The cooler days of fall are almost here which means the kids are going back to school. Diabetes is one of the most common chronic diseases of childhood. Parents of children with diabetes need to make additional preparations for a healthy, enjoyable and safe school year. In recent years, there is a sizable increase in type 2 diabetes in children and teens which is often related to higher body weight and lower activity levels. Type 1 diabetes remains common in school age children. Whether your child has type 1 or type 2 diabetes, many of the tips and guidelines below apply. Focus on the ones that will help you and your child specifically. Discover a few savvy school tips for children with diabetes:
A person with diabetes must always manage this chronic illness. Talk with your child about proper diabetes self-management skills based on his or her age. Build confidence in your child’s knowledge and diabetes self-care as your child gets older. Try not to show your child your worry and concern which may upset them and make them uncomfortable. Younger children may want to share some information about diabetes with the rest of the class. Try to keep the information very simple. Some pediatric endocrinologists offer short information/education sessions pertaining to diabetes to help get students ready for school. Check with your own physician to see what they offer.
Have your child ask the doctor/nurse any questions he or she might have and write down the answers. There is a new era in technology, especially for those with type 1 diabetes. Ask if there is any new technology available to make your child’s school day easier. There are CGM (continuous glucose monitoring) systems which can now alleviate glucose testing during the day. There is an insulin pen which keeps track of insulin dosing for those children who may forget if they have taken it. School staff such as nurses, coaches, teacher’s aids, administrative staff, principal and teachers can work with you and your child on properly managing diabetes during the school year. There are laws in place discussed below that have been set-up to help protect your child with diabetes from discrimination.
Create a diabetes management plan with your child’s school. Meet with the staff and your child to find out how the school helps care for students with diabetes. Review how they handle diabetes-related emergencies. Find out which surrounding hospital your child will be taken to in an uncontrollable emergency. The level of help your child needs is based on his or her age and condition. Assistance that may be provided by the school could include checking blood sugar levels, helping a child take medications, encouraging physical activity throughout the day, helping the child select healthy foods and being ready to treat hypoglycemia. This help is dependent on the child’s age and ability. Schools that receive federal funding cannot discriminate against those with diabetes in accordance with the Individuals with Diabetes Education Act, the Americans with Disabilities Act and Section 504 of the Rehabilitation Act of 1973. Proper accommodations must be made for your child with diabetes. Ask questions if you are not satisfied with the conditions your child’s experiences.
Medical Management Plan
Create a diabetes medical management plan with your child’s doctor and the school staff. Make sure your child’s physician signs a HIPAA agreement, so they can discuss your child’s medical condition with the school. Check to see that all school medical forms are updated prior to the start of the school year. Diabetes needs to be managed during school hours and extracurricular activities such as sports, clubs and field trips. School staff should know how to recognize high and low blood sugar levels, and what to do about them. Low blood sugar kits should be supplied by you in each area such as the gym, cafeteria, nurse’s office, art room, classroom and study hall, in case of hypoglycemia emergencies. Glucose tablets or a source of glucose must be readily available. If your child needs help with administering insulin or needs to eat snacks in the classroom, discuss implementation of these needs with school staff. Bathroom privileges and eating snacks should be available as needed. Teamwork is critical. Provide a list of key contacts to the school, including doctors and emergency contacts. An older student should have your phone number memorized. Verify where and when your child can test blood sugar and administer medications on a schedule.
Eye and Dental Exam
Make sure to schedule an eye exam and dental exam prior to the start of school. If your child wears glasses, make sure the prescription has not changed. This requires additional testing beyond the eye exam which checks for changes from diabetes called retinopathy. Make sure to pack an extra pair of glasses in case the originals get lost or broken. This will help decrease levels of anxiety in your child’s day. Dental checkups are important prior to starting school, but even more with diabetes. Supply a toothbrush, dental floss and travel size toothpaste in your child’s backpack to help keep a healthy and clean mouth after lunch/snacks.
Medical ID and Diabetes Supplies
Have your child wear a medical ID bracelet or necklace. Create a package of diabetes supplies for your child to carry in his or her backpack. Keep extra supplies and snacks in a locker, if available. Make sure the school has diabetes supplies on-hand that you supplied and that they are stored at the proper temperatures. Supplies to have on-hand at school and in a backpack include water, insulin and diabetic syringes or pens with pen needles, ketone testing supplies, antiseptic wipes, a blood glucose meter with extra batteries, lancets. If your child wears an insulin pump, have backup insulin and pump supplies in case the pump fails. Insulin kept in a backpack should be stored in a temperature-controlled container. Have a solid plan for sharp disposals for everyone’s safety. Your child should have glucose tablets and snacks to boost their blood sugar in an emergency. These snacks may include 4 to 6 ounces of regular soda, 3-5 pieces of hard candy, 6-8 gummy bears, or 2 tablespoons of raisins. Verify the school staff has a glucagon emergency kit by bringing one to the school nurse to hold and make sure they can use it properly if your child has a low blood sugar emergency. Make sure your child knows where to go in an emergency. With small children, have an emergency person in the classroom, either the teacher, teacher’s aide or a fellow student to help guide your child to the school nurse since they be frightened or disoriented.
