The number of children living with Type 1 diabetes is at an all-time high. More than 30,000 children have been diagnosed with the condition in the UK, and it is vital that every one of them receives the appropriate support at school to manage their condition and protect their health and wellbeing.
By adhering to statutory guidelines, working closely with parents, carers and healthcare services, and having the right policies in place it is possible that all schools can provide children with Type 1 diabetes (or other medical conditions) with the care and support they need to thrive and reach their full potential.
What is Type 1 diabetes?
Type 1 diabetes develops when the insulin cells in the body have been destroyed and the body is unable to produce any insulin. Insulin is vital to help convert glucose into energy.
It is the most common form of diabetes in childhood, with the peak age of diagnosis between nine and 15. Unlike Type 2 diabetes, it is not linked to weight or lifestyle, and can't be prevented. The condition is always treated with insulin, which is either taken in the form of regular injections during the day or via a pump, which is attached to the body 24-hours-a-day.
When in school, many children with the condition will require some support with injecting, checking their blood glucose levels, using their pump, and counting the carbohydrate content of their meals. However, it is important to note that no young person with Type 1 diabetes is the same, and so they will require varying levels of support.
The right support
Good care in school for children and young people with Type 1 diabetes is really important because Type 1 diabetes is a serious and complex condition, and if not managed properly can lead to the young person's blood glucose levels going either dangerously high or dangerously low.
Short-term this can lead to drowsiness, behaviour changes, headaches, and feeling or being sick. High or low blood glucose levels may also require hospital attendance. Long-term, high blood glucose levels in childhood can increase the risk of serious complications such as amputation, blindness and stroke later in adult life.
Type 1 diabetes, if not well-managed, can affect learning, and a child can have difficulties with attention, memory, processing speed, planning and organising, and perceptual skills. It can also negatively affect the child's wellbeing and confidence, at a time when they are already vulnerable. This can make anxiety disorders, depression and eating disorders more likely.
It was these concerns that led Diabetes UK, as chair of the Health Conditions in Schools Alliance, to call on the government to introduce a new legal duty on schools to support children with long-term health conditions such as Type 1 diabetes. The new duty was introduced in September 2014 as part of the Children and Families Act and applies only in England. It requires schools to make arrangements so that pupils with long-term health conditions are supported to manage their condition well in school and can have access to a full education, including participation in school trips, PE lessons and extra-curricular activities. Other UK nations have guidance in place that should be followed as best practice.
The new legal duty is underpinned by statutory guidance, which states that to look after a child with a long-term condition, such as diabetes, the following should be in place in school.
Medical conditions policy
All schools should have a medical conditions policy, which outlines the school plans and procedures for supporting children with a medical condition. It should include information about the school's complaints procedure, where medication will be stored, what to do in an emergency, and training requirements for staff. Headteachers and school governors are responsible for ensuring that the medical conditions policy is in place. A sample medical conditions policy is available on the Diabetes UK website (see further information).
Individual Healthcare Plan (IHP)
Every child with diabetes will need an IHP. The IHP should identify the child's needs around managing their diabetes, outline how these will be met in school, and by whom. Headteachers, school governors and responsible bodies should make sure that each child with diabetes in their care has an IHP and that it is being carried out. The IHP should be updated whenever the child's care needs or treatment changes, and at least every year. A sample IHP is available on the website.
Appropriate training for staff
It is likely that most school staff will have no experience of diabetes so schools should make sure sufficient staff are trained to care confidently for children with diabetes in their care. At least two members of staff will have to be trained, normally by the child's paediatric diabetes specialist nurse (PDSN). All school staff should have a basic awareness of Type 1 diabetes and what to do in an emergency.
PDSNs
A working relationship between the child, their parent or carer and the PDSN is vital. The guidance from the Department for Education states that the views of families shouldn't be ignored. Headteachers (or another appropriate member of staff) should arrange a meeting with parents/carers and the PDSN to agree the IHP and to monitor it regularly. It is important that the parent or carer is listened too. Poor relations with the parent or carer can hamper a child's ability to get the care they need in school.
Inclusion in the whole-school curriculum
No child should be excluded from any part of school life because of their diabetes, and this includes extra-curricular activities. Heads, school governors and responsible bodies should make sure that children with Type 1 diabetes are able to take part in PE, extra-curricular activities, school trips and residential trips just like other children without the condition. Staff organising these activities should make necessary arrangements so that the child can take part. Only allowing a child with diabetes to take part in an extra-curricular activity or trip if one of their parents or carers accompanies them is not acceptable practice.
A helping hand
Diabetes UK recognises that some schools may have concerns about how to implement the guidance, which is why we have produced a collection of free resources to help schools, families and healthcare professionals to get the right support in place as part of our Type 1 Diabetes: Make the grade campaign – these are also available online.
- Libby Dowling is a clinical advisor with Diabetes UK.
Further information
For the sample policies and other resources mentioned in this article, visit www.diabetes.org.uk/schools