ALKHOBAR: For most parents, the first weeks of school mean resetting sleep schedules, packing lunches and getting children back into a routine. For Maha Al-Dossari, whose 9-year-old son has type 1 diabetes, the preparation also includes making sure the adults around her child know what to do when she is not there. Before the school year begins, Al-Dossari prepares her son’s diabetes supplies and speaks to his teachers about what to watch for if his glucose drops during class or physical activity. “The hardest part for me is that I’m not there to see what is happening,” Al-Dossari said. Returning to school can mean changes in meal times, physical activity, sleep and insulin timing, all of which can affect glucose levels. “For many parents, the biggest concern is simple: Will someone at school know what to do if my child’s glucose becomes too low or too high?” Dr. Yousef Al-Zahib, diabetes and family medicine consultant, told Arab News. Type 1 diabetes requires regular glucose monitoring and insulin treatment. In Saudi Arabia, an estimated 46,469 children and adolescents under the age of 20 were living with the condition in 2024, according to the International Diabetes Federation’s latest country data. For those children, managing diabetes does not stop at the school gate. “I recommend preparing a simple, written diabetes plan with the child’s healthcare team and sharing it with the school,” Al-Zahib said. “It should clearly explain insulin doses and timing, glucose monitoring, meals and snacks, when to check ketones, how to manage low or high glucose and who to contact in an emergency.” Children should also have easy access to their diabetes supplies, including insulin, glucose-monitoring equipment, fast-acting carbohydrates for hypoglycemia and glucagon for severe hypoglycemia, he added. Saudi Ministry of Health guidance similarly advises parents of children with chronic conditions to inform schools before the academic year begins and explain the condition, required medication, possible emergencies and warning signs. Specific guidance for diabetes says insulin should be available at school and teachers should know the symptoms of high and low blood glucose, and how to respond. Technology has made some of that management easier. Continuous glucose monitors can provide glucose readings and trends throughout the day, while some systems allow parents or caregivers to follow a child’s glucose remotely. Insulin pumps and automated insulin delivery systems can also reduce some of the daily burden. Al-Zahib said technology does not remove the need for people at school to understand the child’s individual plan. “They do not need to become diabetes experts, but they do need to know that every child has an individual management plan. “They should understand when the child needs insulin, food or a snack; when glucose should be checked; and how exercise can affect glucose levels. Physical activity is encouraged for children with type 1 diabetes, not something they should routinely be excluded from.” Saudi clinical guidelines say children with type 1 diabetes should receive enough support and supervision at school to take part in activities, including sports, alongside their peers. They should have access to glucose-monitoring devices, fast-acting sources of glucose, snacks, water and bathroom facilities, while school personnel should be able to recognize and manage hypoglycemia. “I don’t want him to feel that diabetes means he has to sit out while everyone else is playing,” Al-Dossari said. “I want the school to understand his condition, but I also want him to be treated like the other children.” One of the most immediate risks during the school day is hypoglycemia. Al-Zahib said low blood glucose may cause sweating, shaking, hunger, dizziness, irritability, confusion or unusual behavior. A glucose level below 70 mg/dL requires prompt treatment. “If the child is awake and able to swallow, fast-acting carbohydrate should be given and glucose rechecked after about 15 minutes. Severe hypoglycemia causing loss of consciousness, seizure or inability to swallow is an emergency: Glucagon should be given according to the child’s plan and emergency medical help obtained.” Ministry of Health guidance also defines hypoglycemia as generally occurring below 70 mg/dL and recommends rechecking glucose after 15 minutes following treatment. It advises glucagon and immediate medical care when hypoglycemia progresses to unconsciousness. High blood glucose brings different warning signs, including thirst, frequent urination, fatigue, headache or blurred vision. If glucose is significantly elevated, particularly when a child is unwell, vomiting or experiencing abdominal pain, Al-Zahib said ketones should be checked according to the individual diabetes plan. “Diabetic ketoacidosis, or DKA, is a serious complication caused by insufficient insulin. The body begins breaking down fat for energy, producing ketones that can accumulate and make the blood acidic,” Al-Zahib said. “Missed insulin doses, illness and problems with insulin delivery — such as a pump interruption — can increase the risk. “Changes in routine around school can also make diabetes management more difficult if meals, insulin or monitoring are disrupted.” Saudi health guidance lists nausea, vomiting, abdominal pain, rapid breathing, drowsiness and loss of consciousness among symptoms requiring immediate medical attention in children with undiagnosed or uncontrolled type 1 diabetes. While Saudi Arabia has school-health guidance covering diabetes, research has identified gaps in how care is delivered in practice. A nationwide study from 2019 involving 632 parents and 983 teachers from all 13 regions of Saudi Arabia found that 27.3 percent of students represented in the parent survey had no help available at school to measure their blood glucose, while 28.3 percent had no treatment for hypoglycemia available. The findings provide a snapshot rather than a measure of every Saudi school today, but they underline the importance of consistent preparation between families, healthcare teams and schools. “The next step should be consistency,” Al-Zahib said. “Every school caring for a child with type 1 diabetes should have a clear individual diabetes plan, trained staff, readily available emergency supplies including glucagon, and a defined pathway for dealing with hypoglycemia, hyperglycemia and ketones.” For families, however, school preparation is not only about preventing emergencies; it is also about allowing children to spend their day learning and playing, without diabetes unnecessarily setting them apart. For Al-Dossari, that is what she wants the conversations with teachers, the supplies and the planning to achieve. “I want him to know what he needs to do, and I want the school to know, too,” she said. “Then he can focus on what he is actually there for — learning, seeing his friends and being a child.”