Understanding &

Supporting
Diabetes Management
at School
Introduction

• Introduction
• Key Issues
• Short term strategies
• Long term strategies
• Conclusion
• Question & Answers
• Contact Information
Key Issues

• 1. Reliance on Continuous Glucose Monitoring

(CGM) & Bolusing
1. Reliance on Continuous Glucose Monitoring (CGM) & Bolusing

This Photo by Unknown Author is licensed under CC BY-NC-ND

 Concerns & Impact - CGM
• 1. Accuracy and Calibration:-
• Concern: CGM accuracy varies due to factors like sensor
calibration and lag comparted to blood glucose.
• Impact:Impact: Inaccuracies can lead to incorrect insulin
dosing decisions, risking hypo/hyperglycaemia.
• 2. Sensor Discomfort:
• Concern: Sensor insertion discomfort can lead to
reluctance, especially for a child.
• Impact: Discomfort may affect consistent CGM use.
• 3. Device Maintenance:
• Concern: Regular sensor replacements and upkeep can be
challenging.
• Impact: Managing maintenance adds logistical complexity.
• 4. Dependency on Technology:
• Concern: Overreliance on CGM hampers independent
trend interpretation.
• Impact: Dependency becomes a barrier without CGM
availability.
• 5. Psychological Impact:
• Concern: Continuous monitoring can cause anxiety,
affecting well-being.
• Impact: Psychological stress may influence diabetes
management.
• 6. Data Overload:
• Concern: CGM generates overwhelming data.
• Impact: Data overload complicates decision-making.
• 7. Technology Reliability:
• Concern: Technical issues disrupt monitoring.
• Impact: Unreliable data causes stress and affects
management.
• 8. Privacy and Peer Awareness:
• Concern: Peer awareness may affect Brent's comfort.
• Impact: Self-esteem may be impacted in social
situations.
Concerns & Impact - Bolusing
1. Meal Timing and Physical Activity
Timing and • Concern: School schedules may not align with mealtime and insulin
dosing.
• Impact: Inconsistent bolusing timing affects blood sugar and 1. Concern: Physical activities post-meals are common.
Schedule concentration. 2. Impact: Coordination with exercise prevents
hypo/hyperglycaemia.

Carbohydrate • Concern: Accurate carb counting is challenging. 2. Communication

• Impact: Inaccurate dosing leads to hypo/hyperglycaemia and
1. Concern: Effective communication is crucial.
Estimation disrupts school day.
2. Impact: Poor communication leads to missed boluses or
mismanagement.
Privacy and • Concern: Insulin use may make Brent self-conscious.
• Impact: Stigma affects confidence and social interactions.
3. Unpredictable Factors
Stigma 1. Concern: Unexpected events disrupt bolusing.
2. Impact: Disruptions result in blood sugar fluctuations.
4. Responsibility and Independence
Teacher • Concern: Teachers may not fully understand T1D management.
• Impact: Lack of awareness leads to missed boluses or inadequate 1. Concern: Brent is transitioning to independent
Awareness support. management.
2. Impact: Correct bolusing fosters independence and safety.

• Concern: School policies on insulin administration vary.

5. Hypos and Hypers
School Policies • Impact: Policies affect discreet bolusing and timeliness. 1. Concern: Improper bolusing leads to
hypo/hyperglycaemia.
2. Impact: Episodes affect concentration and participation.
Remember !
• Evidence: A 2020 study “Monitoring of Paediatric Type 1 Diabetes highlighted CGM accuracy
Accuracy and Calibration: variations. Fingerprick checks calibrate CGM for accuracy Marks and Wolfsdorf (2020).

Detection of • Evidence: A 2018 study by Wadwa et al. (2018) stressed fingerstick checks for timely
hypo/hyperglycaemia detection
Hypo/Hyperglycaemia:
• Evidence: A 2023 study by Forlenza et al. (2023)demonstrated that combining CGM and
Treatment Decision Support: fingerstick checks aids treatment decisions.

• Evidence: According to (Rodbard, 2017) a review Diabetes Technology & Therapeutics"

Calibration and Accuracy: emphasised fingerprick checks for sensor calibration and accuracy.

• Evidence: Clinical guidelines by ISPAD and stress fingerstick checks for diabetes management,
Safety and Guidelines: backed by research and clinical experience (International Society for Paediatric and Adolescent
Diabetes, 2022)
Key Issues

•2. Hypos During Sports

 • To address the immediate issue of hypoglycemia during sport
you can consider the following strategies
• 1. Pre exercise snack – Encourage Brent to have a small easily
digestible carbohydrate snack before his sport session. Staff
can remind Brent to have this snack and ensure its readily
available.
Short term strategies • Snacks to consider savoury - Cheese slices or cubes, corn
chips & Salsa, Rice Crackers and Hummus, Boiled Egg,
Popcorn or Pretzels
• Sweet snacks can include, Plain biscuit, low fat tub of yogurt,
berries,
• Fresh fruit, pikelet or museli bar (oats, dried fruit & nuts
 • CGM checks

• Allow Brent to perform CGM checks during sports class

breaks
• IF CGM indicates a low blood sugar reading he should have
Short Term glucose gel or snack to raise his blood sugar to a safe level.
• Emergency response Plan:
Strategies • Have a Plan: Ensure that Brent, his caregivers, and school
staff are familiar with an emergency response plan for severe
hypoglycaemia, which may include the use of glucagon if he
becomes unconscious or unable to swallow.
 • Workshops - Regular workshops for school staff on
T1D, its management and student specific needs.
Long Term Open dialogue is encouraged.
• Individulised Plan – This will be developed in
Strategy: Diabetes collaboration with the healthcare team, shared with
school staff, specifying accommodations and
Education & emergency procedures.

Communication • Communication: Regular updates with teaching staff,

including any insulin changes and target blood sugar
ranges.
• Point of contact appointment of a designated staff
member as the primary contact for diabetes-related
concerns.
 Training: training for emergency response, covering
hypoglycemia and hyperglycemia recognition and
glucagon use.

Integration and Awareness: Encourage Teachers and

Staff to incorporate management into lesson plans

Emergency Blood Sugar Checks: Implement discreet blood sugar

check routines
preparedness
Physical Activity: Collaborate with PE teachers for
blood sugar management during physical activity

Supportive Environment: Promote an inclusive school

culture, focusing on the emotional well-being of
students with T1D
 Annual Review: Conduct an
annual review of Brent's
care plan, making
necessary adjustments.

Connect to Resources: Help

teachers access local Peer Education: Consider
diabetes support groups involving classmates in

Planning and and resources for

information on T1D
management.
diabetes awareness
activities.

Feedback

Feedback: Establish a
feedback system for Brent
Community Resources:
and his family to improve
diabetes support.
 1. CGM Reliance:
1. Concerns about CGM over-reliance.
2. Need for fingerstick checks for calibration and accuracy.
2. Hypoglycaemia During Sports:
1. Brent's hypoglycaemia during sports impacts his participation.
2. It affects his academic performance and behaviour.
• Long-Term Strategies for School:
• Implement staff diabetes education.
Conclusion – Key • Develop an individualized Diabetes Care Plan.
• Maintain regular communication with teachers.

Issues • Appoint a diabetes point of contact.

• Conduct emergency training for severe hypoglycaemia.
• Encourage diabetes integration in lessons.
• Establish discreet blood sugar checks.
• Collaborate on sports blood sugar management.
• Promote a supportive school environment.
• Conduct annual care plan reviews.
• Consider peer education.
• Establish a feedback mechanism.