Taking responsibility for newly diagnosed T1 diabetic

[1SillySossij]

One of my class has been diagnosed with T1 diabetes and I have been told I have to check her bloods before and after every time she eats, before and after physical activity including breaks. I need to count the carbs in her meal and calculate her insulin and if she doesn't eat it all, recalculate it and find something else for to eat. The child is needle phobic and is not what you would call a compliant child at the best of times. I have no TA and don't even have time for the loo. I have no lunchtimes free due to staff shortages Apparently no funding comes with the condition. I am really not happy about taking on the responsibility for this life threatening condition on top of all the other kids over half of whom have their own special needs.

Speak to your union

We have a pupil with T1 diabetes who has an EHCP and a 1-1 TA who deals with all of this. Is your SENDCo sure they won’t qualify for one? That’s a lot to ask of one teacher who is also dealing with 29 other children (many of whom likely also have needs of their own!)

Have you had any diabetes training?

Ideally there should be at least 2 of you with the appropriate training with the diabetes team. And for safeguarding purposes there should be at least 2 trained staff members present whenever insulin is being administered. The school's First Aid Lead should also be involved.

We've had a few children at our school with T1. So far they have all had devices that measure their levels without the need for having blood tested.

I've had diabetic children in my class before. I've done injections for one, and programmed an insulin pump for another. Could this child be offered a pump if they are needle phobic? Not your decision I know, but something to query. Treatment has moved on so much now. I'm surprised a needle phobic child isn't being offered a pump.

It is a huge responsibility, but a necessary one to take on as a duty of care for a child in your care. You will be given full training before you are signed off to administer independently. Training will include how to test blood, how to inject insulin (plus how to operate a pump, should this information be needed instead), how to manage hypos and hypers etc. At least 2 members of staff should be trained up, in case of staff absence or unavailability (best practice would be 3+). You will also need to be witnessed by another trained member whenever you administer a dose, to cover you and sign that they've witnessed. Again, best practice is to alternate who administers and who witnesses, so everyone can keep the skill up. Nobody wants to be in the position of having to administer one day, having not done it since the training months ago.

The part I would query is that you need to carb count. It is the parent's responsibility to provide this information if they have a packed lunch, or should be provided by the catering company if it's a school dinner (this information should be readily available from them). The child should then have a book which will tell you the dosage of insulin required, based on their carb intake and blood readings.

At the end of the day, if it's something you're truly not comfortable with you need to address it with your SLT, but I don't think it's an unreasonable ask that the class teacher is involved (if they are comfortable with it). What would be unreasonable (and unlawful) would be expecting you to take his on solo. Personally I would advise at least attending the training before reassessing how you feel. It may put your mind at ease. You definitely shouldn't be the only one trained though, not do I believe you should be carb counting.

The council pay the school for every term with a child with special needs. My son is type 1 diabetic and I understand the worry it causes. All children are now eligible for constant glucose monitoring like dexcom or libre. The only need for a blood test is if they feel hypo or go high and need a ketones test. Depending on the area children can have pods which
avoids having to give injections as this is done through there handset and works out the carb ratio. This would help some. In my son's school it's the lunchtime staff who have been trained that count his carbs or the dinner ladies.

I would say that it is absolutely not the sole responsibility of a class teacher to manage this. Not by themselves, while at the same time being in charge of teaching and organising the rest of the class. Of course it should be managed, safely and carefully, by trained people who can focus solely on the child while administering. Our First Aid Lead, who is a TA, and a member of the admin staff are trained and carry out all the checks on the two children we have with the condition. Speak to SLT and then, if no joy, your Union.

As a teacher and the parent of a type 1 diabetic, you really, really need training. It is a serious condition which, if handled badly, can quickly (and I mean quickly) end up with hospitalisation or worse. It is covered by equality legislation which essentially means there is no choice but to have to manage things.

Firstly, do not have the child in your class until you have received training. That is a minefield that if it goes wrong, you won't have a leg to stand on. Have a home/school book so you can note down levels, your carb counts and any insulin you give. If unsure, phone the parent. If newly diagnosed, the parent will likely struggle to be secure in their answers but they will be learning fast. Make sure you have plenty of hypo treatments (pack of haribo, apple juice, small cans of coke). Remember '4 is the floor' so you will need to treat the hypo - it is an emergency and cannot wait. Ever. Never send a hypo child to seek another adult for support - treat in situ (even if that means dropping to the floor where they are), send other children.

It's a shit condition - some days you literally cheat death on multiple occasions. It has a massive impact on mental health. It is not helpful to be told you need to manage it better. It is unpredictable and what worked yesterday is way off today. Most children are quick to a closed loop these days, usually dexcom 6 with omnipod 5. That will massively help manage needle phobia. You will nees pump and cgm training when she switches to them.

Happy for you to ask questions here - but be warned there will be as many opinions as there are people who post.

No, the council do not pay the school for every term with a child with special needs.

They have done for my son with the two counties we have lived in. His school have employed a teaching assistant to help with the 2 diabetics in the class.

