Managing Type 1 Diabetes at Home and School

After a type 1 diabetes diagnosis, many families feel like they have been handed a new full-time job: numbers to check, carbs to count, supplies to pack and a school to bring up to speed. It gets easier, and children with type 1 diabetes play sports, go to sleepovers and do what their friends do. Here is how daily care works at home and at school.

A typical day

Type 1 diabetes means the body no longer makes insulin, the hormone that moves sugar from the blood into cells for energy. Your child's care team will give you a written plan, and the daily routine usually looks something like this:

• Check blood sugar before meals, at bedtime, and at other times the plan lists
• Count the carbohydrates in meals and snacks
• Give insulin based on the carb count, the blood sugar level, and the plan
• Adjust for activity, illness and growth

Regular meal times help keep things steady. Kids with type 1 diabetes can eat the same healthy foods as the rest of the family.

Checking blood sugar

There are two main ways to check:

• Finger-stick meters use a tiny drop of blood on a test strip.
• Continuous glucose monitors (CGMs) use a small sensor under the skin that reads glucose levels every few minutes. Many can alert a parent's phone to highs and lows, even overnight.

Your diabetes team will tell you your child's target range and when to double-check a CGM reading with a finger stick.

Insulin basics

Insulin is given with a pen or syringe, or through a pump attached by a small tube or pod. Most plans combine background insulin for the whole day with rapid-acting insulin for meals and high readings. Some pumps work with a CGM to adjust insulin automatically.

The right amount of insulin is different for every child and changes as they grow. Always follow the doses your child's diabetes team sets, and call them with questions before making changes.

Lows: hypoglycemia

Low blood sugar can happen if a child gets more insulin than they need, skips or delays a meal, or is more active than usual. Signs include:

• Shakiness, sweating or pale skin
• Hunger, headache or dizziness
• Crankiness, crying or sudden mood changes
• Confusion, trouble paying attention or sleepiness

When you see signs of a low, check right away if you can. If you cannot check, treat. Give the fast-acting sugar listed in your child's plan, such as glucose tablets or juice, and recheck after about 15 minutes. Once the level is back in range, a snack may be needed if the next meal is a while off.

A severe low, where a child is too confused to swallow safely, passes out or has a seizure, is an emergency. Give glucagon as your child's plan directs, then call 911. Caregivers, coaches and school staff should know where it is kept.

Highs: hyperglycemia

High blood sugar can come from missed insulin, extra food, illness, stress or a pump problem. Signs include thirst, frequent peeing, tiredness and blurry vision. Your plan will say how to correct a high and when to check for ketones in the urine or blood.

Ketones build up when the body burns fat because it does not have enough insulin. High ketones can lead to diabetic ketoacidosis (DKA), which is dangerous. Signs of DKA include vomiting, belly pain, fast or deep breathing, fruity-smelling breath, and unusual sleepiness or confusion.

Sick days

Illness often raises blood sugar, even if your child is not eating much. Common sick-day steps:

• Never stop insulin without talking to your diabetes team, even if your child is not eating.
• Check blood sugar more often, often every few hours.
• Check ketones as your plan directs.
• Offer plenty of sugar-free fluids, and sugar-containing fluids if blood sugar runs low.
• Call your diabetes team early if you are unsure. Vomiting with diabetes needs prompt advice.

Sports and activity

Exercise is good for kids with diabetes, but it can lower blood sugar during activity and for hours after, even overnight. To play safely:

• Check before, during long practices, and after.
• Have fast-acting sugar on hand at every practice and game.
• Talk with your diabetes team about adjusting insulin or snacks around sports.
• Make sure coaches know the signs of a low and what to do.
• In San Antonio's heat, keep supplies like insulin and CGM sensors cool and out of direct sun, since high heat can damage insulin.

School: what Texas requires

Texas has specific rules for caring for students with diabetes, found in Chapter 168 of the Texas Health and Safety Code. According to the Texas Diabetes Council's school training guidelines on the DSHS website (updated January 2025):

• Diabetes Management and Treatment Plan (DMTP). Your child's doctor writes the orders the school follows. Give a copy to the school each year and whenever it changes.
• Individualized Health Plan (IHP). The school nurse or principal builds a plan from the DMTP that spells out who does what during the school day.
• Trained staff. Schools must train non-medical staff members, called unlicensed diabetes care assistants, to help with diabetes care, so care is available even when the nurse is not.
• Self-care. When the plan allows, students may check their blood sugar, take insulin, treat lows and highs, and carry their supplies in the classroom or anywhere at school. A student who manages their own care cannot be required to go to the nurse's office to do it.
• Bus rides and field trips. Staff who transport or supervise your child off campus must receive information about your child's diabetes and emergency contacts.

Meet with the school nurse before the school year, or soon after diagnosis, and bring supplies, glucagon and your child's plan. Some families also set up a Section 504 plan to cover things like snacks in class and extra time for tests after a low.

For more on daily care, see MedlinePlus on diabetes in children and teens.

When to call us

Call your A thru Z Pediatrics office for help with school forms, if your child has a common illness and you want help alongside your diabetes team's sick-day advice, or if you notice your child struggling emotionally with their diabetes. For insulin dose questions, call your child's diabetes team.

Call 911 or go to the ER if your child has a severe low with confusion, passing out or a seizure; has signs of DKA such as vomiting, belly pain, fast breathing, fruity breath or unusual sleepiness; or cannot keep fluids down.

For a checkup or school paperwork, request a visit.