Supporting Children and Students with Prevalent Medical Conditions in Schools: Diabetes Procedure

This procedure has been created to support Policy/Program Memorandum No.161 (PPM161): Supporting 
Children and Students with Prevalent Medical Conditions in Schools, and Durham District School Board Policy.

The goals of this procedure are:

• to support students with diabetes to fully access school in a safe, accepting, and healthy learning 
  environment that supports well-being;
• to empower students, as confident and capable learners, to reach their full potential for self-management of their diabetes, according to their individual Plan of Care.

This procedure assists school principals, staff, parents/guardians, and students in preparing mutually 
acceptable diabetes management plans. Since parents/guardians, students (if age appropriate), and staff have responsibilities in this matter, consultation, on-going communication and regular training are essential for a successful plan.

Diabetes management is the “cornerstone of diabetes care in order for students to live well with diabetes and to prevent or delay complications of diabetes. It involves following prescribed medication, diet, and physical activity patterns, checking blood glucose and adjusting treatments. Students and their parents/guardians are encouraged to be actively involved in the decision-making around the student’s diabetes care.” (Guidelines for Care of Students Living with Diabetes at School. Canadian Diabetes Association, 2014).

Parents of Children with Diabetes

As primary care-givers of their child, parents are expected to be active participants in supporting the 
management of their child’s diabetes while the child is at school. Parents should:

• educate their child about their diabetes with support from their health care professional, as needed;
• guide and encourage their child to reach their full potential for self-management and self-advocacy;
• inform the school of their child’s diabetes and co-create the Plan of Care for their child with the principal 
  or designate;
• communicate changes to the Plan of Care, such as changes to the status of their child’s diabetes or changes to the child’s ability to manage the medical condition to the principal or designate; 
• confirm annually to the principal or designate the child’s medical status;
• initiate and participate in meetings to review their child’s Plan of Care;
• supply their child and/or school with sufficient quantities of medication and supplies in their original, clearly labelled containers, as directed by a health professional and as outlined in the Plan of Care;
• seek medical advice from a medical doctor, nurse practitioner, or pharmacist where appropriate.

Students with Diabetes

Depending on their cognitive, emotional, social, and physical age of development, and their capacity for self-management, students are expected to actively support the development and implementation of their Plan of Care. Students should:

• take responsibility for advocating for their personal safety and well-being that is consistent with their 
  cognitive, emotional, social, and physical stage of development and their capacity for self management; 
• participate in the development of their Plan of Care;
• participate in meetings to review their Plan of Care; 
• carry out daily or routine self-management of their medical condition to their full potential, asdescribed 
  in their Plan of Care (e.g., carry their medication and medical supplies; follow school board policies on 
  disposal of medication and medical supplies); 
• set goals on an ongoing basis for self-management of their medical condition, in conjunction with their 
  parent(s) and health care professional(s);
• communicate with their parent(s) and school staff if they are facing challenges related to their medical 
  condition(s) at school; 
• wear medical alert identification that they and/or their parent(s) deem appropriate; 
• if possible, inform school staff and/or their peers if a medical incident or a medical emergency occurs.

School Staff

School staff should: 

• review the Plan of Care for any student with whom they have direct contact;
• participate in training on prevalent medical conditions including diabetes (at minimum, this training must occur annually);
• share information on a student’s signs and symptoms of low or high blood glucose, if the parents give 
  consent to do so and as outlined in the Plan of Care and authorized by the principal in writing;
• follow strategies that reduce the risk of student exposure to triggers or causative agents in classrooms, common school areas, and extracurricular activities, in accordance with the student’s Plan of Care; 
• support a student’s daily or routine management, and respond to medical incidents and medical 
  emergencies that occur during school, in accordance with School Board policies, school protocols and applicable Collective Agreement provisions relating to supporting students with medical conditions; 
• support inclusion by allowing students with diabetes to perform daily or routine management activities in a school location (e.g., classroom), as outlined in their Plan of Care, while being aware of confidentiality and the dignity of the student;
• enable students with diabetes to participate in school to their full potential, as outlined in their Plan 
  of Care. 

