The symptoms of hypoglycemia in children with type 1 diabetes may cause behaviors that can be perceived as rebellious or cantankerous. You should be aware of any changes in behavior that clue you into a drop in blood glucose. Imagine your ordinarily quiet child becomes rowdy and uncontrollable, or your active child becomes quiet and subdued. Shifts from their normal behavior range should indicate that it is time for you to check their blood glucose level. Unfortuately, you can not be around your child all day. This is why it is important to educate everyone involved—family, healthcare providers, teachers, nurses, and fellow students—that this may be the best way to stabilize behavior.
Hypoglycemia can occur when snacks are not eaten at the proper time, or as a result of overmedicating with insulin.
Managing at School
While many parents find that their diabetic children receive both excellent education and in-school management of their diabetes, others report a variety of problems.
One parent tells the story of her fifth grade son's move from a familiar, small private school to a large public school. She gave the registrar an information packet about her son's diabetes and was assured that her son would be watched carefully. She later discovered that an unfamiliar privacy act prevented several teachers and school workers from ever being informed of her son's condition.
Alarmed to receive a midterm progress report of failing grades for her son—who had previously been an honor student—she arranged a teacher conference. She was astonished to learn that the science teacher perceived her son as passively rebellious and a daydreamer. It turns out that her son was embarrassed to request early dismissal from midmorning class to have time for his snack. By the time he reached science class (right before lunch), his blood glucose levels fell dangerously low, causing him to become confused and disoriented.
Communication Is Key
The key to good diabetes management at school is educating the teacher and the school nurse. Today, teachers deal with overcrowded classes, so monitoring a particular student's behavior can be challenging. Make contact with each teacher at the beginning of the school year to point out your child's typical behavior patterns so they know what to look for. After seeing test results with particular behaviors, the teacher should become accustomed to the warning signs.
It is important to maintain ongoing contact with your child's teachers. You should also consider arranging a conference with the principal, teacher, and the school nurse to resolve conflicts with teachers who are reluctant to recognize that behavior changes may be related to abnormal blood glucose levels. There are also federal laws that help children with chronic illnesses obtain a free, appropriate education if parents can show that their child’s illness adversely affects his or her performance in school.
Even Tougher For Teens
The issue of blood glucose levels affecting behavior and moods becomes increasingly important during puberty. Increased hormone levels further complicate the picture, causing fluctuations that cannot be anticipated simply by monitoring dietary intake, while stereotypical teen behaviors complicate matters even more. Growth spurts also make it difficult to get a handle on correct dosing. For example, a disoriented or confused teen may be mistaken as someone using drugs or alcohol. Educating an ever-changing roster of your child's junior and senior high school teachers can be challenging, but it is well worth the effort.
How Can You Avoid These Problematic Situations?
It is important that you understand your child's condition, because you are responsible for their safety. Plus, medical personnel who do not regularly manage people with type 1 diabetes can make mistakes.
Teach the Teachers
Make an information packet for each of your child's new teachers every year. Arrange conferences periodically. Accompany your child's class on field trips and become active in parent-teacher organizations. Also, get to know your child's friends and teach them to recognize subtle hints that the child's glucose levels may be running high or low.
Arrange for your child to attend camps or workshops with other children who have diabetes. At a time when fitting in is so important, it is vital that your child interact with other children who share some of the same challenges.
Monitor the Condition Closely
Be diligent in monitoring your child's blood glucose levels and dietary intake. Children sometimes deviate from prescribed regimens as they become more independent and may even lie about meter readings. They may also try to inject extra insulin to cover up overeating with friends. Complications from erratic control may not surface for several years, but when they do, they can be devastating.
Be Aware of Timing
A diabetic reaction is not the time to discuss the situation with your child. When blood glucose levels are low, the child is unable to think clearly.
At this time, there is no cure for type 1 diabetes, although researchers are making great strides. It is a life-long disease, but it can be managed to allow a happy and healthy life. Because the formative years are critical, it is your responsibility to help your child accept and control the disease.
Family Doctor—American Academy of Family Physicians
Juvenile Diabetes Research Foundation
About Kids Health—The Hospital for Sick Children
Canadian Diabetes Association
Barrett JC, Goodwin DK, Kendrick O. Nursing, food service, and the child with diabetes [Review]. J Sch Nurs. 2002 Jun;18(3):150-6.
Diabetes mellitus type 1. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 11, 2016. Accessed January 13, 2016.
For parents & kids. American Diabetes Association website. Available at: http://www.diabetes.org/living-with-diabetes/parents-and-kids/?loc=lwd-slabnav. Accessed January 13, 2016.
McCarthy AM, Lindgren S, Mengeling MA, et al. Effects of diabetes on learning in children. Pediatrics. 2002 Jan;109(1):E9.
McDonnell CM, Northam EA, et at. Hyperglycemia and externalizing behavior in children with type 1 diabetes. Diabetes Care. 2007;30(9):2211-2215.
National Institute for Health and Clinical Excellence. Type 1 Diabetes: Diagnosis and Management of Type 1 Diabetes in Children and Young People. London: RCOG Press;2004. Updated 2009.
Roche, EF, Menon A, Gill D, Hoey H. Clinical presentation of type 1 diabetes. Pediatr Diabetes. 2005; 6:75.
Last reviewed January 2016 by Michael Woods, MD Last Updated: 2/6/2014