Morgan Coburn, Department of Neurobiology and Behavior

*Please consult with your school’s unique medical support protocol for information on your institution guidelines for treating Type 1 Diabetes.

What is Type 1 Diabetes?

Type 1 Diabetes (T1D) is an incurable autoimmune disease where the insulin-producing cells of the pancreas are attacked. The cells of your body use insulin as a meal ticket, allowing sugar to enter. Without insulin, sugar cannot enter the cells, and they starve surrounded by food.

How is Type 1 Diabetes Treated in the Classroom?

Unless your student is very young or newly diagnosed, they will typically have a treatment plan. Asking them about it will inform you of how they prefer to be treated in cases of emergencies. In general, students will need to deliver insulin and frequently test their blood sugar levels during the school day (Wagner et al., 2006). This constant management is necessary for maintaining healthy in-range blood sugars.

Low Blood Sugar or Hypoglycemia

Hypoglycemia is a serious and potentially life-threatening condition that can be treated with glucose tablets or juice. Concerns about hypoglycemia and its effective treatment in the classroom setting can lead to anxiety on both the student’s and instructor’s end. In fact, 38% of school personnel report concerns about their ability to assist a student with hypoglycemia (Schwartz et al., 2010). Be compassionate with your student and communicate with them about their own experiences/struggles with hypoglycemia.

High Blood Sugar or Hyperglycemia

Though higher blood sugars are less dangerous in the immediate present, consistent hyperglycemia can lead to long-term complications and issues with student performance. Students with consistently high blood sugars have been found to miss more days of school and have reduced abilities to maintain focus in class (Glaab et al., 2005). These issues stem from the unpredictability of T1D and by impeding students from treating their high blood sugars. One study found nearly 80% of students are not allowed to administer insulin in class (Jacquez et al., 2008).

How Can I Best Help My Student?

Above all else, be empathetic and flexible. Each diabetic manages their disease differently and is often faced with their own unique difficulties. Compounding the symptoms of diabetes the student must cope with, mental health issues also have a higher incidence in T1D, including depression (11-27% of diabetics), anxiety (13-21%), and eating disorders (2.5 times increased) (Northam et al, 2005; Rechenberg et al., 2017; Goebel-Fabbri, 2008). Below are some simple suggestions to better accommodate T1D in the classroom. However, asking a student about their own individual needs is the best practice.

  1. Learn to recognize the signs of hypoglycemia, hyperglycemia, and undiagnosed diabetes. Consult the Mayo Clinic and ADA for early and severe signs of both.
  2. Communicate with your student. Building trust and communication between the school and the diabetic, especially as the teacher, can help tremendously improve the student’s day-to-day stressors, care, and reduce anxiety on all sides (Holmström et al., 2018; Edwards et al., 2014; Kise et al., 2017).
  3. Don’t have a limited bathroom policy. If your student is experiencing high blood sugars they may need to use the restroom more frequently and should not be forced to hold it. Additionally, a student my feel more comfortable leaving the classroom briefly to test blood sugar, administer insulin, or consume carbohydrates.
  4. Allow food and drinks to be consumed in class. Diabetes can be isolating and embarrassing. By allowing all to eat and drink, rather than make exceptions, the student may feel less out of place in the classroom.
  5. Be flexible with exams and assignments. Hypoglycemia can occur rapidly and often takes at least 15 minutes to begin feeling better. Likewise, hyperglycemia can last for hours despite treatment and in either situation concentration can be severely affected. Furthermore, in high pressure situations, like a timed final exam, cortisol levels can trigger even higher blood sugars in T1D. Having a policy for project extensions or allowing a diabetic student to step aside and eat during an exam without missing out on the time may help alleviate some of the anxiety around test-taking and diabetes.

Further Resources

For more information on classroom diabetes care visit The National Institute of Diabetes and Digestive and Kidney Diseases and American Diabetes Association.

Resources

Edwards D, Noyes J, Lowes L, Spencer LH, Gregory JW. An ongoing struggle: a mixed‐method systematic review of interventions, barriers and facilitators to achieving optimal self‐care by children and young people with type 1 diabetes in educational settings. BMC Pediatr. 2014;14(228):1‐27.

Glaab, L.A., Brown, R. & Daneman, D. (2005). School attendance in children with Type 1 diabetes. Diabetic Medicine, 22, 421–426. doi: 10.1111/j.1464–5491.2005.01441.x

Goebel-Fabbri, A. E. (2008). Diabetes and eating disorders. Journal of diabetes science and technology2(3), 530-532.

Holmström, M. R., Häggström, M., & Söderberg, S. (2018). Being Facilitators in a Challenging Context-School Personnel’s Experiences of Caring for Youth with Diabetes Type 1. Journal of pediatric nursing43, e114-e119.

Jacquez F, Stout S, Alvarez‐Salvat R, et al. Parent perspectives of diabetes management in schools. Diabetes Educ. 2008;34(6):996‐1003.

Kise, S. S., Hopkins, A., & Burke, S. (2017). Improving school experiences for adolescents with type 1 diabetes. Journal of School Health87(5), 363-375.

Northam EA, Matthews LK, Anderson PJ, Cameron FJ, Werther GA. Psychiatric morbidity and health outcome in T1D–Perspectives from a prospective longitudinal study. Diabetic Medicine. 2005;22:152–157.

Rechenberg, K., Whittemore, R., & Grey, M. (2017). Anxiety in youth with type 1 diabetes. Journal of pediatric nursing32, 64-71.

Schwartz, F.L., Denham, S., Heh, V., Wapner, A. & Shubrook, J. (2010). Lifestyle and behavior. Experiences of children and adolescents with type 1 diabetes in school: survey of children, parents, and schools. Diabetes Spectrum, 23, 47–55.

Wagner, J., Heapy, A., James, A. & Abbott, G. (2006). Brief report: glycemic control, quality of life, and school experiences among students with diabetes. Journal of Pediatric Psychology, 31, 764–769.

Matthew Mahavongtrakul edited this post on March 5th, 2020.

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