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Managing Low Blood Sugar at School: A Guide for Teachers and Nurses

Are you a teacher or school nurse who has wondered how you can help your students with diabetes feel their best at school? Low blood sugar episodes at school can affect a student with diabetes’ ability to learn, concentrate, and participate in activities. 

School staff needs to recognize and respond to low blood sugar to ensure a safe learning environment for students with diabetes. By the end of this blog post, you’ll have the knowledge and tools needed to confidently support students with diabetes and their well-being at school. 

Causes of Low Blood Sugar

Teachers and nurses should understand why blood sugar levels can become too low, a condition called hypoglycemia, as it is the greatest immediate danger to students with diabetes. 

Here are some reasons why students might have a low blood sugar episode:

Administering Too Much Insulin

Insulin is a medication that helps people with diabetes manage their blood sugar levels. Students may take too much insulin by accident or even due to a slight miscalculation. This can make their blood sugar levels drop too low. 

Skipping or Delaying Meals and Snacks

Even though schools have set times for eating, sometimes students might not eat during their usual timeframe. If they skip meals or snacks or eat them later than they’re supposed to, their blood sugar levels can drop too low. 

Extra, Intense, or Unplanned Exercise

Students may participate in more exercise or activity than usual, like during gym class, recess or walking between classes. Extra or unplanned activities can use up a lot of extra energy or glucose in their bloodstream. If a student did not adjust their insulin or eat enough food, their blood sugar levels can drop too low. 

Not Eating Enough Food

If a student takes insulin but doesn’t eat enough carbohydrates to match their insulin dose, there won’t be enough glucose in the bloodstream to balance out the insulin. This can cause blood sugar levels to drop too low. 

What Symptoms Will Students Have During a Low Blood Sugar Episode at School?

During a low blood sugar episode at school, students may display various symptoms, which can vary depending on how severe the episode is. Teachers and nurses need to recognize these symptoms and take action to treat a low blood sugar episode promptly to keep students safe and healthy at school.

Mild-Moderate Low Blood Sugar Symptoms

When blood sugar levels are mildly or moderately low, typically falling between 70 mg/dL and 54 mg/dL, teachers may notice changes in the student’s behavior, such as acting irritable, confused, or having trouble concentrating. 

Students may also experience physical changes like sweating, looking pale, shakiness, or tiredness. Other symptoms might include complaints of headache, a fast heartbeat, weakness or feeling nauseous. 

Severe Low Blood Sugar Symptoms

When blood sugar levels drop below 54 mg/dL, indicating a severe low blood sugar episode, students may experience more serious and potentially dangerous symptoms. These can include a loss of coordination, difficulty staying conscious, being unable to swallow properly, having seizures, or being unresponsive to others. 

How Should Educators and Nurses Treat Low Blood Sugar Episodes at School?

Low blood sugar episodes can usually be treated easily and effectively by providing the student with fast-acting carbohydrates to bring glucose levels back into a safe range. 

It is best to try to stop low blood sugars before they happen, but it isn’t always possible. If a low blood sugar episode does happen, it should be fixed quickly because students can lose consciousness and they can become life-threatening when left untreated. 

Below are the generally accepted approaches for the treatment of low blood sugar, but each student’s specific treatment plan will be given to the school. 

Mild-Moderate Low Blood Sugar Treatment

If a student is experiencing mild to moderate low blood sugar, they might need 7-15 grams of fast-acting carbohydrates, such as glucose gel or glucose shots. The exact treatment will be outlined in the student’s emergency care plan. After 15 minutes, their blood sugar should be checked again to see if additional fast-acting carbohydrates are needed. 

Severe Low Blood Sugar Treatment

Severe low blood sugars are rare and generally can be prevented with prompt treatment of mild to moderate low blood sugars. When low blood sugars become severe, school nurses or trained diabetes personnel must be notified and respond immediately. 

Severe low blood sugar episodes can lead to unconsciousness and disrupt the student’s ability to swallow. School personnel should never attempt to give the student food or drink by mouth when unconscious because it can cause choking. 

Severe low blood sugar episodes should be treated by administering glucagon by injection or dry nasal spray. Glucagon is a life-saving hormonal treatment that raises glucose levels by causing the release of glycogen from the liver. 

The school nurse and/or trained diabetes personnel must know where the student’s glucagon emergency kit is stored, have access to it at all times, and be familiar with the glucagon administration instructions before an emergency arises.

What Are the Potential Risks if Low Blood Sugar Goes Untreated at School?

If a low blood sugar episode goes untreated at school, it can pose a significant risk to the health, safety and well-being of students with diabetes. The potential risks include:

  • Disruption in learning: Low blood sugar can interfere with how well students think and pay attention. This means they might have trouble learning and participating in classroom activities.
  • Emotional distress: Low blood sugars can be scary and distressing for the student, leading to feelings of anxiety, confusion, and vulnerability.
  • Loss of consciousness: If blood sugar levels continue to drop, the student may lose consciousness, which can become dangerous and life-threatening.
  • Seizures: Severe low blood sugar episodes can lead to seizures which can be frightening for the student and require medical intervention.
  • Brain damage: Severe low blood sugar episodes can deprive the brain of glucose and in some cases result in permanent brain damage.
  • Death: In the worst cases, low blood sugar that’s not treated can be deadly. 

How Can School Personnel and Nurses Help Prevent Low Blood Sugar at School

Preventing low blood sugar episodes in students with diabetes at school requires collaboration between school personnel, school nurses, parent/guardian, and the students themselves. Here are some ways to work together to prevent or reduce low blood sugar episodes:

    • Education and training: School personnel, including teachers, administrators, and staff, should be trained in recognizing the signs and symptoms of low blood sugar episodes and how to respond appropriately. This includes understanding the student’s individualized diabetes management plan for when and how to treat low blood sugar episodes.
    • Communication: Maintaining open communication between school personnel, nurses, parents/guardians and students is essential to address any concerns or changes in the student’s diabetes management plan or special considerations about parties or special events. 
  • Emergency preparedness: School personnel should be prepared to respond to low blood sugar emergencies. This may include having fast-acting sources of glucose readily available and knowing how to administer glucagon, if needed.
  • Provide information for substitute teachers: Information on the day-to-day needs of the student with diabetes and emergency information should be available for substitute teachers. 


About Amanda Ciprich, MS, RD

Amanda Ciprich, a registered dietitian with a specialization in type 1 diabetes, was diagnosed with T1D herself at the age of 18. With her expertise and personal experience, she has authored two books, including "The Caregiver's Guide to Diabetes: Practical Advice for Caring for Your Loved One." As the founder of T1D Nutritionist, a virtual insurance-based private practice, Amanda provides counseling and guidance to individuals with T1D and their families, supporting them in effectively managing diabetes.

*Disclaimer: All content and information in this blog is for informational and educational purposes only.

This article was medically reviewed by Amanda Ciprich, MS, RD. Last updated on X.

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