Diabetes Policy. Written by

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1 Diabetes Policy Written by Sarah Florence Creation date Spring 2017 Adopted by Governors Spring 2017 Reviewed by Last Reviewed date Next Review Date Spring 2020

2 Headlands School DIABETES IN SCHOOLS LEGAL INFORMATION The Equality Act 2010 (England, Scotland and Wales) The NHS, local authorities and all schools in England, Scotland and Wales all have duties towards children with diabetes, who are legally defined as being disabled. Fee-paying independent schools are also legally obliged to meet the duties in the Equality Act The relevant aspect of this act to schools is that governing bodies or proprietors must make reasonable adjustments to ensure that children and young people with disability are not put at a substantial disadvantage compared with their peers. Importantly, this duty is anticipatory, which means adjustments must be put in place in advance to prevent disadvantage from occurring. This is particularly relevant to schools in making sure they have enough staff trained so that a child with diabetes can take part in all aspects of school life. If all the trained staff leave contingency plans must be in place to train up replacements quickly. The Equality Act also states children with disability must not discriminated against, harassed or victimised. England legal duties on schools Children and Families Act 2014 The Children and Families Act 2014 includes a duty on schools to support children with medical conditions. This is inclusive of children with diabetes. Schools must make arrangements for supporting pupils at schools with medical conditions and in meeting that duty they must have regard to the statutory guidance issued by the Secretary of State. Schools that must meet the duty in the Children and Families Act are: a maintained school an Academy school an alternative provision Academy a pupil referral unit. The legal duty in the Children and Families Act is on the appropriate authority. The appropriate authority means: The governing body of a maintained school The proprietor of an academy The managing committee of a pupil referral unit. The Education Act 2002 Sections 21 and 175 detail how governing bodies of maintained schools must promote the wellbeing of pupils and take a view to the safeguarding of children at the school.

3 Section 3 of the Children Act 1989 This places a duty on a person with the care of a child to do all that is reasonable in the circumstances for the purposes of safeguarding and promoting the child. With relation to a child with diabetes, this will mean knowing what to do in the event of an emergency. Section 10 of the Children Act 2004 This is a particularly important piece of legislation if schools are struggling to get the support and training they need to allow them to look after a child with diabetes properly. Section 10 essentially means the local authority must make arrangements to promote cooperation between the authority and relevant partners. Relevant partners include the governing body of a maintained school, the proprietor of an academy, clinical commissioning groups and the NHS Commissioning Board. They must make arrangements with a view to improving the wellbeing of children, including their physical and mental health, protection from harm and neglect, and education. If a school cannot get the support it needs to look after a child with diabetes then they must approach their local authority. Special Education Needs The vast majority of children with diabetes do not require a Statement of Special Education Needs. If a child s needs cannot be met within the resources normally available to the school, a request for a statutory assessment can be made by a school, parent or other agency. This is done by writing to the Special Education Needs section of the local Education and Library Board. Diabetes and learning Diabetes can affect learning, and if it s not well managed a child can have difficulties with attention, memory, processing speed, planning and organising and perceptual skills. So they might not achieve their full academic potential. The challenges of keeping diabetes well managed may also impact on a child s life. For these reasons, it s crucial that a child is supported to manage their diabetes in all aspects of their life, including their time at school. Some children with diabetes may have more frequent absences that those without. This won t be the case for all, but if they do it might be due to hospital appointments or feeling unwell because of their diabetes. What is diabetes? Diabetes is a lifelong condition where the amount of glucose in the blood is too high because the body can t use it properly. This is because the pancreas doesn t make any insulin, or not enough, or the insulin that it does make doesn t work properly (known as insulin resistance). Insulin Insulin is a hormone produced by the pancreas that helps glucose move into the body cells where it s used for energy. It acts as the 'key' to 'unlock' the cells to allow the glucose in. Once the door is 'unlocked', the glucose can get in to the cells and then be used as fuel for energy. If there s no insulin, glucose builds up in the bloodstream. Glucose Glucose comes from digesting carbohydrate-containing foods which include starchy foods (such as bread, rice, potatoes, chapatti s, yam and plantain), fruit, some dairy products, sugar and other sweet food. Glucose is also made by the body in the liver.

