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At School

Sending a child with type 1 diabetes back to school following his or her diagnosis can be both an encouraging and a scary time. Most kids can't wait to get back to seeing their friends. It's important to remind your child that he or she may still be able to play, exercise, and do their school work, like they used to. At the same time, they should know who will be helping them with blood sugar checks and taking insulin, before they're ready to take care of these things on their own. School employees—like teachers, administrators, and especially school nurses—can be great allies in helping you and your child with type 1 diabetes get into a routine at their school.

Laws that impact type 1 diabetes at school

There are both federal and state laws working for you and your child that can help make the transition from home to school more seamless. Federal laws, like the 504 Rehabilitation Act of 1973 (Section 504) and the Individuals with Disabilities Education Act (IDEA), require public schools, private schools receiving federal funding, and some day care providers and camps to make adjustments to meet the needs of children with diabetes, and also to allow children with diabetes to participate in all of the same things as their classmates. Some state laws provide other legal protection for students and say who can provide care at school.

Set up a written plan

One of the most important things is to set up a healthcare plan and an education plan for managing your child's type 1 diabetes while at school. These plans are for your child's immediate safety, long-term well-being, and optimal performance at school. Accommodations for standardized tests should be listed in your child's 504 Plan or IEP (see below for more information about these).

  • Diabetes Medical Management Plan (DMMP): This plan is put together by your child's healthcare provider with your help and includes information about your child's type 1 diabetes and their type 1 diabetes treatment plan for the school setting. It will list insulin doses, how to treat episodes of low blood sugar, and when to check blood sugar levels. The DMMP is what other plans, like the Section 504 Plan or IEP, are based on
  • Section 504 Plan: This plan outlines the things that the school personnel will do to make sure your child can have the same access and education as other children at school. This can help to give your child the best chance of succeeding and managing their type 1 diabetes during school-related activities. These things could include, for example, deciding on and training the school personnel who will help care for your child during the school day and on field trips; allowing classroom work and tests to be made up if they are missed due to diabetes-related care or sickness; and giving you access to nutrition information for school lunch menus
  • Individualized Education Plan (IEP): This plan is more specific and focused than the 504 Plan, and can be used in place of the 504 Plan. It outlines the student's academic current level of functioning, needs, support, and goals. This plan is required for students with disabilities who receive special education and related services under the IDEA
  • Individualized Healthcare Plan (IHP): This plan addresses how diabetes medical management for an individual child will be implemented in the school
  • The school nurse should also coordinate an Emergency Care Plan for Hypoglycemia and Hyperglycemia

Who to talk to

Your healthcare team
You may already have a terrific type 1 diabetes healthcare team made up of doctors, nurses, and others. You will want to have a talk with that team about all the things that need to be taken care of when your child with type 1 diabetes is going back to school, and make sure that this is written into your child's DMMP, Section 504, or other plan.

Your child
How much does your child want other kids to know about his or her type 1 diabetes? Their medical ID bracelet will probably spark questions from their classmates. Figure out how comfortable your child is with talking to others about type 1 diabetes and coach them on how to respond to their classmates' questions or concerns.

It may take some of the strangeness and the mystery out of the situation if other students know more about your child's type 1 diabetes. Consider encouraging your child to do a "show and tell" about type 1 in their classroom to help others understand it, and most importantly, to show that it hasn't changed who your child is. Also be sure that your child understands whom to go to if they need help—the teacher, nurse, recess monitor, bus driver, or school administrator.

The school
It's very important that, before your child returns to school, you sit down with the people who are going to be responsible for them during school or school-related activities and develop written care plans. A lot of times, the school nurse will be the point person for helping your child manage their type 1 diabetes. Still, teachers, coaches, school bus drivers, cafeteria staff, and administrators, like the principal, should know about the plan and how to be of assistance to your child to make certain they get the care they need.

