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:
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Frequent blood sugar monitoring (fingersticks or CGM)
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Scheduled or flexible insulin doses
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Carb counting for meals/snacks
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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:
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Shakiness or dizziness
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Sweating
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Confusion or irritability
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Headache
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Slurred speech
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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:
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Increased thirst
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Frequent urination
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Fatigue
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Blurry vision
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Nausea or vomiting (possible DKA warning sign)
What to do: Follow the DMMP, notify parent/guardian, and monitor for ketones if indicated.
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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:
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Blood glucose monitoring schedule
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Insulin dosing and delivery method (injections or insulin pump)
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Meal and snack plans
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Exercise considerations
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Emergency actions for hypoglycemia and hyperglycemia
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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:
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Follow the student’s DMMP as written by their healthcare provider
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Allow capable students to self-manage their care (including testing and insulin) in the classroom or elsewhere
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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:
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Have access to snacks and water at all times
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Can carry glucose tabs or juice
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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
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Have a quick-grab “diabetes emergency kit” in the health office
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Laminate a hypoglycemia cheat sheet to post in your office
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Schedule a staff in-service at the beginning of the school year
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Advocate for 504 Plans when needed
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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!
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Top 10 Type 1 Diabetes Resources for School Nurses & Families
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