Q. What is type 1 diabetes?
A: Young people with type 1 diabetes cannot produce the hormone insulin. Insulin is a hormone that regulates blood glucose levels and is essential for life. Young people diagnosed with type 1 diabetes must take multiple injections of synthetic insulin and regularly check their blood glucose levels throughout the day to stay healthy and well. Type 1 diabetes is a condition that does not have a cure, so these management tasks must be undertaken every day by the young person.
Key staff at schools and early childhood settings need to be aware of diabetes management tasks and undertaking these:
Q: I have a child with type 1 diabetes in my class. What are my rights and responsibilities?
- can be done anytime/anywhere
- is available where the young person is (can check BGL’s and administer insulin in the classroom) whenever needed
- is NOT a sickbay activity
A: Schools and early childhood settings have a responsibility to ensure the safety of all of their students (including those with type 1 diabetes) so that they can participate fully in all learning and play activities. This means teachers need to:
- use and follow the student’s diabetes action and management plans
- support and encourage the student to perform their routine diabetes care activities as outlined in their diabetes management plan.
- communicate with parents as mutually agreed (daily? weekly?).
Key staff at schools/early childhood settings have the right to:
Q: What are my general responsibilities in class to a young person with type 1 diabetes?
- access clear, current and accurate health information that could impact on a young person’s care and educational needs.
- volunteer to undertake or supervise healthcare tasks with appropriate education and training or choose not to undertake healthcare tasks that they are not comfortable with or not qualified to do.
- access professional development on diabetes.
A: Your responsibilities are as follows:
- Student safety while at school/early childhood setting
- Responding to every young person as an individual
- Being familiar with and following the young person’s diabetes action and management plans. (It will detail symptoms of a hypo and hyper. This will help key staff identify when the student’s blood glucose level might be getting too low or high).
- Adhering to legal requirements, protocols, plans and protections
- Being open to diabetes education
- The provision of a normal school life that is inclusive for all students – but working to allow the student discrete and unobtrusive ways to care for themselves
- Being aware of the emotional and behavioural issues and refer students with diabetes and their family members for support and counselling as needed
- Meeting all the legislative requirements for type 1 diabetes plans (refer Department of Education and Training (DET) Schools Policy Guide)
While hypos affect young people differently some common issues include a loss of concentration and a change in behaviour. Sometimes a hypo or hyper will cause a young person to misbehave and this is something they are not able to control. Sometimes symptoms may not be obvious.
Q: Should we store the young person’s diabetes equipment in the sickbay?
A: Some equipment can be kept in the sickbay but the majority of equipment should be kept in the child’s main classroom. The equipment should also go with the child if they attend subjects outside of their main classroom such as PE or art.
This will ensure that the equipment is available for the student to use anywhere/anytime when required.
The day-to-day management of diabetes is not a sickbay activity but a normal part of managing this chronic condition to keep the young person fit and well. By encouraging the student to undertake these self-care tasks in the classroom they are less likely to miss class time and feel different from their peers.
For older students in secondary school who are moving from room to room they may prefer to carry around their own equipment and have back-up supplies in a home room or sickbay.
If you suspect that the student is having a hypo (low blood glucose reaction) it is very important that the student is treated where the hypo occurs (provided it is safe to do so). Students suspected of having hypoglycaemia should not be sent to the sickbay for treatment. This delay in getting them to the sickbay and extra physical exertion to get there can make the student's ‘hypo’ worse.
Storing diabetes equipment
Diabetes equipment such as blood glucose meter, monitoring strips and hypo treatment should all be kept in the classroom where the student is and accessible at all times to the student when required.
Managing the student’s diabetes on a day-to-day basis should not be a sickbay activity.
The young person’s blood glucose meter, hypo prevention and treatment food will reside in a known and accessible location within the school and early childhood setting and made clear in the young person’s diabetes action and management plans.
The location of these items will be decided by key staff in collaboration with the young person’s family and the young person if appropriate.
Safe disposal of medical waste
Please refer to the Department of Education and Training’s and/or school/early childhood setting’s policy regarding sharps management and disposal.
Administration of insulin
People with type 1 diabetes are unable to produce the hormone insulin, and need to replace it by injections of synthetic insulin multiple times, every day. The most common insulin regimens for type 1 diabetes are:
- BD (twice daily injections – at breakfast and dinner time)
- MDI (multiple daily injections – at each meal, sometimes snacks too)
- Insulin pump (continuous delivery via a small computerised device worn 24/7).
The choice of insulin regimen is one that is made jointly by the family and diabetes treating team.
