Table 1 Common elements of effective diabetes management in school

Assembling school health care plans

An individualised diabetes medical management plan should be agreed by the parent/guardian, school, and the student’s Children and Young Persons Specialist Diabetes team [12] and updated on a regular basis [11].

A Diabetes Medical Management Plan (DMMP) should be developed by the student’s personal diabetes health care team with input from the parent/guardian [19, 22] along with specific Individualized Health Care Plans (IMP) and Emergency Care Plans (EMP) [20].

Checking blood glucose during the school day

To provide and clean and safe environment [11].

A location in the school that provides privacy during blood glucose monitoring [19, 22].

Suitable location to check blood glucose [9].

Permission for the student to check his or her blood glucose level and take appropriate action to treat hypoglycaemia in the classroom or anywhere the student is in conjunction with a school activity, if indicated in the student’s DMMP [19, 20, 22].

Accessibility and storage of supplies

Provision of fridge space for spare supplies of insulin [11].

Permission for self-sufficient and capable students to carry equipment, supplies, medication, and snacks; to perform diabetes management tasks [19, 22].

Provide correct storage of supplies where necessary [11].

Diabetes supplies and equipment (for example, glucogel, glucose drinks and some complex carbohydrate to treat hypoglycaemic episodes) should be accessible to the student at all times [8, 9].

An appropriate location for insulin and/or glucagon storage, if necessary [19, 22].

Parents and, where appropriate, school nurses and other carers should have access to glucagon for subcutaneous or intramuscular use in an emergency, especially when there is a high risk of severe hypoglycaemia [17].

The parents/guardian should supply the school with a glucagon emergency kit [20, 23].

Parents and, where appropriate, school nurses and other carers should be offered education on the administration of glucagon [17].

The school nurse and/or trained diabetes personnel must know where the kit is stored and have access to it at all times [20, 23].

An appropriate location glucagon storage, if necessary [19, 22].

The provision of emergency supply boxes [11].

The parents/guardian must provide an emergency supply kit for use in the event of natural disasters or emergencies when students need to stay at school [20].

Hyperglycemia remedies should always be readily available at school [18].

Administering insulin during the school day

Provide and clean and safe environment [11].

The school nurse and/or trained diabetes personnel should assist with insulin administration in accordance with the student’s health care plans and education plans [20].

Suitable, private location to manage injections [9].

A location in the school that provides privacy during insulin administration, [19, 22].

Accessibility to scheduled insulin at times set out in the student’s DMMP as well as immediate accessibility to treatment for hyperglycemia including insulin administration as set out by the student’s DMMP [19, 22].

Accessibility of and participation in physical education in schools

Schools should allow children and young people with diabetes to manage their diabetes according to their chosen management form and to take part in the full range of school activities [12].

Students with diabetes should participate fully in physical education classes and team or individual sports [20].

Staff in charge of physical education or other physical activity sessions should be aware of the need for them to have glucose tablets or a sugary drink to hand [9].

Physical education teachers and sports coaches must be able to recognize the symptoms of hypoglycemia and be prepared to call for help with a hypoglycemia emergency [20].

Food and dietary management

To give permission for child/young person to eat whenever required [11].

School nurse and back-up trained school personnel responsible for the student who will know the schedule of the student’s meals and snacks and work with the parent/guardian to coordinate this schedule with that of the other students as closely as possible [19, 22].

Children and young people with diabetes need to be allowed to eat regularly during the day. This may include eating snacks during class-time or prior to exercise. Schools may need to make special arrangements for them if the school has staggered lunchtimes [9].

Permission for the student to eat a snack anywhere, including the classroom or the school bus, if necessary to prevent or treat hypoglycemia [19, 22].

Snacks should be available during the school day [18].

The food service manager or staff and/or the school nurse should provide the carb content of foods to the parents/guardian and the student [20].

Information on serving size and caloric, carbohydrate, and fat content of foods served in the school [19, 22].

Planning for special events, field trips, and extracurricular activities

Pupils with diabetes must not be excluded from day or residential visits on the grounds of their condition [12].

Full participation in all field trips, with coverage provided by trained diabetes personnel [19].

Information should be readily available from the paediatric diabetes specialist nurse on the inclusion of children and young people with diabetes on school trips [11].

