Helping the Student with Diabetes Succeed

Diabetes is a chronic disease that affects thousands of school-age children nationwide. Findings from the SEARCH for Diabetes in Youth study, funded by the Centers for Disease Control and Prevention and the National Institutes of Health, suggest that rates of new diagnosed cases of diabetes are on the rise among children and teens.

Schools have an important role to play in ensuring that students with diabetes have the support they need to stay healthy, enjoy the same opportunities for learning and having fun as their peers, and are prepared to do their best in school.

Diabetes Overview

What is diabetes?

Diabetes is a chronic disease in which blood glucose, also called blood sugar, is too high. Blood glucose is our main source of energy and comes from the food people eat. People with diabetes have problems regulating the amount of blood glucose in their blood.

Among school-age children, type 1 diabetes is more common than type 2 diabetes. In type 1 diabetes, the body doesn’t make insulin, a hormone that helps glucose get into the cells and be used for energy. As a result, the amount of glucose in their blood may be higher than normal, and their bodies may not use glucose effectively. Students with type 1 diabetes need to take insulin every day to stay alive.

Other students may have type 2 diabetes. This type of diabetes, while more common among middle-aged and older adults, is increasingly being diagnosed among children. In type 2 diabetes, the body may make insulin, but may not make enough to control blood glucose.

Why is it important to manage diabetes?

Keeping blood glucose in the target range can help prevent many health problems.

• Over time, too much glucose in the blood (called hyperglycemia) can lead to serious health problems, including heart disease, stroke, and diseases affecting the kidneys, eyes, feet, and gums.
• Blood glucose levels that drop too low (called hypoglycemia) can be life-threatening and need to be treated right away.

The good news is that research shows these problems can be greatly reduced, delayed, or possibly prevented by keeping blood glucose levels near normal. Maintaining blood glucose levels within a target range can also prevent symptoms that can interfere with learning, such as fatigue, increased hunger, and blurred vision.

How is diabetes managed?

Diabetes is managed by checking blood glucose levels throughout the day and making sure that they stay within a target range. As a general rule, eating food makes blood glucose levels go up after the meal. Physical activity, insulin, and diabetes medicines taken by mouth make blood glucose levels go down.

Students with diabetes may check their glucose levels by using one or both of these devices

• a blood glucose meter, which uses a small drop of blood from a finger to measure blood sugar levels
• a continuous glucose monitor, a device that works through a tiny sensor inserted under the skin of the belly or arm, which can test blood glucose every few minutes

If blood glucose levels are out of the student’s target range, it may be necessary to take action to bring them back to that range. These actions should be specified in the student’s health care plans.

What kind of help do students need to manage diabetes?

The type of help students may need to manage their diabetes may vary by student. In general,

• toddlers and preschool-age children need help with all aspects of diabetes care.
• some elementary school-age students can monitor their glucose, but most will need help from adults.
• middle school- and high school-age students should be able to manage their diabetes themselves, depending on how long they have had diabetes and their level of maturity.

Regardless of their age, there are times when all students who have diabetes need someone else to help them with their diabetes care. This is particularly true if the student experiences low blood glucose, which can be life-threatening.

Students with diabetes must have access to supplies and equipment to quickly treat high and low blood glucose levels at all times.

Effective Diabetes Management in School

Federal Laws Related to Helping Students with Diabetes

Three federal laws address the school’s role in helping students with diabetes

• Section 504 of the Rehabilitation Act of 1973 (Section 504). Section 504 prohibits recipients of federal financial assistance from discriminating against people on the basis of disability and outlines a process for schools to use in determining whether a student has a disability and what services a student with a disability needs.
• Americans with Disabilities Act of 1990 (ADA). Title II of the ADA prohibits discrimination on the basis of disability by public entities, including schools, regardless of whether the entities receive federal financial assistance.
• Individuals with Disabilities Education Act (IDEA). IDEA provides federal funds to assist state education agencies and, through them, local education agencies to make special education and related services available to eligible children with disabilities.

In addition, the Family Educational Rights and Privacy Act (FERPA) and IDEA protect the student’s privacy.

These federal laws provide a framework for planning and implementing effective diabetes management in the school setting, preparing the student’s education plan, and ensuring that the student has access to appropriate care.

The School Health Team

The school health team ensures that students with diabetes receive all the help they need while in the school setting. The team should include people who understand diabetes, the school environment, and federal and state education and nursing laws. Members of the school health team often include

• student with diabetes
• parents or guardians
• school nurse
• teachers, administrators, and other school personnel, such as Section 504/Individual Education Program coordinator, school psychologist or guidance counselor, coaches, and lunchroom staff

The school health team should work closely with the student’s parents or guardians and other key persons involved in the student’s diabetes care outside school. Some students may have a personal diabetes health care team that also includes health care professionals, such as the student’s doctor, nurse, registered dietitian, and diabetes educator. In these cases, the school health team should work closely with the student’s personal diabetes health care team.

Health Care and Education Plans

Three types of health care plans should guide diabetes management in the school setting

• Diabetes Medical Management Plan (DMMP) (DOCX, 251.9 KB) . Completed by the student’s personal health care team, the DMMP contains the medical orders that are the basis for the student’s health care and education plans. The plan is reviewed and updated at the start of each school year; after a change in the student’s prescribed plan for care, ability to manage diabetes, or school circumstances (e.g., a change in schedule); or upon request.
• Individualized Health Care Plan (IHP) (DOCX, 77.15 KB) . Prepared by the school nurse, the IHP contains the strategies for carrying out the medical orders in the DMMP in the school setting. The school nurse prepares the IHP based on medical orders in the DMMP and reviews it with parents/guardians and student.
• Emergency Care Plans for Hypoglycemia (DOCX, 81.69 KB)  and Hyperglycemia (DOCX, 81.24 KB) . Based on the DMMP, the plans provide details about how to recognize and treat hypoglycemia and hyperglycemia and whom to contact for help. The school nurse will coordinate the development of these plans. The school should provide copies to parents/guardians and to all school personnel who are responsible for students with diabetes during the school day and during school-sponsored activities.

Students with diabetes may also have one or both of these education plans

• Section 504 Plan, a plan of services developed under Section 504 of the Rehabilitation Act. The plan describes how the school will ensure that the student with diabetes has access to needed medical services, receives the same education as other students, and is treated fairly.
• Individualized Education Program (IEP), a plan required for students with disabilities who receive special education and related services under IDEA. The plan, which is more specific than the Section 504 plan, addresses the student’s progress in school and needs related to diabetes care.

The school health team should be part of the group that develops and implements the student’s education plan. The information in the education plan should be agreed on before each school year begins or when a student is diagnosed with diabetes, then should be signed by a representative of the school and the student’s parents or guardians. The student’s Section 504 Plan, IEP, or other education plan should include information about needed services. The school should distribute the plans to all personnel who will be involved in implementing them.

For more information on how to help students manage their diabetes, visit the Centers for Disease Control and Prevention’s Managing Diabetes at School and the American Diabetes Association’s Safe at School campaign.

Visit NIDDK’s Diabetes Discoveries and Practice Blog for health care professionals for more guidance on youth and diabetes.

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• Diabetes Care and the Adolescent Population: Navigating the Transition of Roles and Responsibilities