Prepare a healthy breakfast each morning in a calm environment (not rushing and eating in the car) to help your child stay grounded, satiated and focused. Breakfast should include a high-quality protein such as eggs with a whole grain such as whole wheat toast, pumpernickel bread, sour dough rolls or a small bowl of steel cut oats which impacts blood sugar less than white bread and offers more nutrients, minerals and fiber. Whole grains contain the 3 essential parts: bran, germ and endosperm which supply more iron, magnesium, manganese, selenium, and B vitamins, all of which are needed for proper growth. Greek yogurt is a good choice since it is thick and creamy, is higher in protein, and lower in sugars than regular flavored yogurts. Avoid instant, flavored oatmeal packets which contain artificial flavors, colors, added sugar and less fiber than steel cut or rolled oats. Oatmeal has anti-oxidants, beta-glucans and soluble fiber. Include a beverage to keep them well hydrated. Younger children may appreciate a glass of cold, low-fat milk while a teenager may enjoy a cup of hot, regular or herbal tea. Green and black teas contain antioxidants that can boost gut friendly bacteria and have powerful nutrients called catechins. Some green and black teas have small amounts of caffeine which may help with energy needs throughout the day and into after school sports or dance activities. Instead of fruit juice, which can send blood sugars soaring, consider serving a glass of vegetable juice. Vegetable juice is a flavorful drink which supplies a serving of veggies for the day, is delicious and is low in calories without sugar.
Know what time lunch is served to your child. Some schools start lunch as early as 10:15AM and could go as late as 2:15PM. Discuss what works best for your child and what provisions need to be taken. Lunch should include foods such as whole grains, fresh fruits and vegetables, low-fat dairy items and lean meats, as well as snacks such as nuts and fruit. Lean proteins help maintain and grow muscles and tissues and help regulate body processes. Tell your child to avoid the temptation of vending machines. Teenagers, especially those who drive, may be able to have lunch off school campus and head to fast food restaurants. This does not need to be a disaster. If the child makes better choices, by skipping regular soda, by eating smaller portions, avoids bacon, fries, onion rings and other saturated fat items and avoids words like, “smothered, drenched, loaded, triple, super-sized, supreme, or Grande”, they should be able to eat a higher quality meal. All fast food restaurants now offer complete meal salads, bean chili, plain burgers, grilled chicken sandwiches, baked potatoes and diet sodas or bottled water. Some even offer apple slices or fruit cups. Socialization by going out to lunch, should remain a part of your teen’s day. Pack extra nuts, peanut butter or cheese crackers, individual packs of hummus and carrot sticks, celery sticks or cherry tomatoes and fruit for your child to snack on during the day. Review the school lunch menus to see if the choices are suitable for your child. Discuss lunch menus and meal plans with school personnel. Many schools are working with local dietitians to plan better lunch choices. Other schools send surveys during the late summer to get input from the students and families. Many schools have online access to daily lunch menus which lists information about ingredients, calories and allergies related to the specific foods of that day. Pack your child’s lunch if the options are not in accordance with your child’s diabetes self-management plan.
Incorporate a minimum of 30 to 60 minutes of physical activity into your child’s day. Your child should be able to participate in physical education classes and extracurricular sports. Being active can help improve your child’s blood sugar control. Encourage your child to be active after school by going for a bike ride or taking walks together. Reduce the time your child spends on electronic devices such as the TV or computer to 1-2 hours each day. Remember to encourage your child to increase hydration when participating in physical activity. Avoid “enhanced sports drinks” which are full of sugar and are unnecessary. A 20-ounce bottle of Gatorade contains 34 grams of processed sugar, 270 mgs of sodium, synthetic food dyes and other chemicals. Gatorade was the original sport drink made for relentless, college athletes who played in Florida in extremely high temperatures with high humidity. Concentrate on giving them plenty of fresh, cool water and adding a side of fruit which will give them fiber, vitamins, natural ingredients and minerals instead. Other healthy foods that supply a lot of water are sliced cucumbers, beets, watermelon, kiwi and berries. Snacks with protein and carbohydrates are needed for after school activities to help your child maintain a proper blood sugar and lots of energy.
Advise your child to wash his or her hands before eating and after using the restroom. Talk to your child’s doctor to verify your child has recommended vaccinations, including the flu shot. It can take children with diabetes longer to recover from sicknesses. Vaccinations can help ward off illness and reduce the time your child misses school. Talk to the school staff immediately if your child misses a lot of school due to illness so there are no later surprises.
Make sure your child is getting a good night’s sleep to keep up their immunity and increase their concentration and focus. Inadequate sleep can mess with blood sugars. Most young people require approximately 8.5 hours of sleep a night. This helps keep down cortisol levels, a stress hormone that raises blood sugars. Proper rest encourages growth hormone to be produced, to help your child continue to grow. Sleep is when your child’s body repairs and replenishes. Teenagers prefer to go to sleep late and wake up later. If they are still getting required sleep hours, they should be allowed to do this if it coordinates with their school start times. Be aware that 1 in 10 children suffer from snoring which may indicate a problem with sleep apnea, allergies, sinus issues, tonsils or a deviated septum. Know if your child snores since they will not be getting all the important stages of sleep.
Your child may benefit from a support group or peer group specifically for children with type 1 and type 2 diabetes. Some children like to share experiences or learn from older children about how to deal with diabetes during and after the school day. Talk to your physician, local hospital, the YMCA or local community center about starting one if there is none available in your area.
Check with school transportation if your child rides the bus. They should have supplies available and provided by you, in case of a low blood sugar. You need to know that the bus driver is comfortable helping your child during diabetes emergencies. Smaller children with diabetes should always sit in the front of the bus, near the driver or bus monitor.
Children with diabetes can have a safe and productive school year with proper planning and the assistance of school staff. Provide the essential medical information to the school to ensure they have the resources needed for your child’s well-being. Talk to your child about diabetes self-management so he or she is well-prepared for the school days ahead. Make it a productive school year!
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NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.
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