Diabetes management in school

There are three main elements to diabetes management which work together to produce good control. These are medication (insulin), food and activity.

Insulin

Most children with diabetes will have Type 1 diabetes and will be treated with insulin injections. Insulin has to be injected – it is a protein that would be broken down in the stomach if it was taken by mouth like a medicine.

The majority of children will take two injections of insulin a day, one before breakfast and one before the evening meal. They are unlikely to need to inject insulin at school, unless on a school trip. Some children will take more than two injections a day, but this is not because their diabetes is ‘worse’ or harder to control. Taking more injections can give greater flexibility and older children, especially, may choose to take three or four injections a day. This will mean that they have to inject themselves at lunchtime and so will need to bring insulin and their injecting equipment to school. In most cases this will be an insulin ‘pen’ rather than a syringe. The child’s parents/carers or DSN can demonstrate the device used and discuss where the pen/insulin should be kept.

Food and snacks

The diet for children with diabetes is based on the healthy diet recommended for every child – a diet that is low in sugar and fat and high in fibre. There is no special diabetic diet and diabetic foods are not recommended by Diabetes UK as they offer no benefit over ordinary foods and can be expensive.

A regular intake of starchy carbohydrate at meals and snack times is important. The child will have seen a dietitian at the hospital, who will have advised her/him about suitable food choices on which daily meals can be based. The child’s parents/carers will be able to explain any particular needs to staff.

Meals and snacks should be eaten at regular intervals, following a plan drawn up by the family and the dietitian. It is important for the child to eat at regular times in order to maintain stable blood glucose levels. A missed or delayed meal or snack could lead to hypoglycaemia.

It is important for you to know the times when the child needs to eat and make sure that the child keeps to these times. S/he may need to be near the front of the queue (and at the same sitting each day) for the midday meal.

The child with diabetes will also need to have mid-morning and mid-afternoon snacks, such as fruit or crisps or a cereal bar, which the child should bring to school. These snacks are needed to maintain the blood glucose at a sufficient level between meals. Snacks may need to be eaten in class, but are best eaten at break time, if this is at a suitable time.

Carbohydrate foods are important because the child will need to eat enough of these to maintain near normal blood glucose levels. These foods can be roughly divided into quickly absorbed and slowly absorbed carbohydrate.

Slowly absorbed starchy carbohydrates help to maintain near normal blood glucose levels. They can be found in the following foods, at least one of which should be eaten at every meal:

potatoes, rice, bread, chapatis, pasta, pulses, fruit and breakfast cereal.

Quickly absorbed carbohydrate (sugary foods) is useful for raising blood glucose levels quickly (as in treating hypoglycaemia). These include:

fizzy drinks (non diet), puddings, sweets, chocolate, syrups, squash, jam, fruit juice, fruit.

Sweets and chocolates may be incorporated into the diet (but should be limited in the day-to-day food intake), either before exercise when extra energy is required or after a meal as a treat. Likewise the occasional pudding will not do any harm as part of an overall healthy diet.

Exercise and activity

Diabetes shouldn’t stop the child from enjoying activities or sport. In addition to thousands of people who enjoy sports, there are successful footballers, ballet dancers and marathon runners with diabetes. People with diabetes, such as Sir Steve Redgrave, have competed in and succeeded at top-level sports at national and international levels. Therefore, there is no reason why children with diabetes should not join in all school sports, or be selected to represent school and other teams, providing they have made some simple preparations.

These preparations are needed because all forms of activity, such as swimming, football, gymnastics and walking, use up glucose. If the child with diabetes uses too much glucose or does not eat enough before starting activity, the blood glucose will fall too low and the child will experience hypoglycaemia.

It is important for the child with diabetes to eat some additional sugary food before vigorous activity. This will depend on the individual child but could include:

·      mini chocolate bar

·      cereal snack bar

·      two biscuits.

This will provide the extra glucose needed for the activity. The more strenuous and prolonged the activity, the more food will be needed before, and possibly during and after, the activity.

During activity sessions, it is important to have glucose tablets or a sugary drink nearby (eg on the side of the pool or at the side of the pitch) in case the child’s blood glucose level drops too low. During any school sports activity it is important that teachers keep watch over all the children. The child with diabetes need not be singled out for special attention. This could make the child feel different and may lead to embarrassment.

After activity the child may need to eat some more food. This depends on the timing of the activity and the level of exercise taken.

Most children love joining in activities, but some less favoured activities, such as cross country running, may elicit a range of excuses from some children. We hope that the child with diabetes will not use their diabetes as an excuse for not participating. If this does occur regularly, speak to the child’s family to find out more about the individual situation. Diabetes should not be an excuse for opting out of school activities.

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