The school nurse or trained diabetes personnel should accompany the student with diabetes on field trips [20].

Parental attendance at field trips should never be a prerequisite for participation by students with diabetes [20].

Full participation in all school-sponsored activities, with coverage provided by trained diabetes personnel [19, 22].

The school nurse or trained diabetes personnel should be available during school-sponsored extracurricular activities that take place outside of school hours [20].

Flexible accommodation for exams and tests

Permission for the student to use the restroom and have access to fluids (i.e., water) as necessary [19, 22].

Alternative times and arrangements for academic exams if the student is experiencing hypoglycaemia or hyperglycaemia [20].

Dealing with emotional and social issues

The student’s personal diabetes health care team and school health team must be aware of emotional and behavioral issues and refer students with diabetes and their families for counseling and support as needed [20].

Assisting the student with performing diabetes care tasks

(Blood glucose monitoring, insulin and glucagon administration, and urine or blood ketone testing)

Support for blood glucose monitoring and guidance on the interpretation of blood glucose results and any subsequent action [8, 9].

Assignment of diabetes care tasks, must take into account State laws that may be relevant in determining which tasks are performed by trained diabetes personnel [20].

Support of administration of insulin including treatment changes and a suitable location [8, 9].

The school nurse is the most appropriate person in the school setting to provide care for a student with diabetes [20].

The School nurse and back-up trained school personnel who can check blood glucose and ketones and administer insulin, glucagon, and other medications as indicated by the student’s DMM [19, 22].

Permission for the student to see the school nurse and other trained school personnel upon request [19, 22].

Permission to miss school without consequences for illness and required medical appointments to monitor the student’s diabetes management. This should be an excused absence with a doctor’s note, if required by usual school policy [19, 22].

Diabetes education and training of school nurses and school personnel

Staff in schools should receive appropriate and consistent training, advice and support from health services and children’s diabetes specialist service [11].

All school personnel - Level 1. Diabetes Overview and How to Recognize and Respond to an Emergency Situation [19, 20, 22].

Education about diabetes must be provided to teachers and other school personnel, including school receptionists, PE teachers and school nurses, on a regular basis [12].

School personnel who have responsibility for the student with diabetes throughout the school day (e.g., classroom, physical education, music, and art teachers and other personnel such as lunchroom staff, coaches, and bus drivers).- Level 2 Diabetes Basics and What to Do in an Emergency Situation [19, 20, 22].

Children and young people, their parents, schoolteachers and other carers should be offered education about the recognition and management of hypoglycaemia [17].

School staff members designated as trained diabetes personnel who will perform or assist the student with diabetes care tasks when allowed by State law - Level 3. General and Student-Specific Diabetes Care Tasks [19, 20, 22].

Staff members need an appropriate level of diabetes education, and this should be relevant to activities that take place on the premises as well as those associated with participation in school trips and camps [24].

It is important that when staff agree to administer blood glucose tests or insulin injections, they should be trained by an appropriate health professional [17].

School nurses need to update their diabetes knowledge regularly and have their competencies checked on a regular basis [21].

Training of nonmedical school personnel to perform diabetes care duties is essential and should be facilitated by a diabetes-trained health care professional such as the school nurse or a certified diabetes educator [20].

When staff agree to administer blood glucose tests or insulin injections, they should be trained by an appropriate health professional [8, 9].

Opportunities for the appropriate level of ongoing training and diabetes education for the school nurse [19, 22].

Recognizing and treating hypoglycemia

Ability to recognise and manage hypoglycemia [8–16].

Early recognition of hypoglycemia symptoms and prompt treatment [20].

All school personnel who have responsibility for the student with diabetes should receive a copy of the Hypogycemia Emergency Care [20].

Recognizing and treating hyperglycemia

Awareness by school staff of the signs of hyperglycaemia [8–16].

Hyperglycemia needs to be recognized and treated in accordance with the student’s DMMP [20].

All school personnel who have responsibility for the student with diabetes should receive a copy of the Hyperglycemia Emergency Care Plan and be prepared to recognize and respond to the signs and symptoms of hyperglycemia [20]. Supervision until appropriate treatment has been administered [19, 22].

Communication between school health personnel and diabetes healthcare providers

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Self-care and management at college/university

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