Supporting Students with Type 1 Diabetes: A School Nurse’s Role

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.

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Asthma At School

Understanding Asthma in Schools:

What Every School Nurse Needs to Know

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Asthma is one of the most common chronic conditions in children, making it a significant health concern in the school setting. As school nurses, it’s essential to understand the basics of asthma, how it affects students, and how to manage it in the school environment to ensure students are safe and supported throughout their school day.

What is Asthma?

Asthma is a chronic disease that affects the airways in the lungs, making them inflamed and narrow, which can make breathing difficult. Asthma symptoms can vary from person to person but typically include:

• Wheezing (a whistling sound when breathing)

• Shortness of breath

• Coughing, especially at night or early in the morning

• Chest tightness

Asthma attacks occur when the airways become even more inflamed and narrow, making it harder to breathe. Triggers can include allergens (like pollen or pet dander), irritants (such as smoke or strong odors), physical activity, and even cold air or stress.

Prevalence of Asthma in Schools

Asthma is one of the most common chronic conditions among children in the United States. According to the Centers for Disease Control and Prevention (CDC), about 1 in 12 children has asthma. This means that in many schools, it’s likely that several students will be managing asthma on a daily basis.

Children with asthma may have different levels of severity. Some may only experience occasional symptoms, while others may face frequent asthma attacks that require medication or even emergency medical care. As school nurses, we need to be prepared to manage asthma in both mild and severe cases.

Critical School Tools

When managing asthma in schools, it’s important to understand the distinct roles and differences for the following types of forms / documents!

Asthma Action Plan, Individualized Healthcare Plans (IHPs), and State Policies & School Procedures

1. Asthma Action Plan (AAP) – An Asthma Action Plan (AAP) is a written, personalized guide created by the student’s healthcare provider, usually their doctor, to manage their asthma. This plan provides clear instructions for both the student and school staff on how to handle asthma symptoms and prevent attacks. It’s designed to help everyone involved know what steps to take during a specific student's asthma episode. There are many free examples available online to help create or update an AAP. A comprehensive Asthma Action Plan typically includes:
• Personalized triggers – What sets off the student's asthma, such as dust, pet dander, or cold air.
• Symptoms to watch for – How to recognize the early signs of an asthma attack, such as coughing, wheezing, or chest tightness.
• Medications – Detailed instructions about daily medications (like inhalers) and emergency medications (such as rescue inhalers).
• Emergency actions – Steps to take if the student’s asthma symptoms get worse, including when to call for help or seek medical attention.
• Contact information – Emergency contact numbers, including the student’s doctor and parents.
2. Individualized Healthcare Plan (IHP) – Written by the school nurse, the IHP is a comprehensive plan that outlines the student’s health needs and how nursing staff will meet those needs during the school day. For students with asthma, and IHP would most likely include the nursing assessment, nursing diagnoses, goals, interventions, expected outcomes, and an evaluation area. IHPs should be reevaluated and updates as needed, but at least each school year.  
3. State Policies and School Procedures – When it comes to managing asthma in schools, it’s important to understand the difference between state policies and school procedures—both are essential, but they serve different purposes.

State Policies- State policies are laws or mandates passed by the state legislature. In Illinois, for example, the law 105 ILCS 5/22-30 allows students to carry and self-administer their asthma medication (like an inhaler) at school, as long as the proper documentation is provided by the parent/guardian and the student’s healthcare provider.

These laws are designed to protect students' rights and ensure schools follow standardized safety guidelines across the state. In Illinois, 105 ILCS 5/22-30 requires schools to:

• Permit self-carry/self-administration of asthma medication with appropriate written authorization

• Ensure staff are informed and trained on the school’s asthma policies

• Maintain an asthma emergency response protocol

• Request an Asthma Action Plan for each student diagnosed with asthma

School Procedures- School procedures are the step-by-step processes each school or district puts in place to carry out the state policy. They are the way each school or district follows the law, based on their own staff, setup, and available resources. Examples of school-level procedures include:

• How inhalers are stored in the nurse’s office (if not self-carried)
• When and how staff are trained to recognize and respond to asthma symptoms
• Which forms need to be submitted and how often
• Protocols for field trips, gym class, or after-school activities

