Classroom as the Site for Type 1 Diabetes Self-Care Activities

Children and adolescents with Type 1 diabetes (T1D) require bolus insulin before each meal, necessitating self-care activities including blood glucose checking to determine insulin dose (or check for hypoglycemia) and injecting insulin during school hours. Though these activities are essential for optimizing glycemic control, they are met with reluctance from parents, the child, school authorities, and sometimes peers. This requires ongoing education and support for the child, school staff, and other students, by the diabetes care team. Many problems of performing self-care activities can be greatly reduced by allowing them in the child's classroom itself, a strategy which offers several logistical, safety, psychological and social benefits. The glucometer and strips, continuous glucose monitoring device, insulin in a cool case, and hypoglycemia kit are kept in the teacher's custody, and used by the child as needed, under supervision. This normalizes diabetes and its care, obviates concealment of diabetes, enhances the child's and teacher's confidence, optimizes diabetes care by ensuring timely and consistent insulin dosing, encourages hypoglycemia prevention and management, and reduces the chances of the child being bullied. It also promotes acceptance of diabetes by peers and greater community awareness. Other places for self-care like the medical room or the toilet have disadvantages. Possible limitations of this strategy could be objections occasionally raised by some school staff, lack of privacy needed by adolescents, or bullying by classmates: issues which need proactive handling. The diabetes care team may do well to emphasize performing self-care activities in the classroom, working with school staff and parents to this end.