The child with type 1 diabetes: glucose checks, insulin teaching, hypoglycaemia, sick days and school

What it is

A child with type 1 diabetes needs insulin every day for life. The family, and later the child, does most of the care, so nursing work is mostly teaching and checking skills: glucose and ketone checks, insulin technique, recognising and treating hypoglycaemia, sick-day rules, and a written plan for school. Doses are set by the diabetes team; the nurse checks, administers and teaches according to the prescription and the protocol.

What it requires

• Capillary glucose and ketone checks at the times and targets the diabetes team sets.
• Insulin given exactly as prescribed, by pen, syringe or pump, per protocol.
• Sick-day plan taught at diagnosis and reviewed at least once a year.
• Emotional support: watch for diabetes distress, especially in adolescence.

How it is applied (and why)

1. Check glucose (and ketones when indicated) before giving insulin and record it — the dose follows the reading and the plan.
2. Check the insulin type, the label and the expiry date; roll cloudy insulin gently, do not shake — the check prevents giving the wrong insulin.
3. Rotate injection sites and keep a log; avoid bruised, lumpy or scarred skin — rotation prevents lumps that slow absorption.
4. Teach the signs of a low and how to treat it with fast sugar, then a snack — families must act before the child is confused.
5. For a severe low or unconsciousness: nothing by mouth, emergency medicine as prescribed, call for help — swallowing is not safe.
6. Teach sick-day rules: keep insulin, check glucose and ketones often, keep fluids going — illness raises the risk of ketoacidosis.
7. Teach when to seek urgent care: vomiting, rising ketones, deep fast breathing, abdominal pain, drowsiness — DKA can develop fast.
8. Help prepare the written school plan and check who is trained there — staff need it to recognise and treat lows.
9. Teach safe sharps disposal and insulin storage (never frozen, not left in a hot car) — this protects others and the insulin.

In nursing practice

• Gastroenteritis is the most common cause of low glucose during sick days.
• Seek urgent review if vomiting persists beyond 2 hours (especially in young children) or glucose cannot be kept up.
• Insulin needs often rise in puberty, and low glucose can happen at night or after an active day.
• Children want to manage more of their own care as they grow; hand over gradually, with supervision.

Common mistakes

• Telling the family to skip insulin because the child is not eating.
• Giving food or drink by mouth to a child who is drowsy or unconscious from a low.
• Using only urine ketones when blood ketone testing is available.
• Leaving the school without a plan, trained staff or supplies.

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Guías de Práctica Clínica de la ISPAD 2022: Manejo de días de enfermedad en niños y adolescentes con diabetes (International Society for Pediatric and Adolescent Diabetes (ISPAD), 2022); Treatment of Low Blood Sugar (Hypoglycemia) (Centers for Disease Control and Prevention, 2024); Managing Diabetes at School (Centers for Disease Control and Prevention, 2024); Giving an insulin injection (MedlinePlus, U.S. National Library of Medicine, 2024).

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Representative model, for educational purposes only.