Health and Safety Notes
California Childcare Health Program
Diabetes in the
Child Care Setting
What is it?
reaction” or “insulin shock.” It occurs when the body
Diabetes is a serious illness in which the body is un-
gets too much insulin, too little food, a delayed meal
able to properly change sugar from food into energy.
or more than the usual amount of exercise. Symptoms
A simple sugar called glucose is the main source of
may include hunger, pale skin, weakness, dizziness,
energy for our body. Insulin, a hormone produced by
headache, shakiness, changes in mood or behavior (irri-
the pancreas—a large gland behind the stomach—
tability, crying, poor coordination), sweating, and rapid
helps the body to use the glucose for energy.
pulse. Treatment commonly involves quickly restoring
Diabetes happens when the body does not produce
glucose levels to normal with a sugary food or drink
enough insulin (Type 1 or insulin-dependent), or use it
such as cola, orange juice, candy, or glucose tablets. If
properly (Type 2 or non-insulin-dependent). As a result
not treated properly, hypoglycemia can result in loss
glucose begins to builds up in the blood, creating high
of consciousness and life-threatening coma. Glucagon
sugar levels in the body.
injections are used in these life-threatening situations
Very young children with diabetes usually have
to increase blood glucose.
Type 1 diabetes, in which the body does not make insu-
lin. They therefore need daily injections of insulin
What factors affect
blood glucose level?
Who gets it and how?
Exercise helps to lower blood sugar. Regular exercise is
As obesity rates in children have increased, type 2 dia-
important because of the need to balance the effect of
betes has become more common in children. Child care
exercise with food and insulin. A caregiver or teacher
providers are now much more likely to have a child with
may be asked to test blood sugars during the day to see if
diabetes in their care.
the child needs more insulin or a snack. Types, amount,
Diabetes is not contagious. People cannot catch
and frequency of meals and snacks have different effects
it from each other. At present, scientists do not know
on blood sugar. Children with diabetes need special
exactly what causes diabetes, but they believe that both
diets in reasonable amounts, and on regular schedules.
genetic factors and viruses are involved. Diabetes can
Working with the family to develop a special care plan
run in families.
will help caregivers plan for meals and snacks. A child
with diabetes may need to eat a snack before, during,
What are the symptoms?
or after energetic exercise..
Two kinds of problems occur when the body does not
The law, licensing and diabetes
The Americans with Disabilities Act, a federal law,
1. Hyperglycemia, or high blood sugar, occurs with
considers diabetes a disability, forbids discrimination
both types of diabetes. It occurs when the body gets too
against the disabled, and puts legal responsibility on
little insulin, too much food, too little exercise or with ill-
child care providers to care for the special needs of
ness. Stress from a cold, sore throat, or other illness may
children with diabetes.
increase the level of blood glucose. Symptoms include
Effective January 1, 1998, child care providers in
frequent urination, excessive thirst, extreme hunger,
California are allowed to perform a blood-glucose
unusual weight loss, irritability and poor sleep, nausea
test (using a finger-stick test) on a child in their care.
and vomiting, and weakness and blurred vision.
However, they may not give an insulin injection to any
2. Hypoglycemia, or low blood sugar, is more common
child in a child care facility. California Community Care
in people with Type 1 diabetes. It is the most common
Licensing (CCL) requires certain conditions be met to
immediate health problem and is also called “insulin
care for a child with diabetes. To include a child with
California Childcare Health Program
diabetes the local licensing evaluator must be notified
meet the special needs of children with diabetes, and
to determine what legally needs to be in place before a
help them lead healthy, active, and fulfilled lives with-
child enters care. Licensing form 92222 Blood Testing
out having to change their regular program. A written,
Consent/Verification is used to show compliance and
special care plan should include:
is completed by the parents.
• When to test blood glucose and take insulin
In 2005 Community Care Licensing allowed the
administration of glucagon as a life-saving measure
• Regular meal and snack times
for children with diabetes. A child care program must
• Preferred snacks and party foods
request and receive an exception from licensing and fol-
• Usual symptoms of hypoglycemia and preferred
low the department conditions for the administration of
glucagons which includes but is not limited to parental
consent, staff training and responsibility, written instruc-
• When and how to notify the child’s parents
tion from the health care provider, etc
Blood glucose testing
• When and how to contact the child’s health care
Regular testing of blood glucose levels is a very impor-
tant part of diabetes care. Testing is done by taking a
• Who will give insulin injections when nedded
drop of blood, usually from a fin-
Infant, toddlers and pre-school-
ger, and placing it on a special test
age children with diabetes often
Summary of key points
strip in a glucose meter. Caregivers
need frequent blood glucose tests
Good diabetes care practices include
must practice universal precautions
because they have not yet learned
when handling and disposing of
• eating reasonably, consistently,
to recognize the symptoms of low
testing equipment. Glucose meters
and on schedule
blood sugar, can’t tell what they
are easy to use, and most children
• testing blood glucose levels
feel, or may try to avoid or delay
over 4 years old quickly learn how
finger-prick and insulin injections.
to do their own blood glucose tests.
• adjusting insulin as glucose levels
They may also drink and urinate a
Keeping blood glucose levels within
and activities warrant
lot, so make sure they can go to the
a normal range is rarely possible in
• recognizing and responding to
bathroom as often as they need
children with diabetes. A health care
signs of hypoglycemia
For more information on diabetes,
provider will often identify a target
• following an up-to-date
please call our toll-free Healthline at
range for blood glucose levels for
diabetes health care plan for
1-800-333-3212 or American Diabe-
each young child — for example,
tes Association 1-800-DIABETES.
80 to 180 mg/dl.
How is it managed?
Care for diabetes is more flexible than it used to be. It
American Diabetes Association, www.diabetes.org (check out
requires self care or assistance with care if the child is
Wizdom Pod for ideas on working with infants and toddlers
very young. Children with diabetes can participate in
who have diabetes)
all child care activities. Except for paying attention to
Assembly Bill (AB) 221 Chapter 550, Statutes of 1997, Section 1596.797
of the Health and Safety Code.
their special care plan, you do not need to treat them
Care of Children With Diabetes In the School and Day Care Set-
differently just because they have diabetes.
ting, by the American Diabetes Association. 2003 Diabetes
The goals for treatment of diabetes in children are to:
Cares 26: S131-S135 accessed June 11, 2008, http://care.
(a) Maintain normal growth and development
(This very good article includes links to a “Diabetes Health Care
Plan for School and Day Care,” training resources for school and
(b) Keep blood glucose levels within a target range (not
day care, and outlines responsibilities for parents and schools or
too high, not too low)
child care personnel).
National Institutes of Health (NIH) http://www.ndep.nih.gov/
(c) Promote healthy emotional well being.
Community Care Licensing regulations, www.ccld.ca.gov
Child care providers in coordination with parents and
health care providers can prepare a special care plan to
By A. Rahman Zamani, MD, MPH (updated 09/09)
California Childcare Health Program • 1950 Addison St., Suite 107 • Berkeley, CA 94704-1182
Telephone 510–204-0930 • Fax 510–204-0931 • Healthline 1-800-333-3212 • www.ucsfchildcarehealth.org
California Childcare Health Program