Teachers Guide to T1d

As a mother to a very young Type 1 diabetic child, it’s very difficult to be away from her for more than an hour or two. The thought of leaving her in the care of anyone else is stressful on its own. I hope that the teachers and school administrators who may be reading this, know that I am both appreciative of their time and effort to learn more about how to manage my daughter’s dysfunctional pancreas. Please kindly read below some tips to help guide you through a few things you should know about any child in school with this chronic autoimmune disease. Thanks in advance!

Tips for teachers and faculty of kids with Type 1 diabetes

• Please include my child in all activities at school or field trips (refer to 504/IEP plan for all items listed on this page moving forward)
• Notify parents of any change in schedule at least 24-48 hours in advance – this will allow the parents to make any necessary changes to their child’s daily diabetes regimen and plan accordingly per event.
• Please forward me the contact info of anyone who may be responsible for managing my child’s T1d at school.
  • Goal: establish open constant communication to ensure my child’s safety at school.
• Please update me as soon as possible for any changes to nurses and their availability
  • Give me the nurses phone number and email too
  • Have school office admins assist in this area as much as possible
• Don’t let his/her diabetes get in the way of them having fun
• Don’t penalize them for performing below “standard” if they have a low or high BG for any activity whatsoever (Parents: This is why it’s also important to have an IEP in case diabetes affects child’s educational performance in school all the way through college)
• Don’t let anyone eat their snacks – my child does NOT have to share food especially if they need it to treat a low BG or if she’s already received a bolus (fast-acting insulin) for that particular snack or meal.
• Do keep child’s low treat box near her throughout the day and follow parent’s or doctor’s orders for how to treat their hypo’s (short for “hypoglycemia” or low BG)
• Do educate yourself on how to properly care for and manage my child’s BGs using their CGM, pump or injections according to our individual needs and management style until and if the nursing situation is stable and consistent.
• Do educate yourself on the basics of T1d so as not to confuse it with Type 2 diabetes:
  • T1ds need insulin to live (insulin dependent) either by injection or pump therapy.
  • Whereas Type 2’s can’t use the insulin they may still be producing efficiently due to either poor lifestyle habits and/or genetics. They can treat their condition with either medication, by making healthier lifestyle choices, and sometimes require insulin depending on the resiliency of each individual’s pancreas.
  • Please read these Training Resources from the American Diabetes Association.
• Do observe and discipline other children from making fun of my child’s autoimmune disease and intervene when appropriate.
  • As a parent, I will continue to educate and empower my child so they can grow with confidence despite having a hidden chronic autoimmune disease. However, bullying on either parties is not tolerable. Other parents would be wise to show compassion, be open to diabetes education, and discipline their children as well.
• Do NOT let other children touch my child’s CGM or pump – their parents will be held responsible for any damages or if my child needs hospitalization because of their ignorance
• Please be aware that 10-15 minutes of physical activity may typically lower my child’s BGs quickly especially with any insulin on board or IOB (have nurse check pump for IOB status). This is working insulin in her body. Physical activity builds insulin sensitivity.
• Low BGs require fast-acting carbs like juice, fruit (oranges, watermelon, grapes are fastest) or glucose tabs.
• High BGs typically over 180 mg/dL require insulin.
• Please share all you’ve learned with the entire faculty and other families to help us create more awareness for Type 1 diabetes. Educate the rest of the class on Type 1 diabetes with our slideshow at your earliest convenience.
• Know that you are doing the best you can to keep our child safe at school and we’re so grateful for you. Don’t be too hard on yourself. I already do that to myself and want to help alleviate as much anxiety from you as possible [both Coral, my husband and I suffer from anxiety in regards to her diabetes lack of care in early 2022 and the ongoing pandemic].
• Please also don’t take things too personally – parenting a T1d along with a younger sibling is extremely stressful knowing everyday is life or death for Coral. Our bad days mean we fought hard to keep our child out of the hospital or a diabetic coma. We also don’t have any other kind of support outside of school – no family here in the mainland U.S. My family in Hawaii couldn’t learn how to monitor her BGs or treat her lows either.

Note: Fortunately, I’ve met a wonderfully cooperative faculty at Coral’s school. The above is a general list for some teachers of T1d kids who may not be as knowledgeable, experienced or as obliging as others.

Things you should know in advance

Symptoms my child may experience when her BG is low (less than 80 mg/dL) or hypoglycemic:

• Oddly sleepy – she’ll want to just lay down and sleep wherever she is. Very URGENT because that means she’s under 50!
• Sweaty
• Shaky
• Blurred vision
• Slurred speech
• Very angry or easily agitated
• Unconsolable
• Ravenous appetite – this is because the body is not able to absorb nutrients into the cells and use it for energy.

