Important consideration when reading this Policy:

The Policy outlined below is purely a GENERIC POLICY and absolutely NOT SPECIFIC to any individual. Each child has his/her own unique Diabetes Policy/Health Care Plan containing pertinent medical information relevant solely and exclusively to the particular child in question. 

Policy Objectives

The prime objective of this policy is to ensure that (child’s name) is managed in the school in such a manner as to ensure that (he/she) participates fully in the life of the school and benefits fully from the educational opportunities offered.

The policy aims to ensure that clear, safe and medically sound procedures are in place for (child’s name) as part of (his/her) daily routine.

The policy aims to ensure that clear, safe and medically sound procedures are in place in the event of (child’s name) entering a state of Hypoglycaemia or a state of hyperglycaemia.

The policy aims to ensure that all those involved in the management of (child’s name)’s diabetes are fully aware of this policy and of the procedures contained within it.  It further aims to ensure that all of these people are in agreement with these procedures.

This policy aims to clearly delineate the responsibilities of the school and its employees in relation to the monitoring and recording of BGL, administration of insulin to (child’s name), and in their response to (child’s name) entering a state of Hypoglycaemia or Hyperglycaemia.

This policy includes an Indemnity which indemnifies the Board of Management and school staff in relation to medical procedures or the administration of medicines as they might apply to (child’s name).

Actions for the Board of Management

The Board of Management has responsibility to:

• Develop school guidelines for diabetes management during school and school outings.
• Ensure substitute personnel are aware of the needs of a student with diabetes and the Diabetes Emergency Plan.
• Arrange for diabetes management training of staff members with responsibility for students with diabetes.
• Alert all school related staff members who teach or supervise a student with diabetes. Ensure that they are familiar with emergency procedures.
• Have sufficient knowledge of diabetes to make informed decisions regarding the safety of students.
• Support and implement the Healthcare Plan and Emergency Diabetes Plan agreed with the school and the student’s parents/guardians.

Actions for teachers

The teachers have a responsibility to:

• Participate in the school meeting with parents/guardians and all relevant staff.
• Work with the school team and the parents to develop a written Healthcare Plan, including a specific Diabetes Emergency Plan for the student.
• Be prepared to recognise the triggers, respond to the signs and symptoms of hypoglycaemia and hyperglycaemia, and know what to do in an emergency.
• Maintain effective communication with parents/guardians, including informing them if their child has been unwell at school through the homework diary, any changes to regular school day.
• Provide a supportive environment for the student to manage their diabetes effectively and safely at school. This may include unrestricted access to the bathroom, drinking water, snacks, blood glucose monitoring and adequate time/supervision of all necessary food eaten at break times.
• Treat the student with diabetes the same as other students except when meeting medical needs.
• Ensure the hypo kit is in a safe place in the classroom and available to staff in the event of hypoglycaemia. This hypo kit will be provided by the parent.
• Ensure that the student with diabetes has the appropriate medication or food with them during any exercise and are allowed to take it when needed during the school day.
• Provide alternative options for unplanned vigorous physical activity by allowing an extra snack, provided by the parents to be eaten, for every 30 – 40 minutes of activity.
• Provide information for substitute teachers that communicate the day-to-day needs of the student with diabetes and the Diabetes Emergency Plan.
• Attend diabetes management training.
• Send the hypo kit home at the end of each school year.

Actions for parents/guardians

The parents/guardians of a student with diabetes have a responsibility to:

• Inform the Board of Management, School Principal, and the teacher that their child has diabetes.
• Attend and participate in the school meeting to develop a written Healthcare Plan to meet their child’s needs.
• Provide accurate emergency contact details and participate in the development of a Diabetes Emergency Plan for their child within the school team.
• Inform school staff of any changes in their child’s health status in writing
• Provide the school with any necessary equipment such as hypo kit, and replenish supplies as needed. The parents must provide the school with extra supplies, such as hypo kit, extra test strips, spare insulin pen, batteries for pump etc.
• If their child is having abnormally high BGL over a period of time, it is their responsibility to check ketone levels and inform the school of these levels.
• Ensure that their child’s medication is labelled with the child’s name.
• Ensure medication and all necessary equipment is within the expiry date.
• Bring medication home on the last day of the school year and return it to the school at the beginning of the new school year.
• Provide the school with appropriate treats for their child on Fridays (treat day).
• If a school trip is between 1 hour and 1.5 hours away, it is vital that one parent will attend in a separate car. This may also apply if the child’s BGL has been irregular in the days prior to the trip.