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What to talk about

  • With proper planning and the education and training of school personnel, your child will still be able to do many, if not all, of the same things they did before diagnosis. While some special allowances will need to be made so that they can manage their type 1 diabetes, they should be able to fully participate in the school experience like their classmates
  • How well your child is able to check their own blood sugar levels and give themselves the insulin they need versus what they need help with and who will help them. Your child's level of self-care will depend on the individual child, their age, their abilities, and their willingness to perform self-care tasks. Your child may also need an adult to provide all the aspects of type 1 diabetes care. Self-care tasks for children in elementary school and middle school will depend on how mature the child is and how long they have managed their type 1 diabetes. All children need some adult supervision
  • Making arrangements so that your child has all of the supplies and snacks they need to keep their blood sugar level where it should be—you will need to provide these things, but talk about whether you're going to keep them at school or whether they'll be brought in daily, and where everything will be kept
  • Choosing a place where your child can check their blood sugar levels and take their insulin that offers as much privacy as your child wants
  • Recognizing the symptoms of mild to severe low blood sugar (hypoglycemia) and how to treat each, including how and when to use an injectable treatment for severe low blood sugar. Consider providing a handout that describes the symptoms of low blood sugar and high blood sugar (hyperglycemia) for teachers, nurses, administrators, and staff
  • Making a plan for field trips and school-related events that take place away from school, like sports games
  • How type 1 diabetes may affect school performance. Let teachers know that if your child experiences low blood sugar, it can affect their ability to contribute and they may sometimes need to reschedule a quiz or test
  • Making sure that the people at school understand your child's condition and that your child feels free to do whatever they need in order to manage their type 1 diabetes, like speak up when they need something or take extra bathroom breaks
  • Being able to get to bathrooms and water and making time for snacks. Children with type 1 diabetes may feel thirsty more often, need more snack breaks, or need to use the bathroom more frequently as a result of their type 1 diabetes

This content in this section of the website was written with the help of the American Diabetes Association.

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Important Safety Information for Humalog

What is the most important information I should know about Humalog?

  • Do not change the insulin you use without talking to your healthcare provider. Doses of oral antidiabetic medicines may also need to change if your insulin is changed.
  • Test your blood sugar levels as your healthcare provider instructs.
  • When used in a pump, do not mix Humalog with any other insulin or liquid.

Who should not take Humalog?

  • Do not take Humalog if your blood sugar is too low (hypoglycemia) or if you are allergic to insulin lispro or any of the ingredients in Humalog.

Before using Humalog, what should I tell my healthcare providers?

Tell your healthcare providers:

  • About all of your medical conditions, including liver, kidney, or heart problems.
  • If you are pregnant or breastfeeding.
  • About all the medicines you take, including prescription (especially ones commonly called TZDs [thiazolidinediones]) and non-prescription medicines, vitamins, and herbal supplements.

How should I use Humalog?

  • Humalog is a rapid-acting insulin. Take Humalog within fifteen minutes before eating or right after eating a meal.
  • Always make sure you receive the correct type of Humalog from the pharmacy.
  • Do not use Humalog if it is cloudy, colored, or has solid particles or clumps in it.
  • Do not mix Humalog with insulin other than NPH when using a syringe. Do not mix or dilute Humalog when used in a pump.
  • Inject Humalog under your skin (subcutaneously). Never inject into a vein or muscle. Change (rotate) your injection site with each dose. Make sure you inject the correct insulin and dose.
  • Depending on the type of diabetes you have, you may need to take Humalog with a longer-acting insulin or with oral antidiabetic medicines.
  • If you forget to take your dose of Humalog, your blood sugar may go too high (hyperglycemia), which can lead to serious problems like loss of consciousness (passing out), coma, or even death.
  • Your insulin dose may need to change because of illness, stress, other medicines you take, change in diet, or change in physical activity or exercise.

What are the possible side effects of Humalog?

  • Low blood sugar is the most common side effect. There are many causes of low blood sugar, including taking too much Humalog. It is important to treat it quickly. You can treat mild to moderate low blood sugar by drinking or eating a quick source of sugar right away. If severe, low blood sugar can cause unconsciousness (passing out), seizures, and death. Symptoms may be different for each person. Be sure to talk to your healthcare provider about low blood sugar symptoms and treatment.
  • Severe life-threatening allergic reactions (whole-body reactions) can happen. Get medical help right away if you develop a rash over your whole body, have trouble breathing, have a fast heartbeat, or are sweating.
  • Reactions at the injection site (local allergic reaction) such as redness, swelling, and itching can happen. If you keep having skin reactions or they are serious, talk to your healthcare provider. Do not inject insulin into a skin area that is red, swollen, or itchy.
  • Skin may thicken or pit at the injection site (lipodystrophy). Do not inject insulin into skin with these types of changes.
  • Other side effects include low potassium in your blood (hypokalemia), and weight gain.
  • Serious side effects can include:
    • - swelling of your hands and feet
    • - heart failure when taking certain pills called thiazolidinediones or “TZDs” with Humalog. This may occur in some people even if they have not had heart problems before. Tell your healthcare provider if you have shortness of breath, swelling of your ankles or feet, or sudden weight gain, which may be symptoms of heart failure. Your healthcare provider may need to adjust or stop your treatment with TZDs or Humalog.
  • These are not all of the possible side effects. Ask your healthcare providers for more information or for medical advice about side effects.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

How should I store Humalog?

