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Canadian Paediatric Society

Management of type 1 diabetes in school

About 1 in 300 children have type 1 diabetes, a chronic disease where the pancreas no longer produces insulin.52 People with type 1 diabetes rely on injections or infusions of insulin to keep their blood sugar levels in a target range. Maintaining good control of diabetes, by minimizing low and high blood sugars, reduces the risk of short- and long-term complications.

Children younger than 5 years and early school-aged children are the fastest growing group of new type 1 diabetes diagnoses. These children need support for the daily tasks of diabetes management. Because they spend about 30 to 35 hours a week in school, ensuring that children and youth are safe and well-managed throughout the day is critical. One of the biggest concerns for children with type 1 diabetes in school is the potential for low blood sugar (hypoglycemia) which, if not treated, can rapidly lead to loss of consciousness or seizure.53

The Canadian Paediatric Society and the Canadian Paediatric Endocrine Group recommend that all provinces and territories establish a comprehensive policy on the management of type 1 diabetes in school, which should require schools to: develop an Individual Care Plan; identify and require at least two school personnel to be trained to provide support; ensure teachers of students with type 1 diabetes are trained to recognize and treat low blood sugar (hypoglycemia); provide a clean, safe area for diabetes self-care; provide accommodations in the event of hypoglycemia before/during an exam/test.54 The Canadian Diabetes Association has similar guidelines.55 56

Province/Territory2012 status2016 statusRecommended actionsComments
British Columbia

Not assessed

Good

Implement a reporting/evaluation mechanism to demonstrate consistency and effectiveness of policy.

Under BC’s provincial standards for supporting students with type 1 diabetes, a template care plan is completed by Nursing Support Services with the child’s parents, health team and school administrator. This care plan can be individualized to the student’s needs.

Alberta

Not assessed

Poor

Develop comprehensive policy on managing type 1 diabetes in school, consistent with CPS/CPEG and CDA recommendations.

Saskatchewan

Not assessed

Poor

Develop comprehensive policy on managing type 1 diabetes in school, consistent with CPS/CPEG and CDA recommendations.

Manitoba

Not assessed

Poor

Develop comprehensive policy on managing type 1 diabetes in school, consistent with CPS/CPEG and CDA recommendations.

Ontario

Not assessed

Fair

Expand guidelines to provide support for insulin administration, for students who require assistance with injections or pump.

The ministry requires that school boards have policies and procedures in place to support children and students with certain medical conditions in schools. The policy will be finalized in winter 2018, for implementation by September 2018.

Quebec

Not assessed

Good

Implement a reporting/evaluation mechanism to demonstrate consistency and effectiveness of policy.

A provincial protocol is in place for parents, school administration and school nurses. Extra support may be available when necessary through application of code 33, ‘mild organ deficiency’ (déficience organique légère).

New Brunswick

Not assessed

Fair

Expand guidelines to provide support for insulin administration, for students who require assistance with injections or pump.

Diabetes management is recognized as an essential routine service in Policy 704 – Health Support Services, and the province has developed a Handbook for Type 1 Diabetes Management in Schools for school administrators and staff.

Nova Scotia

Not assessed

Fair

Expand guidelines to provide support for insulin administration, for students who require assistance with injections or pump. 

2010 guidelines call for the development of an individual care plan, with information and training for school personnel.

Prince Edward Island

Not assessed

Poor

Develop comprehensive policy on managing type 1 diabetes in school, consistent with CPS/CPEG and CDA recommendations.

Newfoundland and Labrador

Not assessed

Fair

Expand guidelines to provide support for insulin administration, for students who require assistance with injections or pump. 

2014 guidelines recommend development of a Diabetes Management and Emergency Plan.

Yukon

Not assessed

Poor

Develop comprehensive policy on managing type 1 diabetes in school, consistent with CPS/CPEG and CDA recommendations.

Northwest Territories

Not assessed

Poor

Develop comprehensive policy on managing type 1 diabetes in school, consistent with CPS/CPEG and CDA recommendations.

Nunavut

Not assessed

Poor

Develop comprehensive policy on managing type 1 diabetes in school, consistent with CPS/CPEG and CDA recommendations.

Excellent

Province/territory has a policy on the management of children and youth with type 1 diabetes in schools, consistent with recommendations from the Canadian Paediatric Society, the Canadian Paediatric Endocrine Group and the Canadian Diabetes Association. Mechanisms are in place to demonstrate that the policy is being implemented consistently and effectively across the province/territory. 

Good

Province/territory has a policy on the management of children and youth with type 1 diabetes in schools, consistent with recommendations from the Canadian Paediatric Society, the Canadian Paediatric Endocrine Group and the Canadian Diabetes Association. The policy requires the development of an Individual Care Plan and the provision of appropriately trained personnel to assist students with daily management, including insulin administration and glucagon as needed.

Fair

Province/territory has guidelines on type 1 diabetes in elementary and secondary schools, but guidelines lack some components recommended by the CPS/CPEG and CDA, and does not provide for the administration of insulin while in school. Guidelines include provision for management of hypoglycemia, support for blood glucose checks and emergency plans.

Poor

Province/territory has no guidelines on type 1 diabetes in elementary and secondary schools.

Endnotes

  1. Lawrence SE, Cummings A, Pacaud D, Lynk A, Metzger DL; Canadian Paediatric Society; Canadian Pediatric Endocrine Group. Managing type 1 diabetes in school: Recommendations for policy and practice. Paediatr Child Health 2015;20(1):35-39.
  2. Ibid.
  3. Ibid.
  4. Canadian Diabetes Association, 2014. Guidelines for the care of students living with diabetes at school: www.diabetes.ca/getmedia/173678f6-1a4a-4237-bd55-aa7ba469a602/guidelines-for-students-in-school.pdf.aspx (accessed April 20, 2016).
  5. Canadian Diabetes Association. Position on students living with diabetes at school, 2014: www.diabetes.ca/about-cda/public-policy-position-statements/students-living-with-diabetes-at-school (accessed April 20, 2016).