If your child is diagnosed during the school year, you (and your child) are not going to want to miss a beat. Sometimes, this will mean that a morning after returning home from an inpatient experience, you have to send your child off into the world without you. First days back to school can be worrisome for parents, for children, and for school officials. You and your child have not settled into your diabetes routine yet. You're barely getting a grasp of his first set of doses, and he may not have even experienced his first low yet. But back to school he must go, and your first step is first-day planning.

The First Visit to the School Nurse

The nurse is going to be your friend for life. At least that's your hope. So the first thing you need to do when sending a child back to school is to meet first with your child and the school nurse. Let the nurse know that today, you're just setting up day-to-day parameters, and that a long-term plan will be worked out in the near future with your medical team's expertise, your expectations, and her assistance. For this first day, agree to times your child will check her blood sugar and how that will happen.

Bring with you vials of your child's insulin, syringes, a second meter to keep at school and test strips to go with it, a second ketone meter if you can get one (and ketone strips if you cannot), and depending on the size of your school, one or more glucagon kits to keep at school at all times. It's also a good idea to provide the nurse with a mini carbohydrate-counting directory. You can find one in the cookbook section of your local bookstore.

Ask the nurse to open the vials only when necessary, since they stay usable longer if they are unopened. You'll also want to provide the nurse and the classroom with their own supply of goodies to treat low blood sugar. Fill a plastic sealable container with individual bags of chips, crackers, and juice boxes, as well as a package of glucose tabs.

Blood Checks with the Nurse or in the Classroom

Although some students check their blood sugar levels in the classroom (more on that in the long-term plans section), most parents opt for their children to visit the nurse the first few days and even weeks. It's a good idea even if your child seems independent, if only to encourage a relationship between her and the nurse (something you'll cherish in time). These visits can also help the nurse get up-to-speed on diabetes and your child. The nurse will see what your child's plan and pattern is, how she deals with the new routine, and how she looks and feels during highs and lows. You're going to want this kind of relationship, even if your long-term plan is to have your child not visit the nurse as often.

Teacher in the Loop

What is the teacher's role during these first days? You'll need to sit down with him as well and go over a short-term plan for the first few days. The teacher will need to know that your child must be allowed to see the nurse, visit the restroom, or go for water at any time she requests. Point out to the teacher that you and your child are in a learning phase, and that the first weeks will be all about figuring things out. Ask the teacher to be part of the planning meeting you hold soon to develop a long-term diabetes plan for your child in school.

Some teachers will be fearful; others will be helpful. Encourage your teacher to share his honest concerns about your child and her diabetes. If you don't have good answers, promise to find them. A calm, involved teacher is best for your child.

Your teacher will need to understand what times of day your child needs to eat and why. Some teachers will allow all students in their class to have an optional snack at the same time the child with diabetes has hers, often at 10 a.m. and 2 p.m. on the two-snack-a-day program. This solution helps the child feel “normal” and also reminds her to eat. If your child's teacher is willing to do this, suggest that class does not have to stop for this snack. Rather, students can be invited to eat a small snack as they continue their lessons.