  • Unopened Humalog should be stored in a refrigerator and can be used until the expiration date on the carton or label.
  • Humalog should be stored away from light and heat. Do not use insulin if it has been frozen.
  • Opened vials should be kept at room temperature or in a refrigerator. Opened cartridges or prefilled pens should be kept at room temperature.
  • Once opened, Humalog vials, prefilled pens, and cartridges should be thrown away after 28 days.

Humalog is available by prescription only.

For additional information, talk to your healthcare providers and please click to access Full Prescribing Information and Patient Prescribing Information.

Please see Instructions for Use that accompany your pen.

HI CON ISI 29MAR2013

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Humalog® KwikPen is a registered trademark of Eli Lilly and Company and is available by prescription only.

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Other product names mentioned herein are the trademarks of their respective owners.

Important Safety Information for Glucagon

What is the most important information I should know about Glucagon?

  • Glucagon should not be used if you have pheochromocytoma or if you are allergic to Glucagon.
  • Make sure you tell your healthcare provider if you have been diagnosed with or have been suspected of having an insulinoma as Glucagon should be used cautiously in this situation.
  • You and anyone who may need to help you during an emergency should become familiar with how to use Glucagon before an emergency arises. Read the Information for the User provided in the kit.
  • Make sure that your relatives or close friends know that if you become unconscious, medical assistance must always be sought. If you are unconscious, Glucagon can be given while awaiting medical assistance.
  • Do not use the kit after the date stamped on the bottle label.
  • If you have questions concerning the use of this product, consult a doctor, nurse or pharmacist.

WARNING: YOU MAY BE IN A COMA FROM SEVERE HYPERGLYCEMIA (HIGH BLOOD GLUCOSE) RATHER THAN HYPOGLYCEMIA. IN SUCH A CASE, YOU WILL NOT RESPOND TO GLUCAGON AND REQUIRE IMMEDIATE MEDICAL ATTENTION.

Who should not use Glucagon?

Glucagon should not be used if you have pheochromocytoma or if you are allergic to Glucagon.

What should I tell my doctor before taking Glucagon?

Tell your doctor about all of your medical conditions and prescription and over-the-counter drugs. Tell your doctor if you have been diagnosed with or have been suspected of having pheochromocytoma or an insulinoma.

How should I use Glucagon?

  • Act quickly. Prolonged unconsciousness may be harmful.
  • Make sure your family and friends know to turn you on your side to prevent choking if you are unconscious.
  • The contents of the syringe are inactive and must be mixed with the Glucagon in the accompanying bottle immediately before giving injection. Do not prepare Glucagon for Injection until you are ready to use it.
  • Glucagon should not be used unless the solution is clear and of a water-like consistency.
  • The usual adult dose is 1 mg (1 unit). For children weighing less than 44 lbs (20 kg), give 1/2 adult dose (0.5 mg). For children, withdraw 1/2 of the solution from the bottle (0.5 mg mark on syringe). Discard unused portion.
  • You should eat as soon as you awaken and are able to swallow. Inform a doctor or emergency services immediately.

What is some important Information I should know about Low Blood Sugar (Hypoglycemia)?

  • Early symptoms of low blood sugar include: sweating, drowsiness, dizziness, sleep disturbances, palpitation, anxiety, tremor, blurred vision, hunger, slurred speech, restlessness, depressed mood, tingling in the hands, feet, lips, or tongue, irritability, lightheadedness, abnormal behavior, inability to concentrate, unsteady movement, headache, and personality changes. These symptoms may be different for each person and can happen suddenly.
  • If your low blood sugar is not treated, you may progress to severe low blood sugar that can include: disorientation, seizures, unconsciousness, and death
  • Low blood sugar symptoms should be treated with a quick source of sugar which should always be carried with you. If you do not improve or you are unable to take a quick source of sugar, you should be treated with Glucagon or with intravenous glucose at a medical facility.

What are the possible side effects of Glucagon?

  • Severe side effects are very rare, although nausea and vomiting may occur occasionally.
  • A few people may be allergic to Glucagon or to one of the inactive ingredients in Glucagon, or may experience rapid heart beat for a short while.
  • If you experience any other reactions which are likely to have been caused by Glucagon, please contact your doctor.

You are encouraged to report negative side effects of Prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

How should I store Glucagon?

  • Before dissolving Glucagon with diluting solution, store the kit at controlled room temperature between 20° to 25°C (68° to 77°F).
  • After dissolving Glucagon with diluting solution, use immediately. Discard any unused portion. Glucagon should be clear and of a water-like consistency at time of use.

For more safety information, please click to access Information for the User and Information for the Physician.

HI GLUC CON ISI 1NOV2013

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