For most children target levels are 4–7mmol/l on waking and before meals, rising to 5–9mmol/l after meals, though some children may have different targets. An individual child’s targets will be stated in their individual healthcare plan (IHP).
A blood sugar test generally takes just a few seconds and a child is likely to need to test:
- before meals
- before, during and/or after physical activity
- if they’re unwell
- any time they/school staff feel that their blood glucose level is falling too low or climbing too high.
The child’s parent or paediatric diabetes specialist nurse (PDSN) will advise on when blood sugar testing should be done and this will also be detailed in the child’s IHP. Children might need help with blood testing, especially if they’re younger, newly diagnosed or have learning difficulties. Their parent or PDSN will discuss the help they need, and this will also be detailed in their IHP.
How to do a blood glucose test
The child’s parent or PDSN will train staff on how to use the child’s blood glucose meter, but the following is a guide:
- Wash the child’s hands (don’t use wet wipes or alcohol swabs as these can affect the result).
- Using the finger pricker*, prick the side of the finger, not the pad or too close to the nail.
- Insert a test strip into the meter. This will turn it on automatically.
- Apply a drop of blood to the test strip.
- The meter will automatically display the result.
- Make a note of the result.
*Finger prickers should only be used by the child it belongs to and should not be shared between children.
Some children will wear a continuous glucose monitor (CGM). This is a small sensor that remains attached to them 24 hours a day, and gives automatic, frequent blood glucose readings. Children wearing a CGM generally won’t need to test their blood glucose levels regularly during school hours, but will do from time to time. CGM is not available to all children but may be used in specific circumstances.
The needles for insulin pens and the lancets used for blood glucose testing need to be changed after they’ve been used once. Children should have a special sharps disposal container (or 'sharps bin') to drop needles or lancets in after doing their insulin injection or blood test. This should be stored in a safe place until it’s full and needs to be collected for disposal. The sharps bin should be readily accessible when a child needs to have an injection or blood test. The child shouldn’t be expected to take it to and from school every day.
Some children carry a needle clipper, a small device that snips off the pen needle after use and stores it safely. Some children have a safety needle on their injector pen, where a sheath covers the needle as it’s withdrawn from the skin. It then deadlocks and so the needle is protected. Safety needles should still be disposed of in the sharps bin. Arrangements for the collection of full sharps bins need to be made with the local authority. These arrangements can vary throughout the country and can differ from area to area. The child's PDSN can advise on what your local arrangements are.
Storing diabetes equipment
Where the child’s injection equipment and blood glucose equipment kept should be decided by the child (where appropriate), parent, PDSN and school, and this will be made clear in the IHP. It may be that the child will keep them in their school bag, and this should be allowed. Or they may prefer them to be stored in a central but readily accessible place. Wherever they are stored, all staff should know where they are and they should remain easily accessible wherever the child is in school (eg on the playing fields). Hypo remedies should always be with the child.
There is no special diet for children with diabetes, they should follow the same healthy balanced diet recommended for every child – one which is low in fat (for older children), salt and sugar, includes regular carbohydrates and at least five portions of fruit and vegetables a day.
Special diabetic foods are not recommended because they still affect blood sugar levels, can have a laxative effect and are expensive. Children with diabetes can enjoy moderate amounts of high-fat, high-sugar foods such as sweets and chocolate just like other children, so they should not be excluded from class treats unless specifically advised by their parent or PDSN.
All children using a pump, and most using multiple daily injections (MDI), will match their insulin exactly to the amount of carbohydrate in the food they’re about to eat. This is called 'carbohydrate (or carb) counting'.
Children might need help with carb counting, especially if they’re younger, newly diagnosed or have learning difficulties. Their parent or PDSN will discuss the help they need, explain exactly how it works, and give you all the information you need to carb count.
We also have more information in our Carbohydrate counting section.
Children who take insulin twice a day and younger children (irrespective of the way they take insulin) may need snacks between meals. Snacks may need to be eaten during class time. The choice of snack will depend on the individual child but could include:
- a portion of fruit
- one individual mini pack of dried fruit
- a cereal bar
- a small roll/sandwich
Older children who take insulin with meals or who are on a pump may not need snacks between meals. The child’s parent or PDSN will advise on whether a child needs snacks and when, and which snack is most appropriate.
Children who take multiple daily injections or who are on a pump usually can usually be reasonably flexible with their eating times. But if a child takes two injections of insulin per day, meals and snacks may need to be eaten at regular intervals. This will help keep blood glucose levels stable. It’s important to know if there are specific times when the child needs to eat and make sure that they keep to these times, as a missed or delayed meal or snack could lead to hypoglycaemia.
The child's parent and PDSN will give you specific advice about the individual child's food intake, and it will also be included in their IHP.
Children will need to plan for physical activity, because all forms of activity (such as swimming, football, running and athletics) use up glucose. This can mean that their blood glucose level falls too low and they’ll have a hypo (low blood glucose level).
On the other hand, if their blood glucose is high before getting active, physical activity may make it rise even higher.
The way a child prepares for activity will vary depending on:
- when they last injected their insulin
- the type of physical activity they’ll be doing
- the timing of the activity and how long it will last
- when they last ate
- their blood glucose level.
So they may need to:
- have an extra snack before/during/after physical activity
- alter their insulin dose
- inject in a particular site
- check their blood glucose more regularly
- ensure a good fluid intake.
School staff should talk to the child’s parent or PDSN who will advise on the specific preparation required. This should also be clearly written down in the child’s IHP.
Insulin pumps and activity
Pumps need to be disconnected if the child is taking part in contact sports and, although some pumps are waterproof, the child may prefer to disconnect their pump when swimming.
Generally, pumps should not be disconnected for more than one hour because they use rapid acting insulin and while they are disconnected no more insulin will be getting into the body. This means that the blood glucose will start to rise. To make sure that blood glucose levels stay as stable as possible, the pump must be reconnected as soon as the activity is over and the child’s blood glucose level should be checked. They might need some extra insulin as well.
In the case of extended activity the child may need to check their blood glucose level during the activity, as it may have started to rise. If necessary, they might need to take some more insulin, either by reconnecting the pump for a short time or by giving an insulin injection.