Managing Type 1 Diabetes at School

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Diabetes at School: What Every School Nurse Should Know About Type 1

Type 1 Diabetes (T1D) is one of the most medically complex chronic conditions managed in the school setting—and as the school nurse, you're at the heart of it all. In 2021, it was reported that approximately 1.2 million children and adolescents are estimated to have T1D globally. source

From blood sugar checks to carb counts to emergency responses, students with T1D need daily support to stay safe, healthy, and ready to learn. Whether you’re brand-new to school nursing or just need a refresher, this guide will walk you through what you need to know to feel confident managing diabetes at school.

Type 1 Diabetes: The Basics

Type 1 Diabetes is an autoimmune condition. The pancreas stops producing insulin, the hormone needed to let glucose into the body’s cells for energy. People with T1D must balance insulin, food, and activity levels 24/7 x 365- no days off!

At school, that means:

Frequent blood sugar monitoring (fingersticks or CGM)
Scheduled or flexible insulin doses
Carb counting for meals/snacks
Emergency plans for highs (hyperglycemia) or lows (hypoglycemia)

Know the Signs of Highs and Lows

Low Blood Sugar (Hypoglycemia):
Can come on fast and be dangerous. Look for:

Shakiness or dizziness
Sweating
Confusion or irritability
Headache
Slurred speech
Seizure or loss of consciousness (in severe cases)

What to do: Follow the student’s Diabetes Medical Management Plan (DMMP). Most students will need 15 grams of fast-acting carbs, rechecked in 15 minutes. Always keep emergency glucose and glucagon nearby.

High Blood Sugar (Hyperglycemia):
Usually develops more slowly. Watch for:

Increased thirst
Frequent urination
Fatigue
Blurry vision
Nausea or vomiting (possible DKA warning sign)

What to do: Follow the DMMP, notify parent/guardian, and monitor for ketones if indicated.

What’s in a DMMP—and Why It Matters

The Diabetes Medical Management Plan (DMMP) is your go-to guide for managing each individual student’s care. It’s typically written by the student’s diabetes care provider and signed by the parent/guardian.

It covers:

Blood glucose monitoring schedule
Insulin dosing and delivery method (injections or insulin pump)
Meal and snack plans
Exercise considerations
Emergency actions for hypoglycemia and hyperglycemia
When to call home—or 911

Keep it updated and easy to access.

Know the Law: Diabetes Care in Schools

In Illinois, the Care of Students with Diabetes Act (105 ILCS 145/) outlines specific responsibilities for schools and staff supporting students with diabetes. It requires schools to:

Follow the student’s DMMP as written by their healthcare provider
Allow capable students to self-manage their care (including testing and insulin) in the classroom or elsewhere
Ensure trained school staff are available to recognize and respond to diabetes-related emergencies

Not in Illinois? Be sure to check your own state’s laws. Many states have similar protections to ensure students with diabetes can safely participate in all school activities.

Snacks, Supplies, and School Staff

Make sure students:

Have access to snacks and water at all times
Can carry glucose tabs or juice
Know where to go when they feel “off”

And don’t forget your team. Educating teachers, coaches, lunch staff, and even bus drivers on basic signs of high/low blood sugar can make all the difference.

Communication Is Key

A solid communication plan with families helps keep everyone on the same page. Use daily logs, messaging apps, or email—whatever works best. Ask questions. Clarify unclear orders. Keep the DMMP updated.

And most importantly: listen to the student. They live with this every day. Even young students often know their bodies better than anyone.

Pro Tips from The School Nurse

Have a quick-grab “diabetes emergency kit” in the health office
Laminate a hypoglycemia cheat sheet to post in your office
Schedule a staff in-service at the beginning of the school year
Advocate for 504 Plans when needed
Don’t forget to check expiration dates on glucagon and supplies

Final Thoughts

Managing Type 1 Diabetes at school can feel like a lot, especially in the beginning. But you don’t have to figure it out alone. Lean on your school nurse community, ask for support when you need it, and create systems that make daily care smoother for both you and your students. Want to make things easier? Grab my ready-to-go T1D Printable Resources HERE!

Top 10 Type 1 Diabetes Resources for School Nurses & Families

1. American Diabetes Association – Safe at School

https://diabetes.org/safeatschool Includes training resources, sample care plans, and guidance on students’ legal rights related to diabetes care at school.

2. National Association of School Nurses (NASN) – Diabetes Resources

https://www.nasn.org/nasn-resources/resources-by-topic/diabetes Offers evidence-based practice tools, care coordination tips, and policy updates for managing diabetes in the school setting.

3. Centers for Disease Control and Prevention (CDC) – Managing Diabetes

https://www.cdc.gov/diabetes/managing/children.html Provides guidance for supporting children with diabetes, including school accommodations and safety measures.

4. JDRF (now Breakthrough T1D) – T1D School Resources

https://www.breakthrought1d.org/t1d-resources/school/ Features school readiness tips, 504 Plan tools, classroom management strategies, and parent resources.

5. Joslin Diabetes Center – School Nurse Information

https://joslin.org/services/pediatric-diabetes/educational-programs/resources-school-nurses Educational tools for school staff, including diabetes care plans and communication checklists.

6. Beyond Type 1 – Educator Resources

https://beyondtype1.org/t1d-and-school/ Practical tips for school staff and families, covering everything from school supplies to emergency protocols.

7. Oregon School Nurses Association – T1D Toolkit

https://www.oregonschoolnurses.org/oregonschoolnurses/resources/toolkits/t1d-toolkit-for-school-nurses Toolkit with editable care plans, delegation guidance, and best practices for diabetes management in schools.

8. Children With Diabetes – School and Legal Support

https://www.childrenwithdiabetes.com/for-parents/diabetes-at-school/ Guidance on students’ rights, 504 Plan tips, and advice for ensuring safe diabetes care in school.

9. Association of Diabetes Care & Education Specialists – T1D School Strategies

https://www.adces.org/store/online-education/detail/going-to-school-with-t1d-essential-insights-strategies-v2 Online course designed for educators and parents to improve diabetes care understanding in school settings.

10. KidsHealth – Diabetes in Children

https://kidshealth.org/en/parents/diabetes.html Family-friendly diabetes education, including school-specific tips, sick day management, and glucose monitoring basics.