Back To School and Diabetes

Preparing for Back-to-school tips and the New HSE Guidelines for caring for children with Type 1 diabetes during school hours are now available for parents, carers, teachers, and school staff.

Late August means back-to-school preparations for parents, children, and teachers alike. Preparing for the new school year means organising books, uniforms, school lunches and much more. For children living with diabetes, it also means adapting to their diabetes management, sometimes changing insulin regimes, and thinking about blood glucose monitoring and safety in school. There can be an added concern for parents, as well as for the teacher if a child with diabetes is starting school for the first time or changing to a new class or school with a teacher who may not be yet familiar with diabetes. The younger the child, the greater the involvement in the diabetes management and care of school staff it is, often including Special Needs Assistants.

HSE Guidelines for schools, diabetes teams and parents/carers

To help make the transition as easy as possible for everyone, guidelines recently published by the HSE provide useful information and a number of tools and easy-to-follow actions to help school staff to understand Type 1 diabetes and the needs of their pupil.

The document sets out clear guidelines that will help structure the conversation and preparations between the family, diabetes team, and school staff. It explains diabetes and diabetes management to teachers and school staff and sets out clear lines of responsibility for all partners.

The document also includes a Personal Pupil Plan to agree on current diabetes management and the needs of a child. This includes information such as personal hypoglycaemia symptoms, what to eat during hypoglycaemia, and when to check glucose levels and deliver insulin. The school can have a personalised ‘information pack’ for all their pupils with Type 1 diabetes.

To further support families and school staff, Diabetes Ireland has also developed a resource for parents and teachers on their website https://www.diabetes.ie/living-with-diabetes/child-diabetes/school-and-diabetes/ where the new guidelines “Meeting the Care Needs of Primary School Children with Type 1 Diabetes during School Hours” document can be downloaded along with lots of useful information on caring for a child with diabetes in the classroom.

Dr Kate Gajewska, Diabetes Ireland Research and Advocacy Manager said “for parents, the challenge of leaving your child on their own or under the care of others can be very stressful so good preparations and effective communication with school staff is vital and will help to reduce the feeling of uncertainty. We hope this online resource will be helpful and we strongly recommend involving the child’s diabetes team early in the planning and communication process and the guidelines will be of great help to everyone involved.”

The online resource has separate sections for parents and carers, and the teachers and school staff. The first section includes tips on how to start planning for back to school early, explains how to prepare the school and what to expect, provides information on special needs assistance and requires non-teaching support, gives tips on healthy lunchtime snacks, and how to support the child from the mental health and well-being side. In the section for teachers, SNAs and other staff educational materials about type 1 diabetes, hypo- and hyperglycaemia and diabetes management are provided, as well as information on how important it is for their mental health and well-being to be included in school life. This section provides tips on what can schools do to support the child and their family and explains how to determine non-teaching support.

Differences between Type 1 & Type 2 Diabetes

What is the difference between Type 1 diabetes and Type 2 diabetes?
Characteristics of the condition:	Type 1 Diabetes	Type 2 Diabetes
Risk Factors: Very Different	Having another auto-immune condition. Having a parent or sibling with type 1 diabetes combined with environmental factors and a common infection which may trigger onset.	Poor diet. Being overweight. Being sedentary. Genetics. Being over the age of 45. Belonging to high-risk ethnic group. If you had gestational diabetes or a baby weighing over 9 pounds. Certain medications.
Symptoms: Some overlapping	Fast onset of extremely high blood glucose levels which cause weight loss, hunger, fatigue, thirst and frequent urination.	High blood glucose, thirst, waking in the middle of the night to urinate, fatigue, high blood pressure, urinary tract infection, neuropathy. But may also have no symptoms or just mild thirst or repeated infections.
Nature of Illness: Very Different	Autoimmune condition, your cells kill off your insulin-producing (beta) cells. Body no longer makes insulin.	Insulin-inefficiency. Body makes insulin, but it isn’t used properly by the body or is not enough to meet body demand.
Onset: Very Different	Quick onset: Generally, within a few weeks or months.	Slow onset: May be several years after blood glucose begin to rise. Up to 12 years can pass between onset and diagnosis of type 2 diabetes.
Treatment: Same to varying degree	Intense daily self-management of insulin to balance food intake or exercise. Must take multiple injections of insulin or infusion through insulin pump.	Daily self-management of food intake, exercise and medication. Over time roughly 40% may need to use insulin injections.
Age when you get it: Typically, different	Typically, early childhood or teenage years, but can occur at any age.	Typically, adults, but can occur at any age.
Numbers of Ireland: Very different	c. 22,000-28,800 persons	c. 180,000 – 234.398 persons.
Complications: Same but to varying degrees	Short term complications give risk to acute emergencies such as hypoglycaemia and ketoacidosis. Long term exposure to low blood glucose levels can cause hypoglycaemic unawareness. Long term exposure to high blood sugar levels can cause blood vessel damage. Blood vessel damage can cause blindness, retinopathy, heart disease, kidney disease, and foot problems including amputation and earlier mortality.	Many people at diagnosis of diabetes may have already had up to 12 years exposure to long term high blood glucose levels and have complications at diagnosis i.e., damage to large and small blood vessels throughout the body which causes blindness, retinopathy, heart disease, kidney disease, amputation, gastroparesis, earlier mortality.
Is it preventable? Very Different	No.	Yes, up to 58% with lifestyle modifications.
Is it reversible? Very Different	No.	Type 2 diabetes can be put into remission when there is significant fat loss around the pancreas which may stimulate insulin production, this will depend on a number of factors including amount of weight loss and duration of diabetes.