Preventing Hypoglycemia at School

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Back-to-school can be a great time for parents, perhaps even more so with type 1 diabetes in the family. Instead of being solely responsible for your child’s care 24/7, come September you have helping hands between 8 a.m. and 3 p.m. -- teachers and staff who have been trained in diabetes basics, so that during the school day you can feel confident that your child’s needs should be met. Still, worries can creep in, especially when it comes to lows. How well will the school react in a hypoglycemic emergency? We consulted certified diabetes educators and fellow parents for their top tips on preparing for and preventing bouts of severe low blood sugar when transitioning back to the classroom.

Get on the School’s Schedule

Making the switch from summer days back to very regimented school days can often make following a diabetes care routine easier. But complications can arise when the school schedule doesn’t quite jibe with the ideal dosing and eating plan you’ve honed over the break. Ease the transition with some advance preparation. “Start a few weeks before school to get into a routine that will be similar to the school day. This way you can spot and correct any potential problems,” recommends Christie Hust, M.S., R.D.N., C.D.E., L.D., director of the Diabetes Education Center at Texas Tech’s Larry Combest Community Health and Wellness Center in Lubbock, Texas.

Scott B., creator of the blog Arden’s Day and father of an 8-year-old daughter with type 1, agrees. “We transition using the same theory as we do with bedtimes, by starting at home ten days before school begins,” he says. “Follow the school schedule and eat at the times the school schedule indicates. Ten days give you enough time to work the kinks out. You’ll be able to plan injection/bolus times, find foods that are easy to pack in a lunch and are easy on blood sugar levels. You’ll be more confident by the time the school bus arrives to pick them up.”

Plan for Substitute Teachers

When the teacher is out sick, you don’t want your child’s health to suffer as well. At the beginning of the school year, work with the teacher to put a plan in place for days she’s absent. “The teacher should keep a printed information sheet on her desk explaining that there is a child with type 1 in the class, that he or she may have needs different from other students such as more frequent trips to the bathroom or unscheduled snacks, and who the substitute teacher is to call for help or advice,” says Diane Ballard, R.N., B.S.N., C.D.E., C.P.T., clinical research coordinator and insulin pump trainer at Kentucky Diabetes Endocrinology Center in Lexington, Ky.

The substitute should be instructed to let your child know what to do when care is needed, advises Hust, “Sometimes a wave of the hand is okay, but sometimes the substitute wants to know where a child is going and whether or not it’s an emergency-type situation.” If your child is old enough, he or she can be the one to bring this up with the sub. “By asking the sub his or her preference, you can prevent any misunderstandings that could potentially happen,” says Hust.

Also, don’t be bashful about requesting a particular sub. “I’m a huge fan of asking the school to use the same subs when possible,” says Scott. That way, the sub gets more and more confident each time.

Manage Snack and Lunchtime

A big part of cafeteria culture is food-swapping or trading, but is this safe for a child with type 1 diabetes? “It depends on the child and how well they understand their eating patterns,” says Hust. “With younger kids, I discourage trading, because they often do not understand carbohydrate counting and portion sizes very well. With older kids, it may be okay. Most tweens understand that the wrong trade can lead to low or high blood sugar.

Scott doesn’t encourage food swapping, but he does ask his daughter Arden to text him cell phone pictures of any unexpected food she wants to eat, so he can make his best guess on carb counts and advise from there.

Cell phones can also help parents prevent and deal with lows through the use of medical apps -- there are free apps that provide carb counts, track blood sugars, or help train caregivers (such as teachers) on giving injections for severe low blood sugar. (Note: These apps do not replace the need for regular blood sugar testing.) Search app stores for keywords like “hypoglycemia” or “low blood sugar.”

If your child is diverging from his or her planned meals and snacks often, Hurst recommends talking with the child about why this is happening: “Are they missing something that can be easily added? Are they craving sweets? Do they truly understand their meal plan and how important it is? Do they just want to be normal?” All of these are things that the two of you can fix together in an easy and healthy way.

 

Disclaimer: The experiences and suggestions recounted in these articles are not intended as medical advice, and they are not necessarily the "typical" experiences of families with a child who has type 1 diabetes. These situations are unique to the families depicted. Families should check with their healthcare professionals regarding the treatment of type 1 diabetes and the frequency of blood glucose monitoring.