Policy Stakeholders

The following are the current stakeholders in this policy:

The child

Name of the child

Parents/guardians

Names

School

• The Board of Management of Kilmacanogue National School
• Principal: Name
• SNA(s): Name(s)
• Class teacher: Name

Medical

Dr Name: Diabetes & Endocrinology Consultant, Hospital Name

Name: Paediatric Diabetes Nurse, Hospital Name

GP: Name

Note: All policy stakeholders will be consulted in the drafting of this Policy and all will agree to be bound by the procedures set down in it.

Conditions under which child’s name is accepted as a pupil in the school

• The Department of Education & Skills (DES) has access to an SNA to meet (child’s name)’s care needs during the school day.
• The Health Service Executive co-operates with the school in the management of (child’s name)’s diabetes during school hours by providing training, advice and emergency cover to the school as required.
• Parents/guardians are contactable by mobile phone and are available to come to the school in the event that they are required to deal with his/her treatment, as outlined in this policy.
• The Board of Management is satisfied that the school has the facilities and support to safely monitor and manage (child’s name)’s diabetes while he/she is at school.
• (child’s name)’s parent/guardian will demonstrate the use of medicines/injections to the relevant staff dealing with (child’s name) during the school year.
• In the event of (child’s name)’s medical care plan being reviewed or changed, (child’s name)’s parent/guardian will attend the school daily for a period of time, until staff are familiar with the procedures.
• (child’s name) and the SNA(s) are comfortable carrying out the procedures outlined in the policy.
• All necessary supports and agreements have been put in place.

Definitions in relation to (child’s name)’s diabetes:

Insulin dose: In the event that (child’s name) will require insulin injections during the day, the parents will determine the amount of insulin required to deal with the carbohydrate count in (child’s name)’s food. Parents/guardians will calculate this figure and write it down each day for guidance.  Verbal instructions given to the child are not sufficient. Any necessary corrections to correct high blood sugars will be advised by the parents.  Any changes to these correction figures must be advised to the school by the parents/guardians in writing. The SNA will record this figure in the record book.

Symptoms relating to Hypoglycaemia (Specific to (child’s name))

Authority of these symptoms

The school has been advised by (child’s name)’s parents/guardians that the following may be/can be symptoms displayed by them in the event of (child’s name) entering a state of Hypoglycaemia:

• Mild Hypoglycaemia

Pale, hungry, in a quiet mood, lethargic.

• Moderate Hypoglycaemia

Pale, very tired.

• Severe Hypoglycaemia (Emergency)

As above, but BSL will be lower.

Symptoms relating to Hyperglycaemia (Specific to (child’s name))

Authority of these symptoms

The school has been advised by (child’s name)’s parents/guardians that the following may be/can be symptoms displayed by them in the event of (child’s name) entering a state of Hyperglycaemia:

• Mild Hyperglycaemia

There are often no symptoms.

• Moderate Hyperglycaemia

Slightly grumpy, lack of concentration, tired, thirsty, going to the toilet frequently.

• Severe Hyperglycaemia (Emergency)

Serious signs requiring immediate attention: nausea/vomiting, lethargy, deep and rapid breathing, sweet smell from breath, rapid heartbeat.

Procedure for checking BSL

• (child’s name)’s BSL will normally be checked twice a day – prior to consuming meals.
• Further checks will be carried out at the discretion of the SNA, class teacher, or Principal.
• The BSL check will be carried out by the child, in the presence of an SNA. The SNA will communicate these results to the class teacher.  In the SNAs absence, the class teacher will check the BSL.  If either the SNA or class teacher is unavailable to record the BSL, the Principal will take over this duty. In the event of the SNA, class teacher and Principal not being available on a particular day, (child’s name)’s parent/guardian will be required to come to the school and check the BSL.
• The result of the BSL will be recorded in the record book.

Procedure for the administration of food and insulin bolus under normal conditions

• When the SNA arrives into the classroom to check BSL, (child’s name) will wash their hands, without the use of soap.

The SNA will:

• Discreetly check and supervise (child’s name) BSL

The teacher will:

• Allow (child’s name) to have their food immediately after BSL check.
• Adequate time should be allowed for all of the above, and there should be discreet observation that all the snack/lunch is consumed.
• The SNA and class teacher will periodically monitor (child’s name) during the school day for symptoms which might indicate the onset of Hypoglycaemia or Hyperglycaemia.

Procedure to be carried out in the event of the SNA becoming aware that (child’s name) is entering a mild state of Hypoglycaemia (BSL <4)

This procedure will be carried out in accordance with hospital guidelines, i.e. hospital staffs agree that the following procedures are in accordance with hospital guidelines:

Note: (child’s name) may not feel the warning signs of a Hypo.

Note: Never leave (child’s name) without adult supervision during a Hypo event.

