Back-to-School Safety and Athletics for Children with Pediatric Diabetes

Medically reviewed by Chelsea Stallman, BSN, RN, CDCES

Parenting is demanding, and the challenges are amplified when a child faces a chronic illness, such as diabetes. If your child has recently been diagnosed, you're likely facing a whirlwind of emotions and questions. It's natural to feel overwhelmed, especially when it comes to your child's safety. Rest assured, you are not alone in this journey.

Worldwide, millions of children navigate the challenges of living with diabetes. Fortunately, WakeMed staff is readily available to empower you and your child on this journey. Managing your child's diabetes begins with a thorough understanding of the condition. Diabetes is a lifelong disease that disrupts the body's ability to process food for energy, specifically affecting the way it metabolizes glucose (sugar).

Chelsea Stallman, BSN, RN, CDCES, is a patient educator for the WakeMed pediatric endocrinology clinic. She works directly with pediatric patients with Type 1 and Type 2 diabetes, supporting patients from the onset of diagnosis and teaching families how to properly monitor blood sugars. She also helps start patients on continuous glucose monitors, insulin pumps, blood sugar meters, blood lancets and diabetic test and ketone strips. Her goal is that, with support, pediatric patients with diabetes can enjoy the same activities and experiences as their peers. 

We connected with Stallman about return to school and participation in school sports to explore how pediatric diabetics can safely experience the fullness of childhood.

It's back-to-school season here in Wake County. What do parents need to know for school safety?

Newly diagnosed patients and families new to the school, should request a meeting regarding the child's condition. At this meeting, families should find out who will be in charge of helping to manage the child's condition throughout the day. Families should also take the care plan to this meeting. They should provide the school an updated care plan provided by the care team at the end of each visit. Wake County specifically requires a 1702 form for chronic illness. It details medication administration. 

Also, I advise families to request a 504 plan for the child. This can be discussed with the school counselor. This allows the child opportunities to be pulled out when necessary. It could also authorize blood sugar testing before exams. If a child is struggling with high or low blood sugars, that needs to be addressed before the test to avoid brain fog. We want to allow children with pediatric diabetes the same opportunities to succeed as their classmates. Learn more at Safe at School | ADA. 

Should children with pediatric diabetes have more blood sugar checks while at school? 

Since the school day can take up a large part of a child's waking hours, it is important to check blood sugar throughout the day.

• Children with pediatric diabetes should check their blood sugar before any meal to verify blood sugar ahead of time. 
• They should have it checked before starting any physical activity, such as a physical education class workout. 
• Blood sugar should also be checked if the child complains of feeling unwell. 

What are the signs and symptoms of low and high blood sugar?

The symptoms of low blood sugars include the following:

• Weakness 
• Shakiness
• Heart racing 
• Stomach ache
• Headache
• Visual changes
• Confusion 
• Lethargy 
• Dizziness
• Profuse sweating
• Feeling cold and clammy
• Anxiety  or nervousness

Signs of high blood sugar include the following: 

• Irritability and moodiness
• Visual changes, such as blurry vision
• Excessive thirst 
• Urinating more frequently
• Extreme hunger 

How would someone properly address low blood sugars?

The rule of fifteens is the best plan of action. It includes 15 grams of fast-acting carbohydrates or simple sugars. They should then wait 15 minutes and recheck the blood sugar. Examples of fast-acting carbohydrates include: 

• 4 ounces of juice or soda
• Glucose tabs
• Fruit snack candies
• Gusher candies 
• Smarties
• Cake frosting
• Skittles

They should, initially, avoid protein-rich foods when treating low blood sugar because they can delay the absorption of carbohydrates. Foods to avoid include the following:

• Peanut butter crackers
• Cottage cheese
• Chickpeas
• Eggs
• Canned fish
• Hummus
• Chocolate

However, these are great foods to follow with once the blood sugar has stabilized since protein and fat will help stabilize the blood sugar for a longer period of time. Only initially should those foods be avoided.

How would someone properly address high blood sugar?

When blood sugars are too high, staff should check ketones and ensure the child is drinking plenty of fluids. If enough time has lapsed since the last insulin dose, a corrective dose would be warranted.

What should parents pack for lunch and snacks?

A balanced diet is very important. Parents should pack lunches rich in protein and fat (peanut butter sandwich and nuts/seeds) and complex carbohydrates (natural fruits).

Snacks should also be a balance of protein, fat and carbohydrates. Various pinwheel snacks are a great option. Find more healthy food options at Diabetes Food Hub.

Children can also eat school lunch. Ideally, most schools should have a meal that has protein and carbohydrates. This would be a matter of monitoring the lunch option for that day and communicating with school nurses and staff about the necessity of this mix. Any treats laden with simple sugars may need to be avoided. Meals need to be combined with fat and proteins to help maintain and stabilize the blood sugar.

As part of the school experience, many children wish to participate in sports. Is this safe for children with pediatric diabetes?

We definitely want these children to participate in everything they desire. We can work with families and talk to them about different ways to address blood sugars.

Coaches need training in pediatric diabetes. They should also be familiar with the child's care plan and have a copy. During practice, children with pediatric diabetes should keep a pencil pouch or another small bag with additional snacks, such as juices, glucose tabs, an emergency pen and other treats.

Is it safe for children with pediatric diabetes to consume electrolyte drinks while playing sports? 

Sports drinks with no sugar are the best option. Of course, if a child is in a crisis of low blood sugar, then simple carbohydrates are needed in that moment, but otherwise, it is best to steer clear of added sugars. 

WakeMed Children's — Pediatric Endocrinology Can Help!

We want children with pediatric diabetes to enjoy everything their peers are doing. It is a matter of preparing ahead of time to best address those situations as well as the what ifs.

WakeMed Children's — Pediatric Endocrinology provides state-of-the-art diagnoses, treatment and management of endocrine problems for children and families throughout Wake County. Visit us at one of our locations in east Raleigh, North Raleigh, Clayton and Apex, N.C.

Our board-certified pediatric endocrinologists care for a diverse population of children ranging in age from birth to 21. Our specialties include treatment of growth, puberty, pituitary, thyroid, intersex, menstrual disorders and many more.