For Educators
An introduction to teaching students with type 1 diabetes while ensuring the protection of their safety and legal rights.
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A R T I C L E
Table of Contents
Table of Contents
This page is intended to serve as a simple starting point for professors, teachers, mentors, and other educational staff (for middle/secondary school and older) who have a student with type 1 diabetes. For more information and specifics details regarding your institution, please consult your school nurse, accessibility office, administration, or other trained professional.
Before You Begin
Before You Begin
This page includes an abundance of information in order to provide the most accurate and useful guide to having a student with type 1; however, you will most likely not need to intervene or treat your student's diabetes during their time in your class.
Most people with type 1 are entirely self sufficient and will not need assistance.
What is type 1 diabetes?
What is type 1 diabetes?
Type 1 diabetes (often abbreviated as T1D) is an autoimmune disorder where a person's body attacks and destroys the insulin-producing cells in the pancreas. Insulin is a hormone that travels through the bloodstream and helps glucose (a type of sugar that is the body's main form of energy) pass from the bloodstream into the cells and tissues that need it.
Without insulin, a person's body can't process glucose, meaning that it has lost its main source of energy. This causes glucose to build up in the bloodstream and the body to start rapidly burning fat as an alternative energy source, both of which are harmful if left untreated.
How is type 1 diabetes treated?
How is type 1 diabetes treated?
Unfortunately, there currently isn't a cure for type 1, but it can be treated and managed with careful monitoring of a person's blood sugar and injections of insulin. Since someone with type 1 diabetes can't produce insulin themselves, they must give injections of insulin, either through a syringe and needle, through a pen, or with an insulin pump (see below). This is used to help their body absorb the glucose from the food that they eat and to ensure that their blood sugar stays within an acceptable range.
However, giving manual injections of insulin isn't as finely tuned and accurate as the pancreas doing the job itself, so people with diabetes must carefully monitor their blood sugar at all times. A person with diabetes can check their blood sugar using either a handheld meter that uses a small finger prick of blood or using a continuous glucose monitor (CGM), which is a device that sits on a persons stomach, leg, or arm with a small wire just below the skin that measures their blood sugar and relays it to a special receiver or sometimes to a smartphone (see below).
A insulin injection can be given using a syringe, needle, and vial of insulin, but this is most common only in hospitals.
A glucose meter uses a small finger prick of blood to check blood glucose levels.
An insulin pen can be dialed to a certain amount and then injected through a needle screwed on the end.
A CGM automatically checks blood glucose and sends that infomation to a connected device or smartphone.
An insulin pump automatically delivers insulin at set intervals and upon request before eating food.
People with diabetes will also use a variety of other medical supplies to help manage their condition.
What should I know as a teacher?
What should I know as a teacher?
There are times when a person's blood sugar may go too low and they need to eat some fast acting sugar (ie. candy, frosting, juice box) to help raise it again. There will also be times when a person's blood sugar goes too high, and they will need to give themselves more insulin to bring it back down. A student with diabetes will likely be actively managing their blood sugar during class, particularly around meal times.
However, most people with type 1 diabetes, especially those who are in middle school or older, are completely self sufficient in their care and will rarely need assistance. There are two main occasions when you may need to intervene, cases of severe hypoglycemia (low blood sugar) or cases of severe hyperglycemia (high blood sugar). Read below about how to notice and treat such cases.
Severe Hypoglycemia (Low Blood Sugar) Symptoms
Severe Hypoglycemia (Low Blood Sugar) Symptoms
Symptoms may include:
Shakiness
Dizziness
Sweating
Hunger
Fast heartbeat
Inability to concentrate
Confusion
Headache
Convulsions of seizures**
Unconsciousness**
Death**
**These symptoms only occur in the most severe and rare cases.
Severe Hyperglycemia (High Blood Sugar) Symptoms
Severe Hyperglycemia (High Blood Sugar) Symptoms
Symptoms may include:
Nausea and vomiting
Shortness of breath
Dry mouth
Weakness
Confusion
Fruity-smelling breath
Abdominal pain
Coma**
Death**
**These symptoms only occur in the most severe and rare cases.
When to Intervene
When to Intervene
If a person is conscious, coherent, and able to take care of their diabetes independently, then there is usually no reason to get involved. However, if the person is unable to treat themselves, is unconscious, or is not responding, then you should follow the steps below.