4 Types of diabetes There are two main types of diabetes, Type 1 and Type 2. Type 1 diabetes Type 1 diabetes develops if the body can t make any insulin and it usually appears before the age of 40. It s by far the most common type of diabetes found in children. Type 1 is always treated with insulin (either by injection or pump), plus following a healthy balanced diet and getting regular physical activity. Type 1 diabetes is an autoimmune condition, meaning that the body has attacked and destroyed its own cells (in this case the insulin-producing cells in the pancreas). Nobody knows for sure why this happens, but it is nothing to do with being overweight or any lifestyle factors, and there is nothing that can be done to prevent it. Around 31,500 children and young people in the UK have Type 1 diabetes. Type 2 diabetes Type 2 diabetes develops when the body can still make some insulin, but not enough, or when the insulin that it does make doesn t work properly. It s more common in people over the age of 40, (or even younger in Black, Asian and Minority Ethnic communities) and is linked with being overweight. While numbers of children with Type 2 diabetes are going up, it s still relatively uncommon in children. Type 2 diabetes is treated with a healthy diet and increased physical activity but medication, including insulin, is often needed as well. Signs and symptoms of Type 1 diabetes If Type 1 diabetes goes untreated, glucose builds up in the bloodstream. The body tries to get rid of this glucose by passing it out in the urine. This causes dehydration, meaning that the child will get very thirsty and drink a lot. As there is no glucose getting into the cells where it can be used for energy, the body starts to break down its stores of fat and protein for energy instead. This is why children with untreated Type 1 diabetes often pass urine frequently, get very thirsty, may feel very tired and lose weight. School staff can be in a position to notice the early signs that a child may have Type 1 diabetes. Signs and symptoms: the 4 Ts of diabetes Toilet (going to the toilet a lot to pass urine) Thirsty (being really thirsty and not being able to quench the thirst) Tired (feeling excessively tired) Thinner (losing weight or looking thinner than usual) If you notice any of these signs in a child you should advise Head of Year who can contact home. Staff training Depending on the level of support needed, training might include administering insulin by a pen or a pump, testing blood glucose (blood sugars), understanding what these readings mean, carbohydrate counting and making sure you know what a hypo and hyper are and how they are treated. You must be properly trained and signed off as competent by a suitable healthcare professional before you are asked to support a child with diabetes. You should never administer insulin or undertake any of their medical care if you have not been properly trained.

5 The school will make sure your training is reviewed and updated regularly. If a child s care changes, eg if they move from using an insulin pen to a pump, then your training must be updated. If you are asked to provide care for a child with diabetes without being trained then you should immediately speak to a senior member of staff. Insulin, record keeping and communication Depending on how much support the child needs, you might be required to look after the child s insulin and equipment. This should always be easily accessible and never locked away. The child s IHP must make clear where it is kept. If a child is taking part in PE you may have to make sure the teacher is given the child s equipment, treatment or hypo kit. What happens in PE will be included in the child s IHP. Schools should keep a record of any prescribed medicines given to children, which means doses of insulin for children with diabetes. It is likely keeping these records will be your responsibility. A log book will help you do this. In this you can record what dose of insulin has been given, carbohydrates eaten, blood sugar levels and room to record any emergency incidents like hypo and hypers. If a child refuses their insulin or other treatments, then what happens next will be covered in their IHP. The school must inform parents of this. Along with formal record keeping, good communication with parents will be very important, particularly if the child you are supporting is young or newly diagnosed. The IHP will state exactly when parents need to be contacted but do not be afraid to ask questions or let them know of any concerns you have. A child and their parents will often know the most about their diabetes so it is important you listen to their views and thoughts. Individual Healthcare Plans Before you begin supporting a child with diabetes, you should have read and understood their individual healthcare plan. The IHP would have been developed after a meetin between the school, parents and the child's PDSN. At this meeting the support the child needs would have been identified. You might not have been at this first meeting, but you should be invited to subsequent ones, as you will be well placed to see how well they are doing in school or progressing with self-management of their diabetes. For instance, you might spot there is a particular lesson a child has a hypo in, which may be a trigger no one else has spotted. Promoting self-management Along with treating each child with diabetes as an individual, school staff can be helpful in promoting self-management of the condition. This is something you will need to contribute to. If a child is very young or newly diagnosed it is likely you will be required to test blood sugars, administer insulin and count carbohydrates (carbs). As the child gets older or more confident with looking after their diabetes, what you will be required to do might change, and should be updated in the child s IHP. A child who has just started injecting themselves might still want you to be there to check they re doing it right, and you might still need to inject them if they re having a bad day. It is also important to remember that self-management isn t always going to constantly improve. An 11- year-old who is very diligent with their care may, as they hit their teenage years, suddenly start skipping insulin doses or avoid treating hypos as soon as possible. Keeping parents and the school informed of any issues you spot is very important.

