Current estimates suggest that by the year 2050, over 600,000 youth will be diagnosed with type 1 diabetes.  Even more alarming is that the data also shows the incidence of type 2 diabetes in children and adolescents is rapidly increasing.  Schools and school nurses play an integral role in the health of children and can make a significant impact on disease management and health outcomes.  It is now more important than ever for schools to foster safe, supportive, and inclusive environments for students with both type 1 and type 2 diabetes and to raise awareness about the prevention of type 2 diabetes including healthy eating and physical activity.

Kids with diabetes just want to be like all the other kids at school–and their school nurses want this for them too.  Unfortunately, for students with type 1 diabetes, and many with type 2, nearly every decision made throughout their school day is carefully planned and meticulously controlled, impacting these students in ways that can make school extremely challenging.  Unpredictable high and low blood sugars can disrupt their learning, cognition, and behavior, while school-induced stress, social adversities, and hormonal changes can make managing diabetes at school both difficult and frustrating.

Type 1 Diabetes

Type 1 Diabetes can, at times, feel like a troubling roller coaster.  What works for a student with type 1 diabetes one day may not work the next.  Be prepared to be flexible, adaptable, and patient when providing care and support at school.

• Have a Diabetes Medical Management Plan in place but work closely with parents to understand the best way to intricately balance care and treatment with “watch and monitor.” Diabetes is often described as an art and there is often no clear-cut answer.
• Utilize technology and encourage families to embrace the safety and convenience that continuous glucose monitors allow. Being able to monitor a student's blood glucose levels from your phone or tablet can, at times, feel overwhelming and stressful.  But the much-needed insight and early recognition of potential lows and highs they can provide are well worth the learning curve.
• Need tech support? Here’s a library of videos that can be great to brush up on or learn more about many of the most popular T1D devices on the market.
• Educate your school staff on how they can support students with type 1 diabetes.
• Ensure Emergency Action Plans are in place for both hypoglycemia and hyperglycemia, as per the Diabetes Medical Management Plan.
• For severe hypoglycemia, make sure glucagon is available and know how to administer the life-saving medication. Some states allow undesignated glucagon in schools–check your local laws on stocking glucagon and appropriate training and administration.

Type 2 Diabetes

Until a few years ago, type 2 diabetes was relatively rare in children.  Due to an increase in risk factors like obesity and inactivity in the pediatric population, the CDC has estimated that the number of youth aged 10-19 living with type 2 diabetes increased from 34 per 100,000 in 2001 to 67 per 100,000 in 2017.   Being a progressive disease, school nurses are responsible for implementing effective strategies to improve health outcomes for students with type 2 diabetes, as well as promoting lifestyle behavior changes including weight control, nutrition, and physical activity.  Everything listed above regarding school support for students with Type 1 diabetes, can also apply to students with type 2 diabetes, and reducing stigma around the disease is arguably even more important.  Additionally, school nurses should combine individual type 2 interventions with efforts to create a healthy school environment that reduces various risk factors for type 2 diabetes.

• Advocate for more physical activity throughout the school day. Refer to our recent blog post about physical activity in schools for more ideas on getting kids active.
• Work closely with your school’s administration and food service provider on making your lunch room smarter, promoting nutritious eating, and weight maintenance.
• Educate your school community on healthy behaviors and risks associated with inactivity and obesity.
• Some states mandate screening for diabetes risk factors. These screenings are typically included as part of the school physical examination, however, in some cases, school nurses may complete the screening.  Additionally, some states require regular screenings for acanthosis nigricans, a skin condition associated with a higher risk of developing type 2 diabetes.

Communication, coordination, and teamwork are key components to supporting students with diabetes at school.  School nurses can establish school as a safe place that keeps kids with diabetes ready to learn and able to participate in all school activities.   With November being National Diabetes Month, there’s no better time to remember the 24/7 challenges faced by individuals with diabetes.

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