Role of the School Nurse in Managing Asthma

As the primary healthcare provider in the school setting, the school nurse plays a key role in managing asthma. Here’s what school nurses should know and do to ensure that students with asthma receive the best care:

• Engage with families and healthcare providers for consistent asthma care

• Ensure Asthma Action Plans are up-to-date 

• Educate school staff 

• Encourage the proper use of inhalers 

• Eliminate and monitor environmental triggers 

• Emergency response preparedness 

On the surface (no pun intended) this video is funny, but it's also scary because it perfectly highlights how crucial it is to educate our students on everything from their diagnoses to recognizing symptoms and using medications properly!

Final Thoughts

As a school nurse, you’re on the frontlines of asthma management. By staying proactive, informed about asthma care, and building strong partnerships with families and staff, you can help students with asthma thrive at school.

The key to success is an individualized approach. When you follow a student’s Asthma Action Plan, recognize early warning signs, and respond quickly, you’re not just managing asthma — you’re helping students stay healthy, confident, and ready to learn.

Together, we can make sure that students with asthma are safe, supported, and fully included in every part of school life — from classroom learning to sports and field trips.

And One Last Final Thought

Ideally, every student with asthma would have an updated Asthma Action Plan on file each school year—but in reality, that doesn’t always happen. When symptoms start to affect a student’s ability to learn, participate fully in class, or join in school activities, an IHP and sometimes even a 504 Plan are the next best way to make sure the right supports are in place.

That’s exactly why I created these editable Asthma templates. They’re designed to save you time and stress—no need to start from scratch. Just adapt them to your student’s needs and you’ll have clear, student-centered plans that support both health and learning. Click on an image below to learn more!

Top 10 Asthma Resources for School Nurses & Families

1. Centers for Disease Control and Prevention (CDC) – Asthma
   https://www.cdc.gov/asthma Offers data, management tips, educational materials, and CDC’s National Asthma Control Program resources.

2. American Lung Association – Asthma
   https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma
   Provides asthma basics, treatment info, downloadable Asthma Action Plans, and school-focused resources.

3. National Heart, Lung, and Blood Institute (NHLBI)
   https://www.nhlbi.nih.gov/health-topics/asthma Offers in-depth clinical guidelines and educational resources for professionals and families.

4. Asthma and Allergy Foundation of America (AAFA)
   https://www.aafa.org A comprehensive resource for asthma facts, webinars, support groups, and multilingual asthma action plans.

5. Allergy & Asthma Network
   https://www.allergyasthmanetwork.org Focuses on patient education and advocacy; includes school resources, handouts, and inhaler technique videos.

6. Healthy Schools Campaign – Managing Asthma in Schools
   https://healthyschoolscampaign.org Offers school-specific asthma policies, training modules, and action plan development guides.

7. National Association of School Nurses (NASN)
   https://www.nasn.org/nasn-resources/practice-topics/asthma Curated asthma resources for school nurses, including toolkits, webinars, and evidence-based practices.

8. KidsHealth – Asthma Center
   https://kidshealth.org/en/parents/asthma.html Parent-friendly and kid-friendly information, plus printable guides and student asthma support tips.

9. Global Initiative for Asthma (GINA)
   https://ginasthma.org International guidelines for asthma management and prevention; excellent for updated care standards.

10. Environmental Protection Agency (EPA) – Asthma and Indoor Air Quality
    https://www.epa.gov/asthma Offers resources about managing asthma triggers in the school environment and improving air quality.

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HIPAA, FERPA, and Teaching Staff About Health: A School Nurse’s Guide

HIPAA vs. FERPA

What New School Nurses Need to Know

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Hopefully Helpful School Nurse Tip: Starting your career as a school nurse can feel like learning a new language—especially when it comes to laws like HIPAA and FERPA. These privacy regulations are often confused, but understanding the differences is essential to managing student health information appropriately. And while you're juggling those details, you’re also teaching school staff how to care for students with health conditions. Let’s break it all down so you feel confident in both roles!