6 Exams - Adjustments The following are examples of simple adjustments that Headlands School could make to ensure that a child with diabetes fulfils their academic potential in an exam: Allowing the child to bring their blood glucose monitor and testing strips in to the exam, and to test whenever necessary during the exam. Allowing the child to bring hypo remedies in to the exam (this might include a sugary drink, sweets or a snack. The parent or PDSN will advise on the most suitable hypo remedy for a child). Allowing them to bring in water (hyperglycaemia can cause excessive thirst). Allowing them supervised toilet breaks, as frequently as they need (hyperglycaemia can cause frequent urination). Allowing the child to sit in the place that is most appropriate for them, eg sitting close to the invigilator if they would like someone to keep a closer eye on them in case of a hypo/hyper. Allowing extra time in case of a hypo/hyper. Making sure that the invigilator/s know that there is a child with diabetes sitting the exam and what adjustments to usual procedure have been agreed. Making sure that the invigilator/s understand about diabetes and how it can affect a child in an exam. This is not an exhaustive list at all, and individual children will have different needs. The child (if they wish), parent, PDSN and relevant school staff should discuss the specific needs of a child in plenty of time so that arrangements can be put in place. This should be detailed in the child's Individual Healthcare Plan. What to take on a school trip Unless the child can manage their diabetes completely independently, someone who has been trained to help manage their diabetes will need to go on the trip as well. Things to take on a trip include: insulin and injection kit blood testing kit hypo remedies pump supplies (if appropriate) extra food/snacks in case of delays or the child doesn t like the food available personal identification card or bracelet copy of the child s individual healthcare plan (IHP) emergency contact numbers. Day trips Depending on what s planned for the day, you might not need to make any adjustments to the child s usual school routine. But talk to the child s parent or PDSN about what will be happening well before the trip to see if any changes are needed. Overnight stays With overnight stays, a child taking injections will certainly need insulin injections as well as blood glucose testing (which may include testing at night), even if these aren t already done in school. Depending on the length of the trip, children on pumps may need a pump set change. If the child can t do their own injections/manage their pump and/or do their own blood glucose levels, they ll need to be done by a member of staff. School staff should meet with the child s parent/carer and PDSN well in advance of the trip to discuss what help is required, and who will assist.

7 Individual Health Plan The IHP should include the following: Written permission from the parent/carer and the head teacher for insulin to be administered by a member of staff, or self-administered by the child during school hours. Exactly what help the child needs with diabetes management what they can do themself and what they need from somebody else. Who is going to give that help and when. Details of the insulin needed, the dose needed, when it s needed and the procedure for injecting or using a pump. Details of when the child needs to test their blood glucose levels, the procedure for testing them and the action to be taken depending on the result. Description of the symptoms of hypo and hyperglycaemia (and possible triggers) and what staff will do if either of these occurs. It should also include when the parent/carer should be contacted and when an ambulance should be called. Details of when the child needs to eat meals and snacks, what help they need around meal or snack time, eg whether they need to go to the front of the lunch queue, need help with carbohydrate counting or have any other special arrangement around meal/snack time. The things that need to be done before, during or after PE, eg blood glucose testing or having an extra snack. Details of where insulin and other supplies will be stored and who will have access to them. It should also include what supplies will be needed, how often the supplies should be checked and by whom. What to do in an emergency, including who to contact. Any specific support needed around the child s educational, emotional and social needs, eg how absences will be managed, support for catching up with lessons or any counselling arrangements. A description of the training that has been given to whom. What plans need to be put in place for exams (if appropriate). What plans need to be put in place for any school trips (including overnight) or other school activities outside of the normal timetable. This is not an exhaustive list, and the IHP might also include other aspects of a child's care. Related Policies Ambulance Policy First Aid Policy Management of Medicines Policy Medical Conditions Policy