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Our Health Library information does not replace the advice of a doctor. Please be advised that this information is made available to assist our patients to learn more about their health. Our providers may not see and/or treat all topics found herein.

Topic Contents

Topic Overview

Federal laws protect children with diabetes from discrimination in schools and child care settings. Schools and child care centers must provide reasonable help for the special needs of children with diabetes while disrupting the usual routine as little as possible. Also, children should be allowed to take part in all school activities.

If your child has diabetes, work with your child care center or school to build a care plan that meets your child's needs and gives specific instructions for how to handle the following:

You may hear a care plan called a "504" plan. 504 refers to Section 504 of the Rehabilitation Act of 1973, the Individuals with Disabilities Education Act of 1991, and the Americans with Disabilities Act. These are laws that protect people who have disabilities. It means that schools that have federal funding cannot discriminate against children who have disabilities, and that includes children who have diabetes. You can find a Diabetes Medical Management Plan on the American Diabetes Association's website.

You will need to give the staff all of the materials and equipment they need to care for your child, including supplies to do a home blood sugar test , insulin, syringes, adidas Seeley Mens Trainers Green Eqt Green S16/Core Black/Ftwr White clearance online under sale online rrtMB2PoG
(if it's in the care plan), and materials for testing ketones. And you need to teach the staff how to use these materials. Remind the staff that your child needs access to the materials and equipment at all times, even on a field trip. Now and then, check the expiration dates of supplies your child has at school.

The child care center or school should provide safe storage for your child's medicines. Also, they should provide a private place for your child to receive care, if desired.

The child care center or school should provide an adult staff member and a backup person who are:

Also, your child should have permission to:

If your child can do a blood sugar test, let the staff know that your child may need help when his or her blood sugar level is low and may need to be reminded to eat or drink something during these times.

A child should never be left alone when his or her blood sugar level is low.

Contact the American Diabetes Association for a sample diabetes care plan and other information for teachers and child care providers.

For older children who take their own insulin to school, check the school rules for kids carrying their own medicine, needles, and blood sugar meters. Many schools do not allow kids to carry any kind of medicine without special permission.

Related Information

References

By Healthwise Staff Primary Medical Reviewer John Pope, MD, MPH - Pediatrics Kathleen Romito, MD - Family Medicine Adam Husney, MD - Family Medicine Specialist Medical Reviewer Stephen H. LaFranchi, MD - Pediatric Endocrinology

Current as of December 7, 2017

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The effect of the fluoroquinolones on insulin secretion has been studied, and the results suggest that these antibiotics cause hypoglycemia by increasing insulin release via blockade of adenosine triphosphate-sensitive K + channels in the β cells of the pancreas [ 30 , 31 ]. This effect may not be clinically significant in all patients because of physiologic mechanisms that regulate blood glucose levels. In contrast, the mechanism of hyperglycemia is not clear. One contributing factor may be overexposure (eg, failure to adjust the dose in patients with renal insufficiency) [ 32 ]. The results of our study and of others [ 12 , 15 , 16 , 20 , 21 ], as well as this potentially common mechanism for hypoglycemia, suggest the need for caution when using certain fluoroquinolones, because the odds of hypo- and hyperglycemia appear to vary among the agents [ 33 ]. This is not unusual; differences in risk have been reported for other adverse effects with this class of antibiotics [ 34 ].

Our results are generally consistent with those presented in the literature. In a retrospective medical-record review of dysglycemia in hospitalized patients receiving gatifloxacin, levofloxacin, ciprofloxacin, or ceftriaxone, dysglycemic events were more likely to occur in patients receiving gatifloxacin (relative risk, 3.29; 95% CI, 2.33–4.65) or levofloxacin (relative risk, 1.55; 95% CI, 1.29–1.88) versus ceftriaxone [ 20 ]. There was no difference in the risk of dysglycemia between gatifloxacin and levofloxacin (P=.8). However, hypo- and hyperglycemic events were combined in this study. None of the patients who received ciprofloxacin experienced a dysglycemic event. In a nested case-control study of hospitalized patients who received gatifloxacin or levofloxacin, the odds of hypoglycemia were greater with gatifloxacin versus levofloxacin (OR, 2.81; 95% CI, 1.02–7.70) [ 12 ]. No comparator antibiotic was included in the study, so the possibility of a fluoroquinolone class effect could not be assessed. In another study of elderly inpatients who received gatifloxacin or levofloxacin, gatifloxacin was independently associated with hypoglycemia (OR, 2.4; 95% CI, 1.1–5.6) and hyperglycemia (OR, 2.5; 95% CI, 1.6–3.9) versus levofloxacin [ 21 ]. Again, a nonfluoroquinolone antibiotic was not included in the study.

Dysglycemic events have also been evaluated among outpatients receiving fluoroquinolones. In a smaller, regional database review of the effect of fluoroquinolones on glucose metabolism among veterans with an outpatient or discharge prescription for any of these antibiotics, Coblio et al [ 15 ] state that gatifloxacin was no more likely to cause hypo- or hyperglycemia than levofloxacin or ciprofloxacin among patients with or without diabetes, but they did not report statistical significance. In addition, no comparator was included, so the possibility of a class effect could not be assessed. In a nested case-control study of outpatient fluoroquinolone therapy and dysglycemia requiring hospitalization, gatifloxacin (OR, 4.3; 95% CI, 2.9–6.3) and levofloxacin (OR, 1.5; 95% CI, 1.2–2.0) were associated with an increased risk of hypoglycemia versus macrolides, but ciprofloxacin and moxifloxacin were not [ 16 ]. Compared with macrolide antibiotics, only gatifloxacin was associated with an increased risk of hyperglycemia (OR, 16.7; 95% CI, 10.4–26.8). The authors' findings were similar when their results were stratified by the presence or absence of diabetes. In our study, the small number of events in patients without diabetes (despite our large sample) combined with low ORs and lack of statistical significance suggest that clinical focus regarding risk with the remaining fluoroquinolones should be on those with diabetes.

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