Schools do not get funding for children with additional needs unless they have an EHCP or other specific funding stream.

I have never known a T1D get additional funding and I have worked with >12 in >5 schools in 5 local authorities.

Everyone has had the training which was about an hour, but the nurse spoke so quickly noone had time to take it in properly or make decent notes. Hopefully she will be set up with an insulin pump eventually, but certainly that isn't the case to begin with.
For those with experience of managing T1, what happens about exercise at break times and PE?

When my son was on injections, he would have a snack before pe if he was not high. When he went onto the pump he would be put on activity mode on the pump. This would mean the pump would reduce putting insulin in to avoid a hypo. If if his blood sugar was on the lower side at break time and he was on injections, he would have a small snack. As a parent of a diabetic child, I let the school know they could call me anytime, if I could help in anyway. The diabetic nurses will also help with any questions or training. I made sure the school had plenty of snacks to manage his blood sugars and to treat hypos. I understand there is a lot to learn. I would ask the diabetic nurses for more training. They are aware how complex diabetes and will help. I think you will be fine, your caring.

Ask your SLT what they plan on telling you to give up or stop doing to allow you to have time for this to happen.

Don't be fobbed off with them telling you it's just something you have to do. It's their job to ensure that you are given the time to ensure to do it properly.

Absolutely this.

You are able to do this. But you aren't able to do this and teach at your current capacity.

You definitely also need at least one additional adult trained. The child cannot come in to school if there are no trained adults in. It would open the school up to disability discrimination if they did not make arrangements for the possibility of you having a day off sick.

Assuming you are in England, the DfE has guidelines on managing medical conditions in school. This lays out exactly what should be done and by whom. The school has to manage the child’s medical needs so they can attend school safely. This does not mean that the responsibility should be solely delegated to you as class teacher in the way you describe. There is also good advice on the Diabetes UK website.

Someone in school will have responsibility for managing medical needs and if you don’t know who it is, you'll need to find out - most likely it is the Senco or headteacher but it may not be. The child should have an Individual Health Care Plan (this is not the same as an EHCP) written by this person in conjunction with the child's parents and the advice from Health professionals.

This should also say who is responsible for carrying out and witnessing the tasks you have described, and information on managing the situations that you have raised such as PE and what to do if the child does not comply with the tasks required.

Staff can volunteer to undertake the tasks required for managing medical needs but can only be directed to do so if it is in their job description. As a teacher, it is highly unlikely that this is the case. You will need your union's support if your headteacher tries to insist. If the training received has not been sufficient, then it needs to be repeated. Again, you may need union backing to make this point.

I also wanted to pick up on "I have no lunchtimes free due to staff shortages" - this is not OK.

Teachers pay and conditions says: "Lunch time is not part of your Directed Time and you should therefore not be directed to undertake any supervision or other lunchtime duties, including management-convened meetings in this time. Any teacher who works for more than one school session on any school day must be given a break of ‘reasonable length’ between sessions or between the hours of 12 noon and 2pm."

You are almost certainly being directed to work beyond your 1265 hours already, even without this new issue.

This needs to be done by another member of staff. As the class teacher you are responsible for 29 children. You cannot do this role and take on the medical support of a child with diabetes. I would speak to the union. They either need to cover you to do this role or get someone else. In all the places I have worked either the office staff, TAs or pastoral support deal with this.

You really need union support. As others have said it's a minefield. Are you a union member?

As a teacher, my concern wouldn't be training as keeps being repeated (because I know it would be provided, and the OP has now confirmed it has) but simply time to do the job properly, which is obviously critical. I would not have time unless I stopped doing something else. It's very different administering insulin in the quiet of your own home to in a busy classroom with 29 other children unsupervised - the OP surely needs to be in a different room where they can concentrate on what they are doing and the child can have privacy. I would not be agreeing to do any carb counting over lunchtime; a paid member of staff needs to be doing it during the teacher's unpaid time.

I'd be pushing back on whether I am to finish teaching 5 minutes earlier and if so who is supervising the rest of the class. It is completely unrealistic given the needs of classes nowadays to imagine it can just be absorbed into the teacher's day. That is not providing the child with the care they deserve.

How old is the child?
I'd say there is no way you should be doing this. Absolutely not. We have two.pupils at our school with T1 and both have full time 1-1 support assistants to manage their care.

I am a primary school leader and I used to organise provision for type 1 children at my school (we have had up to 5 children at one time). We would no way expect that level of care from just the class teacher. You definitely need to be trained but you can’t be expected to carb count and manage hypos etc whilst also having responsibility for your class. You should not be doing any support over lunch. Even with a pump there would be lots to do. We tend to put children in classes where there are LSAs to help. We have several staff who are trained and an allocated LSA who would I be with the children over lunch. If your child has been diagnosed recently, the school will just have to bite the bullet and find more support. There is no funding in our LA.

Do SLT really understand what is involved? Arrange a meeting with them and if they don’t change things, get your union involved. What would they do if you were ill?