Back to School With T1D

Whether you are sending your child with diabetes to school for the first time or you have doing it for years, there are some things you might want to consider before the first day!  Keep in mind, the following is all based on our personal experience as a family and my experience as a teacher. What works for us and is important to us may not be the same for you.  Also, our experience is elementary based but can definitely be modified to meet the needs of your middle or high school student.  



Before the Year Begins…

As soon as you know who your child’s teacher is going to be, set up a meeting.  We feel it’s important to meet with the teacher before the year begins.  You might want to include the school nurse and the special area teachers in this meeting.  Keep in mind that it will most likely be very difficult to find a time when all these people can attend!  What works for us is to meet with the nurse and the teacher separately.  We do not feel we need to meet with the special area teachers.  



Create a diabetes fact sheet for the teacher and the special area teachers.  You can find samples of these under the “School and Caregiver Info” tab.  We include a picture of our daughter at the top.  We also make sure the teacher has an extra copy or two for his/her substitute folder or other needs.  We also create a more detailed information sheet for the teacher that explains type 1 diabetes in more detail.  During our meeting, we go over this sheet and explain how type 1 diabetes affects her at school

Tips for a Successful Meeting…

The most important thing is to approach the meeting with a positive attitude and in a spirit of teamwork.  Most teachers don’t know anything about type 1 diabetes.  However, this does not mean that they won’t be willing to learn.  In my experience as both a parent and a teacher, most teachers truly want what is best for your child.  That’s how I approach the meeting… with a “I know we both want what is best for my child and so let’s talk about how we can have a successful year together!”  


Things you will want to discuss with the teacher:

birthday party treats
food or candy given as rewards
academic concerns related to high/low blood sugar
classroom parties
your child’s unique high/low symptoms
procedures for safety drills
lunch
field trips
anything else you may be concerned or unsure about

There is no right or wrong way to handle these things.  It will vary and depend on the needs and personality of the child and teacher.  

I have offered to send in treats that were more “bg friendly” for our child for the teacher to use as rewards (including small, non food items).  I have also offered to volunteer and/or send in things for classroom parties (I’ve been known to volunteer for the drinks and buy small water or the low carb juice options!)  We would rather our daughter be included in all treats and special occasions than to sit out or have something different from the rest of the class.  We know that covering these treats may not be done perfectly or like we would do it but feel that it’s ok on occasion.  This is when we stress that she CAN eat anything and SHOULD be included in all activities.  We discuss our plan for this - when she is to go to the nurse to check her bg and get insulin, etc.  You might prefer to send in treats so that your child always has something with a known carb count or have your child bring rewards home.  This is entirely up to what works best for your child and your family! 

We have created a special bag for our daughter to take with her during emergency drills that she keeps in her classroom.  We also know and have had some issues with her not being able to perform/remember/etc when her blood sugar is low or dropping so this is when we talk about that and ask that she be reminded to look at her cgm and write that number on top of all tests.

Things you will want to discuss with the nurse:

orders from the doctor
supplies
procedure for checking blood sugar and giving insulin
the plan for the day (when your child will check bg, etc)
lunch
snacks
birthday and other classroom treats
training staff about type 1- including bus drivers!
procedure for substitute nurses
if your child is going to check in the classroom/handle some of his/her own care
how to treat lows/highs
safety drill procedures
playground procedures
anything else you may be concerned or unsure about

Again, there is no right or wrong way to handle these things!  It will vary and depend on the needs of your child and other factors like school/district procedures and policies.  Some nurses have previous experience dealing with T1 and some do not.  Something that I like to stress during this meeting is that every T1 is different so how it was handled with a previous or current student may not be the way it should be handled for my child.  For example, the amount of free carbs given to treat a low might vary considerably.  I also approach this meeting in a spirit of teamwork and collaboration.  I try to be as flexible as possible while making sure my child receives that care that she needs.

You will want to make sure you have extra supplies including meters, strips, juice boxes or other low treats, extra pump supplies, possibly extra insulin, alcohol wipes, ketone tester and strips, glucagon, numbing cream, teagadrem, lancets and lancing device, etc.  This can save you from running to school all the time if something happens!