Young people on a MDI regimen will need to have an injection of insulin at lunch time given by a pen-like device. Some young people will need assistance to give this injection, some may need supervision and older students may be able to do this independently. The details of the young person’s insulin administration will be documented in their diabetes action and management plans.
Some other young people may use an insulin pump to deliver their insulin. Insulin pumps are an expensive, small computerised device that deliver small amounts of insulin continuously. They can also be programed to deliver insulin for meal times and when blood glucose levels are above target. Young people may need assistance or supervision with entering BGLs and carbohydrate amounts into their insulin pump (button pushing), depending on their age, developmental stage and length of time that they have been using an insulin pump.
The young person’s insulin regimen and the degree of assistance they may or may not need will be detailed in their individual diabetes action and management plans.
Q: What are my rights/responsibilities as a casual relief teacher?
A: Your rights and responsibilities are the same as for the teacher you are replacing (refer to Department of Education and Training
Q: Where can I learn more about supporting a young person with diabetes in my care?
A: Diabetes Victoria encourages schools and early childhood settings to send key staff to attend our information seminars for their professional development. Key staff may include classroom teachers, first aid staff, specialist staff (particularly PE), office and support staff. These seminars offer key staff the opportunity to expand their knowledge and become more confident in supporting and facilitating the day-to-day experience of young people with type 1 diabetes in their care. Sessions will include information about diabetes and diabetes management and practical workshops covering a variety of specialised topics in more detail including monitoring, pumps and camps. These sessions are available in Melbourne and regional Victoria. Further information can be found here
Additional professional development opportunities that might help
Although not specific to type 1 diabetes the following professional development opportunities and resources might offer some additional tools that might be helpful.
- Ronald McDonald Learning Program: The Ronald McDonald Learning Program is a national program of Ronald McDonald House Charities helping children with serious illness catch up on their missed education following lengthy hospital stays and absence from school.
- Royal Children’s Hospital Melbourne – Education Institute: The Royal Children’s Hospital Education Institute is committed to providing a rich learning experience for children and young people so that their journey as learners continues in hospital. This personalised inpatient teaching support aims to make the transition from hospital back to school or kindergarten as seamless as possible by keeping students connected to their regular learning environment and their peers.
Q: Can diabetes affect learning?
A: Yes, diabetes can potentially affect learning. If blood glucose levels are high too often or frequently low, a young person can have difficulties with attention, memory, processing speed, planning, organising and perceptual skills.
A young person who has just had a severe hypo will likely need (up to 4 hours) recovery time before completing important classroom activities such as assessment tasks or exams.
If you notice any learning difficulties in a young person, speak to the young person’s parent just as you would for any young person who is struggling in class. The problem may be related to their diabetes or it might in fact be something else. The goal is to support a young person with type 1 diabetes to achieve their full developmental and academic potential.
The challenges of keeping diabetes well managed may also impact on a young person’s ability to cope and their mental health. For these reasons, it’s crucial that a young person is supported to manage their diabetes in all aspects of their life, including their time in school or early childhood setting.
The student will also need to attend some of their medical appointments during school hours. Most students will meet with their diabetes health specialists and/or treating team at least every 3 months.
Q: Who are the diabetes treating team and what do they do?
A: Type 1 diabetes is a very complex condition to manage and requires specialist care by health professionals who are experienced in paediatric type 1 diabetes. A diabetes treating team usually consists of health professionals involved in the young person’s diabetes care and includes a paediatric endocrinologist, diabetes educator, dietitian and social worker. In some regional areas there might not be access to a paediatric endocrinologist, and the young person will see a paediatrician instead.
- Diabetes educator: A diabetes educator is a specialist nurse and usually the main person who will work with and help a person and family living with type 1 diabetes understand and optimise their self-management of living with the condition and prevent complications.
- Paediatric endocrinologist: A paediatric endocrinologist is a doctor who specialises in the diagnosis and treatment of children with conditions of the endocrine system. They can provide expert advice on the management of type 1 diabetes.
- Paediatrician: A paediatrician is a doctor who provides specialist medical care to infants, children and adolescents. To become a paediatrician, doctors must do an extra 6 years of training after they finish their medical degree.
- Dietitian: A dietitian is trained in food and nutrition. They can provide expert individual nutritional advice and develop a personalised healthy eating plan that suits a person’s lifestyle, type of diabetes and individual health needs.
- Diabetes social worker: A diabetes social worker can assist with the emotional and psychological side of living with type 1 diabetes for the young person and their family. They can also inform and support key staff with any matters about diabetes in schools and early childhood settings if required.