Other considerations

Blood glucose testing

Most children with diabetes will need to test their blood glucose levels on a regular basis. They may need to do this at school, especially before or after physical activity, or if they feel that their blood glucose level is falling too low or climbing too high (hyperglycaemia).

Blood glucose testing involves pricking the finger, normally using a special finger-pricking device, to obtain a small drop of blood. This is then placed on a reagent strip, which is usually read by a small, electronic blood glucose meter. A test takes about a minute in total.

The child’s parents/carers can advise on how often blood glucose levels should be tested.

Hypoglycaemia

Hypoglycaemia (hypo) is the most common short-term complication in diabetes and occurs when the blood glucose level falls too low. This is especially likely to happen before meals. This can happen as a result of

·      too much insulin

·      too much activity/exercise without enough sustenance

·      too little food.

Hypos happen quickly but most children will have warning signs that will alert them, or people around them, to a hypo. These warning signs can include:

·        hunger

·        sweating

·        trembling or shakiness

·        pallor

·        drowsiness

·        glazed eyes

·        lack of concentration

·        mood changes, especially angry or aggressive behaviour.

The symptoms can be different for each child and the child’s parents/carers can tell you what symptoms their child will have during a hypo.

It is very important that a hypo is treated quickly. If it is left untreated, the blood glucose levels will continue to fall and the child could become unconscious. The child should not be left alone during a hypo – nor should they be sent out of the classroom alone to get food to treat it.

Initial treatment is to give the child something sugary, to quickly raise the blood glucose level. Sugary foods include Lucozade, non-diet fizzy drinks, mini Mars bar, glucose tablets or fresh fruit juice. Most children will be aware when they are going hypo and will be able to take appropriate action themselves.

If the child still feels hypo after 15 minutes, some more sugary food should be given. Once the child has recovered it is important that they eat some starchy carbohydrate food. This will prevent the blood glucose level from falling again before the next meal or snack is due. Starchy foods include a sandwich, crisps or biscuits and a glass of milk.

If a hypo occurs during activity, there is no reason why the child should not continue with the activity once s/he has recovered.

If the child is very drowsy, but still able to swallow, you can massage Hypostop (a glucose gel) or honey or jam, into the inside of the child’s cheek. The glucose will be absorbed through the lining of the mouth and the child will recover. In the unlikely event of a child losing consciousness, do not give them anything to swallow. Place the child in the recovery position (lying on their side with the head tilted back). Call an ambulance. If the child does lose consciousness, s/he will come around eventually and should not come to any immediate harm.

Extra curricular activities

Day outings should not cause any real problems, as the routine will be much like that at school. Remember to take along a copy of the Diabetes record sheet and some extra food, such as fruit or sandwiches, in case of unexpected delays. In addition, children should take their insulin and injection kit, just in case delays continue over their usual injection time.

In the case of overnight stays, these will include injection routines and blood glucose monitoring. You will need to be confident that the child is able to do their own injections or that there is a member of staff who is willing to take responsibility for helping with injections and blood glucose testing. If the child is not doing their own injections, most parents/carers, quite sensibly, would not consider letting them go away at this stage.

If you are travelling outside the UK, you will find the following Diabetes UK publications useful: Travel and diabetes, which gives advise on managing diabetes confidently away from home and the Country guides, which contain information about local foods and diabetes care and translations of useful phrases It is also important to check that travel insurance will cover pre-existing conditions, such as diabetes, in case of a medical emergency. Diabetes UK produces an information sheet Insurance and diabetes. See page 13 for details on how to order these and other Diabetes UK publications.

Before any longer trip, use the checklist below to make sure that the child has a pack of everything necessary. Things can easily be forgotten in the excitement of the departure. The teacher should carry a spare ‘student pack’ in case of loss. If any medical equipment has been lost or forgotten, contact the paediatric department at the nearest large hospital, who will be able to help.

Checklist for trips/holidays

* see page 13 for details on how to order.