be eaten in the classroom?
- If the whole class has a snack, how will the student with diabetes be accommodated?
- Are there classroom parties or special projects that involve food?
- If so, what are the guidelines and accommodations for the student with diabetes?
How the parents are kept informed of future or past parties or events must also be part of the written plan.
Over the past 10 years, dietary recommendations for people with diabetes have undergone enormous changes. There are therefore many misconceptions about what people with diabetes can and cannot eat. Parents should get the support of the child’s health-care team to let the school team know a kid with diabetes can eat anything that a kid without diabetes can eat. There are no “bad” foods that must be avoided completely; even moderate amounts of sugar can be safely consumed. Written instructions and good communication between parents and school are key to successfully fitting meals, snacks, special treats, and parties into the school routine of a student with diabetes.
Physical activity. Physical activity at school may include gym class, recess, and after-school sports. It is important to remember that while activity is a good thing for students with diabetes, planning is important. Depending on the intensity of the activity, as well as when and how long the student will be active, a change in insulin doses or an extra snack may be necessary to avoid low blood glucose.
The plan should address the following questions:
- Does the student add a snack or increase food at lunch prior to activity?
- Whose job is it to remember the extra food?
- Is the snack something that the student brings from home?
- Is there a set blood glucose level at which activity is restricted?
- What should be done if the child has very high or very low blood glucose levels before or after exercise?
Low blood glucose. A student may have obvious symptoms of low blood glucose, or his symptoms may be so subtle that they are easily overlooked. School staff must be aware of the student’s symptoms of low blood glucose, since these symptoms differ from person to person. Additionally, it is important for the staff to know what blood glucose level is considered “low” for the student; although the American Diabetes Association recommends treating most adults for low blood glucose at 70 mg/dl, some children’s diabetes teams may recommend treating at a slightly higher level to prevent hypoglycemia (low blood glucose).
The plan should address these concerns:
- At what blood glucose level should treatment be given?
- What should be used to treat low blood glucose and how much of it should be given?
- Who will treat low blood glucose?
- Where are the treatments kept?
- When should a teacher let the school nurse know that the student has or has had low blood glucose?
How near the nurse’s office is to the classroom, as well as how safely the student can get to the office, should determine whether the student is sent there. A student with low blood glucose should not be expected or allowed to walk alone to the school nurse’s or principal’s office.
When blood glucose levels drop so low that a student has lost consciousness, can no longer swallow, or is having a seizure, glucagon must be injected (glucagon is a hormone that causes the liver to release stored glucose). In case such an injection should become necessary, the diabetes plan must contain all the relevant information, including who will inject the glucagon, at what dose, and at what injection site. Once the student has been given glucagon, his parents or 911 should be called.