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Remember, I'm not an attorney or legal expert and this is not official legal advice. This information is intended for educational purposes only. Please consult with your school district for all of their definitions, policies/procedures, & guidelines.

HIPAA vs. FERPA: The Basics

If you’re wondering where HIPAA ends and FERPA begins, you’re not alone. Here’s a quick breakdown:

What Is HIPAA?

The Health Insurance Portability and Accountability Act (HIPAA) ensures the privacy of patient health information (PHI) in healthcare settings. It’s what doctors, hospitals, and insurance providers follow to keep patient information secure.

In a school setting, HIPAA may apply if you work with outside healthcare providers, like a student’s pediatrician or therapist.

What Is FERPA?

The Family Educational Rights and Privacy Act (FERPA) protects educational records, including health-related information maintained by the school. These records can include IEPs, 504 plans, school physical exams and immunization records.

FERPA governs how schools collect, share, and store student information. Unlike HIPAA, it’s designed specifically for educational institutions.

Key Differences Between HIPAA and FERPA

• HIPAA applies to healthcare providers.
• FERPA applies to schools and educational records.
• Example: If a student’s doctor faxes you a medication order, that’s HIPAA. Once the order becomes part of the student’s school record, it’s governed by FERPA.

Sometimes, these laws intersect. For instance, if you need to share a student’s health information with an outside provider, you may need consent from the parent/guardian to comply with both HIPAA and FERPA. Always check your district’s policies for specific guidance.

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What About Sharing Health Conditions With Teaching School Staff?

FERPA allows the sharing of student health information with school staff on a "need-to-know" basis if it is necessary for them to perform their job duties and ensure the safety or well-being of the student. Here’s a bit more detail:

FERPA and Sharing Health Information

• Permissible Sharing: FERPA permits school nurses and administrators to share student health information with teachers, aides, and other school staff who need the information to support the student effectively. For example, sharing a diabetes action plan with a teacher who supervises lunchtime would be appropriate.
• Parental Consent: In most cases, schools do not need explicit parental consent to share information internally for legitimate educational interests, such as maintaining safety or providing necessary care.
• Minimum Necessary Information: FERPA encourages sharing only the information necessary for the staff member to perform their role. For example, you might tell a bus driver that a student has severe asthma and what to do in case of an attack, without divulging unrelated medical history.

Emergency Situations

FERPA also provides more flexibility in emergencies. If a student’s health or safety is at immediate risk, you can share relevant information with those who can help, including external parties like first responders.

In General Everyday Situations

One of the most impactful parts of your role is helping teachers and staff understand student health needs of any student in general. What seems like simple knowledge to you, might be new information for someone outside of the health field. Here are a few tips to make those conversations effective:

1. Start With the Basics

Explain the health condition in simple terms. Focus on what staff need to know, like:

• Common symptoms.
• Triggers to avoid.
• Immediate steps to take during an emergency.

For example, when teaching about asthma, highlight signs of an asthma attack and demonstrate how to use an inhaler or spacer if necessary.

2. Create Handy Resources

Quick-reference guides or infographics can be lifesavers for busy staff. Consider including:

• Allergy protocols.
• Seizure action plans.
• Diabetes care instructions.

These resources should be easy to understand and accessible in classrooms, staff lounges, or online portals.

3. Use Real-Life Scenarios

Bring learning to life by sharing real-world examples. Role-playing scenarios, like responding to a student’s allergic reaction and using a trainer epi-pen, can help staff feel prepared and confident.

4. Respect Confidentiality

Remind staff to keep student health information private. Share only what is necessary to provide safe care. For example, instead of saying, “Jasmine has diabetes,” you can teach, “If a student has low blood sugar, offer a snack like juice or crackers.”

Bringing It All Together

As a school nurse, you’re the bridge between student health and education. Understanding the basics of HIPAA and FERPA helps you protect privacy, while teaching staff about health conditions ensures students receive safe, informed care.

By creating a supportive environment with clear communication and resources, you’re setting everyone up for success.

Need More Tools?
Check out this HIPAA vs. FERPA Quick Guide or these Teacher Tips for Staff Training to make your work easier. 

 Check out these other popular DOASN blog posts & product links.