Principal 

In addition to the responsibilities outlined above under “School Staff”, the principal should: 

• clearly communicate to parents and appropriate staff the process for parents to notify the school of their child’s medical condition, as well as the expectation for parents to co-create, review, and update a Plan of Care with the principal or the principal’s designate. This process should be communicated to parents, at a minimum: − during the time of registration; − each year during the first week of school; − when a child is diagnosed and/or returns to school following a diagnosis; 
• co-create, review, or update the Plan of Care for a student with diabetes with parents/guardians, in consultation with school staff (as appropriate) and with the student (as appropriate); 
• maintain a file with the Plan of Care and supporting documentation for each student with diabetes; 
• provide relevant information from the student’s Plan of Care to school staff and others who are identified in the Plan of Care (e.g., food service providers, transportation providers, lunch supervisors, volunteers, occasional staff who will be in direct contact with the student), including any revisions that are made to the plan; 
• communicate with parents/guardians in medical emergencies, as outlined in the Plan of Care;
• encourage the identification of staff who can support the daily or routine management needs of students in the school with diabetes;

School Board

The school board will communicate, on an annual basis, the policy/procedure on supporting students with 
diabetes (including the Plan of Care template) to parents, school board staff, and others in the school 
community who are in direct contact with students. School boards are also expected to:

• provide training and resources on prevalent medical conditions on an annual basis;
• develop strategies that reduce the risk of student exposure to triggers or causative agents in classrooms and common school areas; 
• develop expectations for schools to support the safe storage and disposal of medication and medical 
  supplies, and communicate these expectations to schools and support schools in the implementation of the expectations;
• communicate expectations that students are allowed to carry their medication and supplies to support 
  the management of their medical condition, as outlined in their Plan of Care; 

Privacy Policy 

All school and individual Plans of Care must adhere to DDSB Privacy Policy, Regulation, and Procedure.

Plan of Care (APPENDIX A)

The Plan of Care contains individualized information on a student with diabetes. All students identified as 
having Type 1 Diabetes must have an up to date Plan of Care on file in the school.

The Plan of Care for a student with diabetes should be co-created, reviewed, and/or updated by the parent(s) 
in consultation with the principal or the principal’s designate, designated staff (as appropriate), and the 
student (as appropriate), during the first thirty school days of every school year and, as appropriate, during 
the school year (e.g., when a student has been diagnosed with a prevalent medical condition). Parents have 
the authority to designate who is provided access to the Plan of Care. With authorization from the parents, 
the principal or the principal’s designate should share the Plan of Care with school staff who are in direct 
contact with students with diabetes and, as appropriate, others who are in direct contact with students with 
prevalent medical conditions (e.g., food service providers, transportation providers, volunteers).

Reporting (APPENDIX B)

The Principal is responsible for:

• Maintaining a record of all diabetes-related events;
• Reporting on the number of students with diabetes, and all diabetes-related events to the Operations 
  Dept.

PPM 161 (Ontario Ministry of Education), Supporting Children and Students with Prevalent Medical Conditions (Anaphylaxis, Asthma, Diabetes and/or Epilepsy) in Schools, 2018.

Canadian Diabetes Society. Position Statement on Kids Living with Diabetes at School, 2014

Training Resources

Canadian Diabetes Society. Guidelines for the Care of Students Living with Diabetes at School, 2014

The Canadian Paediatric Society & The Canadian Paediatric Endocrine Group. Managing Type 1 Diabetes in School: Recommendations for Policy and practice, 2015

The Canadian Paediatric Society, The Canadian Paediatric Endocrine Group, & The Canadian Diabetes Society Diabetes @ School (www.diabetesatschool.ca) This website includes a series of short videos on type 1 diabetes in schools. It was developed to ensure that school staff and administrators have the training and resources required to support students with type 1 diabetes.

The following resources have been developed by OPHEA to support the home–school communication of 
parent/guardian responsibilities related to the implementation of PPM 161 – Supporting Children and 
Students with Prevalent Medical Conditions (anaphylaxis, asthma, diabetes, and/or epilepsy) in Schools, are available at: safety.ophea.net/principaldesignate-0

• Parent/Guardian Fact Sheet
• Keeping Students with Anaphylaxis, Asthma, Diabetes, and/or Epilepsy Safe: Information for Parents 
  and Guardians Fact Sheet
• Keeping Students with Anaphylaxis, Asthma, Diabetes, and/or Epilepsy Safe: Information for Parents 
  and Guardians Fact Sheet (AODA compliant)
• Parent/Guardian Video: Keeping Students with Anaphylaxis, Asthma, Diabetes, and/or Epilepsy Safe: 
  Information for Parents and Guardians
• Sample completed Plan of Care
• For student with asthma
• For student with asthma (AODA compliant)