Managing Diabetes in School
Diabetes is a chronic condition that can lead to complications during the school day for a student. The school nurse assists with care management for students with diabetes. Diabetes management in school includes collaboration with family, care coordination with healthcare providers, communication with school personnel who have a legitimate educational interest, coordinating training for identified staff who may provide emergency care, and maintaining documentation. An individualized plan of care must be developed for a student with diabetes to ensure they can participate in all school activities.
National Association of School Nurses. (2021). A model for school nurse-led case management.
What is Diabetes Mellitus?
Diabetes mellitus (DM) is a chronic disease in which there is an impairment for how the body utilizes glucose converted from your food. Insulin is a hormone produced by the pancreas that helps regulate blood glucose levels by helping the glucose get into the cells to be used for energy. Insulin acts like a key to unlock and let the glucose into the body’s cells. With diabetes, either the body does not produce enough insulin, or it can’t effectively utilize the insulin it does produce. CDC: Diabetes
Types of Diabetes
Type 1 diabetes is an autoimmune disorder where the immune system attacks and destroys insulin-producing beta cells in the pancreas. People with Type 1 diabetes require lifelong insulin therapy and blood sugar monitoring.
In the school setting, Type 1 diabetes can require significant school nurse time for care coordination, planning, intervention, education, and training depending upon the age, developmental status and especially when newly diagnosed.
Type 2 diabetes is characterized by insulin resistance, where the body’s cells do not respond effectively to insulin and may produce less insulin. People with Type 2 diabetes typically can manage it through diet, exercise, oral medication, and sometimes insulin therapy.
Gestational diabetes is a form of diabetes that develops during pregnancy and typically resolves after childbirth. Women with gestational diabetes manage it through diet, exercise, blood sugar monitoring, and sometimes insulin or other medications.
What is a Diabetes Management Plan?
A diabetes management plan is a personalized plan designed to individuals with diabetes maintain optimal blood glucose levels and reduce the risk of complications. All students with Type 1 diabetes school have this plan developed by the health care provider / diabetes educator.
- Components included in a diabetes management plan:
- Medication information and dosing
- Blood glucose target range
- When to check blood glucose
- throughout the day and with specific types of activities
- Diet and nutrition, including carbohydrate counting
- And how to dose mealtime insulin based on carbohydrate counting
- How to respond to low and high blood glucose levels
Diabetes management plans are highly individualized and may have frequent adjustments made to it to better control the disease. The school nurse needs to communicate with the healthcare provider and the parent/guardian to understand who is authorized to adjust the diabetes management plan, especially when it impacts management to treatment being provided during the school day.
What is a Diabetes Emergency Action Plan?
A diabetes emergency action plan/emergency care plan is a pre-defined set of step by step instructed to help guide the actions of caring for a diabetes-related emergency such as hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar). This plan is crucial for ensuring quick and appropriate actions to prevent serious complications. This plan is often incorporated into the overall diabetes management plan, but the RN/LSN/PHN may need to provide additional information in a school specific emergency care plans/emergency action plan.
Nurse Care Planning in Schools provides additional information about emergency care plans/emergency action plans.
Self-Management
Determining if a student is ready to self-manage their diabetes involves evaluating their knowledge, skills, maturity, and responsibility. The nurse should work with health care provider and parent/guardian to determine readiness, self-care skills and safety.
Resources
Diabetes Resources for School Nurses: Emergency Care Plans, Training Tools & Resources document is not an exhaustive list; however, represents reputable resources for a School Nurse to utilize in his/her/their practice. These resources may be used in care planning for students, to strengthen competency for a nurse, or may be used to train other people performing these cares.
Learn More
US Department of Education Office of Civil Rights Section 504 Protections for Students with Diabetes