People with diabetes may be prone to episodes of low blood sugar (hypoglycaemia) - these episodes are called “hypos”. They most often occur after exercise, or when a meal or snack is due. You should know the symptoms and be prepared to treat promptly.

Symptoms can include any of the following

• Pallor, sweating
• Shaking or unsteadiness
• Funny feelings in the head or abdomen; faintness
• Uncharacteristic behaviour - either quiet (vague), confused, or obstreperous
• Other*

The treatment is with sugar, for example

• 3 or 4 Glucose tablets (eg Dextro-Energy, Lucozade)
• Half a glass of Lucozade.
• Other*

(If you are not quite sure whether it is a hypo or not you are best to treat anyway - no harm will be done.) The treatment can be repeated after 5-10 minutes if the child is not feeling better. Unless there is a snack or meal just coming up, it is a good idea to give something more solid as well (for example, a couple of plainish biscuits). Parents usually provide the necessary supplies.

Appropriate treatment can be given in class. Many children will treat a hypo without calling attention to themselves and this is to be encouraged. If the child is feeling unwell they should not leave the class unless accompanied by a responsible person. If untreated a hypo can (rarely) cause a child to pass out completely. Should this happen, give nothing by mouth. Lay the child in the recovery position. and call an ambulance.

If hypos are occuring with undue frequency you should share this information with the parent and the school medical officer.

* Parents may be able to advise you on the particular symptoms which their child experiences with hypoglycaemia, and treatment strategies which they have found particularly suitable.

To prevent hypoglycaemia, parents will provide a sweet snack for before PE.

Teachers should permit and encourage this to be taken.

Meals or snacks should not be delayed.

Be aware of this if the lunch box/dinner money gets lost, or if the child is to be detained in class for any reason. Parents will often provide an extra snack for children who stay late for extracurricular activities. The food provided will be at the parents’ discretion.

Children with diabetes do test their blood, ideally at least once each day. It is rarely necessary for this to be done at school, but if the child or the parents wish it, try to provide an environment where they can do so without fuss. The parents may wish to negotiate a system so that you can report the results back to them.

These should present no problem if the following principles are observed

• Regular meals and between - meal snacks (have some extra food with you in case there is an unforseen holdup).
• Extra snacks or sweets for vigourous or sustained physical activity.
• Prompt treatment of hypoglycaemia should it occur.

The parents will liaise with the clinic doctor or nurse well in advance to discuss any changes in treatment which might be required during the trip. This is particularly important if the trip includes an overnight stay. You should discuss with the parents the degree of supervision which their child is likely to need.