I also give the nurse copies of our diabetes fact sheets, directions on how to use our insulin pump and cgm, and information sheets.  I give her copies of the fact sheet for the special area teachers and ask her to pass them out.  I come with copies in hand and do not ask her make copies on her own!  You can also make lanyard tags with diabetes information to give school staff (template under the school tab).


The 504 Plan

Creating a 504 plan is a personal decision for you and your child.  My feeling about a 504 plan is that it’s best to get one when everything is good and wonderful and you don’t need it instead of waiting until there is a problem.  I actually created one for my daughter when she was still in the same school building as me because I wanted her to have it in the future!  

Know your rights!  You are allowed to have a plan in place!  You can find information about 504 plans, IEP’s, and other diabetes management plans on the ADA’s Safe at School site (including state specific information).   http://www.diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-at-school/

You can find my sample 504 plan under the school tab and links to other plans for children of different ages using different insulin therapies.  



Accommodations you may want to include:

* assurance that there are staff members trained to recognize high and low blood sugar and respond in accordance with the plan and or doctor’s orders
* staff members including teachers, coaches, bus drivers, etc should be trained to recognize high and low blood sugar and know what to do in response
* allow the child to check his/her blood sugar and take necessary actions or make provisions for who will do this if the child is unable
* provisions for where blood sugar will be checked and where insulin will be given
* insuring full participation in all sports, extra curricular activities, field trips, etc with necessary assistance and/or supervision provided
* eating whenever and wherever necessary, including eating lunch at an appropriate time with enough time to finish
* permitting extra trips to the bathroom or drinking fountain
* permitting extra absences for medical appointments and sick days
* making academic adjustments for classroom time missed for medical appointments, checking blood sugar, or due to high/low blood sugar
* academic testing in a separate area with accommodations such as access to water, bathroom, and extra time
* allowed to carry glucagon
    ** taken from the ADA’s Safe at School site and my notes from the Safe at School session at FFL 2014


I suggest contacting your school nurse or principal about creating a plan.  Different school districts have different people who are responsible for creating these plans.  It could be the school counselor, psychologist, special services director, etc.  The nurse or principal can tell you who to contact.  You may be welcomed to create your own plan or the district may want to use a form of their own creation.

Again, I approach these meetings with a spirit of cooperation and collaboration.  Many of the people you are working with you to create these plans do not understand or have a lot of knowledge about type 1 diabetes, it’s effect on the body or academics or the needs of people with T1.  You will need to EDUCATE!  This is very important to creating an effective plan!  Most educators truly want what is in the best interests of your child and will want to do what is needed in order to make sure your child is successful.  They just might need some education!  It’s not uncommon for staff attending these meetings - especially if no one has had a plan in place before - to be worried about what is going to be required of them and that you are going to have unrealistic expectations.  This is why I try to approach all meetings in a very non threatening way and try to be as flexible as possible while making sure that my child’s needs are met and her safety is the top priority.  Your willingness to work WITH staff and not against them will go far.

Other Considerations:

Bus Drivers:  You may want to make an information sheet for your child’s bus driver and give it to him or her on the first day.  That day is going to be a little crazy so maybe do a very quick overview, hand off the information sheet and say that you’re very willing to talk about concerns later when there is more time.  If your child is young, you may want to request that he or she have a seat in the front.
See if the lunch menu is online.  Some have the carb counts listed online.  If not, you may be able to obtain that information from the food services office.

We always pack a lunch for our daughter and include a list of items and carb count for everything!
You might want to take your child with you to the meet the teacher and nurse.  Especially for young children, learning where there classroom is and where the clinic is and how to get from one to the other before the first day can alleviate lots of nerves.

If possible, ask if you can come in to talk to your child’s class about type 1 diabetes.  Disney has created some wonderful books that are great for explaining it to little ones and there are other wonderful books for older kids.  My daughter loves for me to come in and read a book to the class and answer any questions they may have.  It helps her feel more comfortable.  It’s not always possible for me to go in so this past year I just gave the teacher the book for her to read at her convenience.  Now that she’s older, my daughter was able to answer the questions on her own.  The nurse may also be a good person to include in this!  If your child is older, he or she may want to have a few minutes to talk to the class and explain what everything is.  This has helped relieve a lot of anxiety for us when she knows that her classmates know what her devices are, why she’s going to the nurse all the time, etc. 

Good Luck!  We wish you a successful and safe school year!