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Back to school tips for parents managing a child with diabetes

Back-to-school is a busy and sometimes stressful time for many families. But for the more than 210,000 US students with type 1 diabetes -- and the growing number of youngsters with type 2 diabetes -- extra planning and unique concerns are a big part of hitting the books again.

Joslin Diabetes Center, one of the world's most trusted resources for diabetes news and information, has compiled tips from its renowned Pediatric and Adolescent Section to help parents and their children with diabetes have a safe, healthy and fun school year -- whether kids have been living with diabetes a long time or are newly diagnosed.

"Planning is crucial for parents of a child with diabetes and communicating that plan with school personnel will help things go more smoothly for the child while they are away from home," says Lori Laffel, M.D., M.P.H., Chief of Pediatrics at Joslin and Associate Professor of Pediatrics at Harvard Medical School. Dr. Laffel, along with Joslin pediatric team members Margie Lawlor, C.D.E., Cindy Pasquarello, R.N., C.D.E., and Deborah Butler, L.I.C.S.W., offers the following tips:

Make a plan and write it down
Parents should develop a detailed diabetes school safety plan that outlines all aspects of their child's disease, how monitoring and blood glucose management will be handled during school hours and extra curricular activities, and what symptoms to look for and steps to take in the case of an emergency. This Diabetes Medical Management Plan (DMMP) should be developed before school starts with the child's healthcare team and should be discussed in a formal meeting between the parents and appropriate school personnel to ensure expectations, roles and responsibilities are mutually understood and agreed upon. The plan should also be revisited throughout the school year to ensure that it continues to address the child's individual needs, which may change.

Cast a wide communications net
When deciding whom to communicate with regularly at school, parents need to cast a wide net. It's important to think about not only specific teachers, school nurses or select administrators but all the people who will touch their child's life throughout the day - bus drivers, cafeteria workers, coaches, after-school volunteers, field trip chaperons, standardized test monitors, close friends, other parents, etc. Communicating with people who are with the child prior to meals, in mid-afternoon and following exercise is especially crucial as this is when blood glucose levels tend to drop, requiring special attention.

Get and keep the child involved
Depending on the age and how long the child has had the disease, a child with diabetes is generally happier and healthier the more s/he is involved with the diabetes care. It is key to engage the child in the school plan and letting him or her help choose when and how fellow students learn about diabetes. Keep the lines of communication open about managing diabetes at school and while the child can help in the care, diabetes is not a do-it-yourself disease, so the adults at school need to remain involved.

Leverage all available resources
"Planning ahead can help make the transition from summer activities to school day activities for your child with diabetes less complicated," says Dr. Laffel. "The important thing is to make sure that everyone, including your child, is involved in providing the care necessary to best manage diabetes while away from home."

Parents, kids and schools are in a better place then ever before to get the diabetes education and support they need. A few key resources available include:

Joslin's Pediatric Programs:
www.joslin.org/771_1873.asp.

The Joslin Diabetes Education Program For School Nurses created in concert with the American Diabetes Association (ADA):
www.joslin.org/1317_2667.asp.

The Joslin Teen Diabetes Discussion Boards:
www.joslin.org/1863.asp.

"Helping The Student With Diabetes Succeed: A Guide for School Personnel" from the National Diabetes Education Program:
www.ndep.nih.gov/diabetes/pubs/Youth_SchoolGuide.pdf

ADA's Safe at School Program:
www.diabetes.org/uedocuments/0505safeatschool.pdf

Strive for a balance between food, exercise and insulin
As parents educate themselves and others about diabetes, it is essential to leverage three elements for their child's health with type 1 diabetes -- food, exercise and insulin. Kids with type 1 diabetes can generally eat any food in moderation, but a school menu high in carbohydrates will need to be counteracted with insulin. As for exercise, there is no doubt that it is great for all kids, but because it can lower blood sugar levels, it is important to ensure an extra eye is kept on a child with diabetes after finishing gym class or sports practice.

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