Diabetes at School: Making School Lunch Run More Smoothly

by Leighann on September 8, 2014

Summary: School lunch with type 1 diabetes can run more smoothly if plans are in place for getting medical care (BG check and insulin), having enough time to eat, and getting recess like everyone else.

Lunch Strategies

A recent news story (which I won’t link to because I feel this child needs her privacy) got me thinking about ways to make lunch at school run a bit more smoothly for our kids with diabetes. I think what’s important is making sure all staff are on the same page from the classroom teacher to the school nurse (or whoever does the lunchtime BG check and insulin) to the cafeteria workers.

The reality is that at some schools the nurse may have to attend to several children with diabetes as well as dispersing medication to many kids. Implementing every single of one my suggestions may not be possible at every single school for each child. But perhaps one or two of these suggestions could help lunchtime run a little more smoothly for your child.

I think there are three key issues that need addressing regarding lunch at school with diabetes:

1. Getting proper medical care (BG check and insulin),
2. Having sufficient time to eat since insulin is based on the number of carbs consumed (particularly important if a child gets her insulin before eating), and
3. Heading to recess with the other children on time because lunch is also about socialization and getting energy out as much as it is about the actual eating (and we don’t want our kids missing out on recess because of diabetes).

In my opinion, it’s good to add some of these accommodations to the 504 plan, while others can be a verbal understanding between you and the school nurse and/or lunch staff and school administration.

(Read: Diabetes at School: 504 Plan)

Location and Timing of Pre-Lunch Blood Sugar Check

I hear a lot of parents say that their child must make a long trek to the office or nurse’s office for the pre-lunch blood sugar check. It’s my philosophy for all aspect of diabetes management in the school that the care come to my daughter as much as possible because it reduces the amount of time spent away from classroom instruction.

Our school nurse comes to my daughter’s classroom a few minutes before lunch begins to check her blood sugar and pre-bolus. My daughter will either walk with the class to the lunchroom or she and the nurse will go ahead and start walking down.

I personally do not feel that a younger child should be missing any part of the lunch period for blood sugar monitoring, especially if it requires them going to the office.

Lunch Line

I noticed when my daughter was in kindergarten that often the lunch line was very long. Whether she just needed to grab a carton of milk or if she was purchasing hot lunch, she just wouldn’t have much time to sit down and eat if she spent a chunk of time in line. Because her insulin was based on the amount of food she ate, I wanted to make sure that she had the most amount of time possible.

We had an accommodation added to her 504 plan that she is allowed to go to the front of the lunch line for either milk or hot lunch. The lunchroom staff were all informed. In the beginning there were a few kids (particularly older kids who didn’t know my daughter) who chided “Hey, you cut in line!” But the assistant principal, nurse, or cashier would matter-of-factly inform them that she was allowed to go to the front. (No medical explanation is needed.)

On days that the line is short, she’ll just wait in line. But if it stretches to the back, then she goes toward the front of the line.

If she is just having milk, often the nurse grabs it for her.

Counting Carbs and Bolus

Because we never know how much my daughter will eat, we give a blood sugar correction and partial pre-bolus before lunch. We have a lunch slip that we tuck into her meter pouch each morning as we make lunch. It includes a spot for her blood sugar, a list of the foods and their carb counts, and a spot for the amount of insulin given.

While my daughter is eating, the nurse tallies up the number of carbs. When she is almost done, the nurse double checks to see if she ate everything and adjusts the carb count if necessary. She then gives the remaining bolus. Early on I made it clear that I wanted this happening before the kids were dismissed for recess as much as possible. (That’s one thing about the PDM being remote. As soon as it beeps that the insulin is being delivered, my daughter can take off.)


I don’t know about your school, but at ours there is no morning recess and the kids have little unstructured time. It’s so important for ALL kids to get recess each day. Recess is important not only for the physical activity, but also because it is a time of social interaction with peers. I do not want diabetes management taking any time away from recess.

Who is Left Holding the Bag

Because I want my daughter to have freedom to hang from monkey bars and run around, she does not carry her diabetes supply bag to lunch. Rather the nurse carries it to lunch, holds it during recess, and returns it to the designated spot in the classroom after lunch. Sure my daughter could carry it, but why make her if she doesn’t have to?

These are just a few strategies we use to make sure that lunchtime at the elementary school level runs more smoothly, that my daughter has enough time to eat, and that she doesn’t miss recess because of diabetes care.

Diabetes At SchoolFurther Reading…

Back to School with Diabetes: Lots of information and links!

I have an entire chapter about school in my book Kids First, Diabetes Second.

Read more posts about Diabetes at School.

Please remember that I never give medical advice. Ask your endocrinologist or pediatrician for advice about your own child. Make your own informed decisions for your own child.


{ 3 comments… read them below or add one }

1 Amy September 8, 2014 at 2:33 pm

My son, in kindergarten, is having such a wonderful experience at school. He has developed a great relationship with his nurse. He and a friend go to her office and he takes his tray and shows her his lunch and goes back into the lunchroom (which is a very short walk). He gets his bolus after she sees what he ate and then goes back to the classroom or to recess. You bring up a good point about the instruction time! He does lose more instruction time than the other students by walking to and from the school nurse, but if he doesn’t fall behind we are going to keep it like this (and he gets more exercise too). I just wanted to share a good story about kids w. diabetes at school, because we hear so many horror stories!


2 Jessica September 11, 2014 at 12:08 pm

Question for you – does the nurse actually stay in the cafeteria with your daughter during lunch every day? I like the idea of the correction and partial pre-bolus, but the nurse has other things to do besides sit in the cafeteria during my daughter’s lunch period. And now that she’s in middle school she wouldn’t want the nurse there anyway. We have been having issues with afternoon lows due to over bolusing at lunch because what the menu says is different from what ends up on her plate and because she’s in middle school and doesn’t want to be “different” she doesn’t go back to the nurse’s office to make changes.


3 Leighann September 13, 2014 at 9:01 am

The nurse is in the cafeteria, but she’s also there giving meds to other kids. She’s not there just for my daughter. Not sure what will happen in middle school.


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