Low Blood Sugar at School – Treatment and Prevention

As a parent of a type 1 diabetic, one of the biggest fears is low blood sugar at school. Everything is hectic in a classroom, the teacher has many students to supervise, and the person in charge of diabetes care likely only pops in at scheduled times to check blood sugar and give insulin. But what happens when your child goes low? Diabetes doesn’t like to stick to a schedule after all.

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Treating low blood sugar at school

The 15-15-15 rule is generally used as a baseline to treat a low, both at school and at home.

This is where you give 15g of fast acting carbs, wait 15 minutes, and then follow-up with 15g of long acting carbs.

You repeat the first 2 steps as many times as needed for the blood sugar to come back up to an acceptable number (one that you and your diabetes team have agreed upon) before doing step 3.

But this doesn’t work for everyone. Some people need fewer carbs, more time, or any number of other variables.

My son, for instance, needs only about 8-10g of fast acting carbs. And if we don’t wait at least 20 minutes to check his blood sugar again, he will still be low. His body hasn’t had enough time to break down and start using the carbs.

Which means a second treatment of fast acting carbs. But, then we’re giving too much sugar and he goes too high.

You know your child best.

Treating a low blood sugar at school should be done similarly to how you treat one at home.

In your 504 or care plan, make sure the instructions are clear. The nurse, teacher, or EA in charge of your child will have to follow the instructions in the plan every time.

Low supplies

In your child’s diabetes kit or bag, you will want some supplies for lows. The school may even want some extras to keep in the classroom, office, or medical room.

Here are some things to have in that kit:

• Fast acting carbs. These will bring your child’s blood sugar up quickly. Popular choices are juice boxes, glucose tabs or gel, skittles or starburst candies. While these bring bg up quickly, they tend to cause a spike and then drop off again.
• Slow acting carbs. These will keep your child’s blood sugar stable after the spike. Popular items include granola bars and protein bars.
• Glucagon. This is an injection (acquired at the pharmacy by prescription) that is used for extreme lows when the person is unconscious or unable to ingest any food/ drinks.

“My child is sick of their low treatments. What are some alternatives that I can use?”

There are a number of items that work for lows. Cake icing gel (make sure you don’t use red… it looks like their mouth is bleeding), honey packets, rockets (called smarties in the US), pixie sticks, gummy bears, Swedish fish, marshmallows, pop, fruit snacks, applesauce, fruit by the foot… there are many great choices.

But often, finding a different low treatment is not what is needed.

If your child is sick of a certain kind of low treatment, ask yourself, how often are they treating low blood sugar at school? If they have to drink a juice box (or more) every day, changing the type of sugar isn’t really the problem.

The problem is frequent, recurring lows. So let’s look at ways to avoid them in the first place.

Preventing low blood sugar at school

Some steps to take to prevent lows at school:

1. Keep a log. Check out this cute log book for blood sugars! Log your child’s blood sugar levels, the number of carbs consumed (or get more detailed and keep a food journal), and how much insulin is being used. This makes it easier to see a trend that might need dosing adjustments.
2. Download your child’s pump data. If your child is on a pump, download the information on a regular basis to look for trends in blood sugar.
3. Check blood sugar before eating. Generally, there is a snack and lunch at school. Even if your child is having a “free snack”, it’s a good idea to check bg at the same time every day.
4. Check blood sugar before activity. Many children drop low during activity. Your child may need an extra snack (without insulin) before activities. These include gym, recess, and walking field trips.
5. Double check. Go over any logs or check your meter or pump history every day after school. If you see something odd, ask about it. Sometimes, errors are made. It’s not reasonable to expect perfection, but if something is happening more than once (like incorrect carb calculations for instance), it needs to be addressed.
6. Pay attention to your child’s schedule. Schools are moving toward more outdoor time. There may be free play time other than recess and lunch on certain days. Or your child may have gym at different times. If your child gets stressed out over tests (causing blood sugar to go high or low) and you know they have a weekly spelling test (for example), you may want to make adjustments to accommodate the difference.

Ideally, if your child’s ICR, ISF, and basal rates are accurate, lows should not be happening too often. (I know with growing children this is not something that is always realistic, but it is the goal).

So, with regular bg checks and accurate logs, you will have better data and tools to discuss dosing changes with your doctor to help avoid too many lows at school.

T1D is complicated

Low blood sugar at school can’t be completely avoided. I’m not pretending it can.

But there are ways to help decrease the instances of low blood sugar (and high blood sugar for that matter) and for the sake of our children, we should strive for “in range” numbers as much as possible.

If you’re having problems with your child’s blood sugar levels, at school or at home, don’t blame yourself. Blood sugar levels are not a reflection of how you’re doing as a parent. If you’re uncomfortable making changes or are unsure what changes to make, always consult your diabetes team. They are there for you. They should make you feel supported and confident.

Sometimes, lows are going to happen. You may know the cause and you may not. But if you do find a reason, make sure you discuss it with your doctor and make adjustments to the 504 or care plan if needed.

Happy carb counting!

~ Leah