Severe Hypoglycemia (Low Blood Sugar) Treatment
Severe Hypoglycemia (Low Blood Sugar) Treatment
Steps to take:
If the person is conscious and able to eat, find them some fast-acting carbohydrates. Good examples include candy, juice boxes, cake frosting, or non-diet soda. Anything with high simple sugar content will work. Most people with type 1 will carry a source of glucose with them.
If the person is unconscious or seizing, you may need to administer an emergency injection/nose spray called Glucagon or Baqsimi. Find more information about that below.
Call 911 if the person is unconscious or seizing. Make note of how long any seizures last and inform medical professionals when they arrive.
Monitor breathing and heart rate. If they stop, begin CPR.
Severe Hyperglycemia (High Blood Sugar) Treatment
Severe Hyperglycemia (High Blood Sugar) Treatment
Steps to take:
If the person is conscious and coherent, have them administer insulin. If they use a pump, try having them use an insulin pen or needle, as a malfunctioning pump could be the cause of hyperglycemia.
Call 911 if the person is unconscious or seizing. Make note of how long any seizures last and inform medical professionals when they arrive.
Monitor breathing and heart rate. If they stop, begin CPR.
Action Chart
Action Chart
If you are concerned about remembering what to do and when to do it if a student needs help, download and print out this quick-reference action chart to help concisely guide you through what to do in the even of a blood glucose emergency. Available in both color and black and white copies for easy printing.
Blood Sugar Action Chart.pdfHow to Administer Glucagon/Baqsimi
How to Administer Glucagon/Baqsimi
In the event that a person is unconscious with suspected hypoglycemia (low blood sugar), then you may need to administer Glucagon (an emergency injection) or Baqsimi (an emergency nose spray). Both serve the exact same purpose of quickly raising blood sugar and are fairly simple to use.
A student with type 1 diabetes should be carrying one or both of these medications either on their person or in their backpack or other belongings. In some cases, a school's nurse office or main office may have the student's medication or have a supply of their own. It is a good idea to check with your student about where they keep their Glucagon and/or Baqsimi beforehand.
The video on the right demonstrates how to administer glucagon. Click on the link to view how to administer Baqsimi.
If either Glucagon or Baqsimi need to be used, call 911 (or your local emergency number). They are not "magical" medicines that will cure hypoglycemia, and the individual will still need professional medical attention. After administering one of these medications, turn the student on their side and place them in the recovery position (see image at right).
They should regain consciousness after about 15 minutes, but if they do not, a second dose of Glucagon or Baqsimi should be administered if available. Both of these medications may cause vomiting, so ensure that the person will have a clear airway by having them in the recovery position. If you have further questions in the moment, ask the emergency dispatcher about what steps to take.
Accommodations and Accessibility
Accommodations and Accessibility
All U.S. public schools and colleges, most private schools, and any institutions that receive federal funding are required by law to provide reasonable accommodations to students with type 1 diabetes (or any disability).
The Americans with Disabilities Act and Section 504 of the Rehabilitation Act state that, “No otherwise qualified individual with a disability in the United States, as defined in section 7(20), shall, solely by reason of his or her disability, be excluded from the participating in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance…” These laws also specifically state that this provision applies to any "college, university, or other postsecondary institution, or a public system of higher education.”
Schools and/or individuals who fail to meet reasonable expectations regarding accommodations or are negligent in their implementation may face civil lawsuits and/or criminal charges. Schools and/or individuals who fail to meet reasonable expectations regarding accommodations or are negligent in their implementation for third party testing (ie. College Board, ACT), may lose their right to administer such tests on a school district or county-wide basis.
Certain testing companies, such as College Board and Princeton Review (the companies that administer the SAT, AP tests, and the ACT), require that accommodations be provided for their test to students who need them as a part of the contract that allows schools to offer these tests.
While accommodations vary based on the individual's needs and the resources available to the school, here are some commonly accepted reasonable accommodations to students with type 1 diabetes:
Access to food and/or drink without restriction in the classroom, or the ability to leave the classroom/lab to access food and/or drink, always and at any time.