IMPORTANT: Severe hypoglycemia (BG less than 55 mg/dL) can be fatal and damages the brains cells. It can result in a seizure and death if not treated immediately with fast-acting sugar. In the event where a T1d isn’t responding and having a seizure, glucagon must be administered. Download the glucagon app here and ask the school’s RN to train you how to use it.

Symptoms she may experience if her BG is high (over 200 mg/dL) or hyperglycemic:

• Very grumpy – almost like a devil child. Seriously, not even joking. Don’t say I didn’t warn you.
• Confusion
• Flushed and/or warm skin
• Deep breathing
• Fruity breath odor – means ketones (acid) in blood is present
• Very hungry – yes, some symptoms are similar to feeling low [not a typo]
• Very thirsty – check for ketones if BG’s over 250 and refer to her doctor’s orders and request nurse assistance asap.
• Urinating frequently – body’s not able to absorb energy into cells hence the insatiable thirst and urination. Again, refer to doctor’s orders for high BG protocol.
• Nausea
• Vomiting – if severe hyperglycemia like this occurs, child may be in diabetes ketoacidosis (DKA) and must be hospitalized immediately.
  • Be sure to rule out any food poisoning or other illness
  • Check pump site
  • Check BGs with glucose meter – parent to provide with nurse
  • Check for ketones with ketone meter – parent to provide with nurse
  • Contact parents and 911 – DKA can lead to a diabetic coma with ketones present and BGs over 400 for many (varies per individual) and can be fatal.

Failed Pump or CGM

In the event of a failed pump site, contact parent or caregiver immediately. Unless, the teacher and/or health aid or nurse has been trained and agreed to change the child’s pump, then parent must go to school to change it. Nurse may have to give child an injection if necessary. Refer to child’s 504 plan and doctor’s orders.

In the event of a failed Dexcom continuous glucose monitor (CGM), contact parent or caregiver immediately. Trained personnel or Nurse, if available, will have to check child’s BGs with a lancet and traditional glucose meter. Parent should provide the school with all necessary diabetic supplies including an extra meter, test strips, lancing device, etc in the child’s diabetes kit (DKit). Refer to child’s 504 plan and doctor’s orders.

Speaking for myself: Recognize that we strive to keep fairly tight control over Coral’s BGs keeping her in-range between 80-180 during and after meals around 80 percent of each day. This is really hard to achieve while allowing her to eat regular foods in moderation without many dietary restrictions. Even hormones like growth, stress (cortisol), and adrenaline can cause fluctuations in BGs. Some days, we can even keep her between 80-150 while fasting like overnight or in-between meals. I will gladly teach any school personnel how we sugar surf – preventing the highs and lows safely and responsibly. Timing is everything. Timing the bolus (fast-acting insulin used to either correct high BGs and/or cover any carbs to be eaten) and treating with just enough fast-acting carbs/sugar to prevent lows.

Carbs or carbohydrates include all sugars and starches which affect BGs. Just because something says “sugar free” doesn’t mean that it’s carb-free which will still affect a diabetics BGs. Basically, the only foods that are carb-free are most meats, eggs, and cheese. These don’t typically require a bolus, but perhaps a temp basal increase (varies) due to the high protein which causes BGs to rise steadily. Tip: Low carb/high protein (LCHP) may work out great before PE or other physical activity.

Net carbs are the Total Carbohydrates minus any fiber (if over 3 grams) and sugar alcohols. For example: TC – (fiber + sugar alcohols) = NC. Sugar alcohols or substitutes include maltitol, sorbitol, dextrose, maltodextrin, Stevia, Truvia (name brand), and erythritol. The latter three are more approved than the former.

The absorption rate is the estimated time it takes for the carbs to metabolize and affect a diabetics BGs. This varies per individual given certain circumstances and/or other chronic conditions. Remember, T1ds need fast-acting carbs to treat low BGs. Anything fatty like dairy products such as milk or chocolate are too slow – their BG will continue to drop and this can be very dangerous leading to severe hypoglycemia, seizure, and death. Some examples for quick carbs are juice, fresh fruit, glucose tabs, jam, or glucose gel. Basically, anything sweet and the less they have to chew it the better.

Special Thanks

My husband and I would like to thank both Coral’s teacher and the teacher’s assistant for literally saving Coral’s life everyday when her LVN is not available due to LAUSDs shortage of nurses in West LA. Especially on days where the nurse isn’t at the school yet or out sick and there’s a sub LVN or RN. They are both using the Dexcom Follow app to help monitor Coral’s BGs and often prevent severe hypoglycemia (less than 55 mg/dL) when she’s dropping from the low 100s. They know the right amount of fast-acting carbs like a glucose tab(s) or 5-8 sips of juice to give her so she won’t spike after treating. They have truly been a blessing and we will forever be grateful. It also helps that her teacher is carb-conscious like myself.

Warmest aloha,

Shelsea

Updated: August 23, 2022