• Step 1: In the event of a BSL of <4, the SNA will give (child’s name) …………………. to raise the BSL.
• Wait 15 minutes, check BSL again.
• If BSL has returned to normal, (child’s name) may require a snack, depending on parent/guardian guidelines, and can continue with normal activities.
• Step 2: If BSL is still <4, the SNA will give (child’s name) ……………….. to raise the BSL.
• Wait 15 minutes, recheck BSL.
• If BSL has returned to normal, (child’s name) can have a snack and continue with normal activities. Inform the parents/guardians.
• Step 3: If BSL is still <4, the SNA/class teacher will give (child’s name) another ……….. to raise the BSL. (child’s name)’s G.P. should be informed.  At this stage, (child’s name)’s parents/guardians should be on the way to collect (child’s name).  If the parents/guardians cannot be contacted, use the phone policy.

Note: Emergency supplies of …………… will be stored in the hypo box in the classroom.  It is the responsibility of parents/guardians to ensure that there is always a supply of …………. In case of emergency. Spare supplies such as test strips, insulin pen, batteries etc., should also be furnished to the school by the parents/guardians at the beginning of the school year.

Procedure to be carried out in the event of the SNA becoming aware that (child’s name) is entering a severe state of Hypoglycaemia (BSL <2 even after following above steps)

This procedure will be carried out in accordance with hospital guidelines, i.e. hospital staff agree that the following procedures are in accordance with hospital guidelines.

• In the event of BSL of <2 (child’s name) will be put in the recovery position, if necessary. Their breathing will be checked. The emergency services will be phoned at this stage.
• Parent/guardian will prepare and administer GlucaGen injection. In the event that (child’s name)’s parents/guardians have not arrived in the school, the next person in the phone policy will prepare and administer the GlucaGen injection.
• In the event that either is unavailable, a member of school staff may prepare and administer the GlucaGen injection. This depends on which member of staff is trained and confident in preparing and administering the GlucaGen injection in the school.
• (child’s name) will be continuously watched for the symptoms of continued Hypoglycaemia, as advised by (child’s name)’s parents/guardians.
• Re-check BSL after 15 minutes.
• If the BSL is normal inform the parents/guardians of the result and the child will be sent home.

Procedure to be carried out in the event of the SNA becoming aware that (child’s name) is entering a mild state of Hyperglycaemia – (BSL >10)

This procedure will be carried out in accordance with hospital guidelines, i.e. hospital staffs agree that the following procedures are in accordance with hospital guidelines.

• In the event of a BSL of >10 the SNA/class teacher will ensure that (child’s name) has unrestricted access to water and the toilet

Procedure to be carried out in the event of the SNA becoming aware that (child’s name) is entering a severe state of Hyperglycaemia (BSL >14)

This procedure will be carried out in accordance with hospital guidelines, i.e. hospital staffs agree that the following procedures are in accordance with hospital guidelines.

• In the event of a BSL of >14, (child’s name) may need extra insulin. The parent/guardian may need to be contacted, this will be instructed in the individual healthcare plan.  Give (child’s name) unrestricted access to water and the toilet.
• If the BSL remains abnormally high over a period of time it is the parent/guardian’s responsibility to check ketone levels and inform the school of this.

Procedure to be carried out when making phone calls in the event of an emergency in relation to (child’s name)

• Two calls will be made to (child’s name)’s parent/guardian, on the phone numbers provided in the healthcare plan. If they cannot be contacted, the school will make.
• Two calls to the alternative contact on the child’s healthcare plan. If they cannot be contacted, the school will make:
• Two calls to GP’s name (phone number) at his surgery. If he cannot be contacted, or is unavailable, the school will make
• Two attempts to contact one of paediatric Diabetes Nurses; name(s), phone number, hospital name. In the event of the Nurses being unavailable, the school will contact the Paediatric Registrar on call.

If the Paediatric Registrar on call cannot be contacted, the SNA/class teacher/Principal will wait for a maximum time of 30 minutes before re-checking (child’s name)’s BSL.  If the BSL still indicates a problem, the SNA/Principal will call an ambulance to take (child’s name) to hospital and will:

• Call hospital in advance
• Send Record Card with child’s name

Review

This policy will be reviewed on an annual basis, at the beginning of each school year.  All the parties concerned will be asked to contribute to such review.  Any suggested changed will be inserted and circulated for approval by all parties.  In the case of any change in (child’s name) condition which necessitates it, the policy will be immediately reviewed.

This policy has last been reviewed in (insert date). It is scheduled for review again in (insert date).

Ratified by the Board of Management of Kilmacanogue National School

To be reviewed annually