Access to restrooms at any time. (Frequent urination can be a symptom of type 1).
Ability to take breaks during tests, exams, or other timed assignments in the event that their blood sugar is out of range.
Ability to make up or postpone assignments in the event that their blood sugar is out of range (both low and high blood sugars can negatively affect mental cognition).
Access to their phone (if used for continuous glucose monitoring) and/or other medical devices required to treat their blood sugar.
Usually, school or district administration and/or the schools accessibility/student services office are responsible for developing 504 plans and ensuring that students receive the proper accommodations that they need. As a teacher, it is your responsibility to ensure that you always follow such guidelines.
Legal Privacy
Legal Privacy
The Family Educational Rights and Privacy Act (FERPA) dictates how personal educational information (including information about accommodations and medical conditions) can be shared and accessed. While the legal implications are long and complex, there are two simple concepts that cover most situations.
Personal information (such as medical diagnoses or information about accommodations) should not be shared with any person who does not need such information to carry out their duties to the school. For example, a test administrator would need such information, but a janitor would not. Similarly, other students do not need personal information about another individual in order to do their job (learning).
School employees should be mindful in how they communicate such information to ensure that it is not accessed by individuals who do not need it. For example, do not leave a copy of a student's 504 plan on a printer where others might see it, and do not ask a student about their condition or information where other students might hear the conversation. Negligence is often included in such provisions (ie. sending personal student information to a wrong email address).
These laws are strictly enforced and come with heavy civil and criminal penalties for negligent or willful violations, including a loss of all federal funding for the most serious cases. It is in the best interest of the institution, the teachers, and any other individuals who have access to private student information to ensure that it is secured privately.
While the legal provisions of FERPA and similar laws extend far beyond what's discussed here, recall the two simple principals above that can be used to determine whether you have the legal right to share a student's personal information.
Ethical Privacy
Ethical Privacy
There is almost universal agreement that ones personal health information should be kept private and only disclosed with their permission. While the laws mentioned above provide robust legal protection, perhaps an ethical approach may resonate more effectively with some individuals.
You can hopefully understand that if you went to a doctor and received a life-changing diagnosis, you would require time to process the sudden news and you may be reluctant to share that information with everybody you know. Not only does such news take time to cope with and understand, but when it is compounded by the fact that one must learn how to treat a complicated condition, the onset of a new disease is a stressful and emotionally traumatic period of someone's life.
Unfortunately, there is also a lot of stigma around diabetes as being a disease associated with obesity, poor eating habits, or laziness, none of which is true for type 1 diabetes.
While some choose to wear their diagnosis of type 1 as a badge of pride and resilience for all to see, others choose to share it only with their closest friends, or even just their family. Neither option is right, wrong, good, or bad, they are all different and reflect how people process their life's difficulties in their own unique way.
As teachers and professors, your job is chiefly to teach students and ensure an appropriate and encouraging environment for learning. Sharing private information without permission can cause significant emotional trauma for some. If you are ever in doubt about what information you can share, always ask the student privately first, or simply do that share information.
Sources and Further Reading
Sources and Further Reading
“The Americans with Disabilities Act and Your Rights as a College Student.” StudentCaffe, http://studentcaffe.com/prepare/students-with-disabilities/ada-your-rights-college-student.
Cornelison, Husch Blackwell LLP-Joseph W. “Changes Are Coming to FERPA, Including the Potential for Fines.” Lexology, 4 Aug. 2015, https://www.lexology.com/library/detail.aspx?g=9f260a90-b1d3-42cb-9ab3-1a8c62a02470.
“Diabetic Hypoglycemia - Symptoms and Causes.” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/diabetic-hypoglycemia/symptoms-causes/syc-20371525.
“Hyperglycemia in Diabetes - Symptoms and Causes.” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631.
Protecting Students With Disabilities. 10 Jan. 2020, https://www2.ed.gov/about/offices/list/ocr/504faq.html.
“Top 5 FERPA & HIPAA Misconceptions for Schools.” Frontline Education, 6 Jan. 2020, https://www.frontlineeducation.com/blog/top-5-ferpa-hipaa-misconceptions-for-schools/.
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