Teen Health: Are Schools Failing Black Students With Diabetes?

School is where children learn, build friendships, and develop independence. It is also where they rely on teachers and other school staff to recognize when something is wrong and respond appropriately. For a child with diabetes, that support can be critical. Blood sugar can change during a lesson, a sports activity, or an examination, and managing it cannot always wait until the school day allows a convenient break.

Research funded by the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health found that type 1 diabetes among young Americans increased between 2001 and 2017. During the same period, type 2 diabetes increased most rapidly among Black and Hispanic youth. A 2025 study published in JAMA Network Open, involving 26,853 young people with type 1 diabetes, also found that Black patients and those insured through Medicaid had lower rates of blood sugar control and diabetes technology use. These disparities persisted or widened over time.

The consequences are serious. In a study of 72,726 hospital stays involving diabetic ketoacidosis (a life-threatening complication in which a lack of insulin causes acids called ketones to build up in the blood), Black children had a higher rate of acute kidney injury than White children, 6.8% compared with 4.8%.

These findings expose inequalities in diabetes care, and they also raise an important question about children’s daily lives. Schools may not cause these disparities. However, inadequate staffing, limited training, and rigid policies can make managing diabetes more difficult. The elephant in the room is a question that deserves an honest answer. Are schools in our communities equipped to keep Black children with diabetes safe, respond to emergencies, and give them the same opportunities to participate in school life as their classmates?

When the school nurse is unavailable, who takes responsibility?

A child’s blood sugar can fluctuate during lessons, lunch, physical education, sports, and school trips. Physical activity, stress over exams, delayed meals, or not having enough food can all affect a student’s blood sugar levels. Low blood sugar, known as hypoglycemia, can cause sweating, shakiness, dizziness, confusion, and difficulty concentrating. Severe episodes can lead to seizures or unconsciousness and require immediate treatment.

A nurse is the natural person to respond, and the American Academy of Pediatrics recommends one in every school. The 2024 National School Nurse Workforce Study found that only 65.7 percent of schools have access to a full-time nurse. The CDC recommends that schools work with families and healthcare providers to develop a Diabetes Medical Management Plan (DMMP). This document outlines the student’s individual needs, including medication, glucose monitoring, meals, physical activity, and responses to high or low blood sugar.

Having a written plan is only the beginning. Staff must understand their responsibilities and know how to respond when the nurse is absent or the student is away from the usual classroom.

Teachers, coaches, and other school employees need appropriate training, with backup arrangements for emergencies.

Classroom rules should accommodate medical needs

During a typical school day, a student with diabetes may need to eat a snack during class, use the bathroom frequently, check their blood sugar, or pause an examination to address an unexpected glucose change. Rules that prevent these actions can interfere with both health management and learning.

In the United States, Section 504 of the Rehabilitation Act can require schools to provide appropriate accommodations to students whose diabetes qualifies as a disability under the law. Depending on individual needs, accommodations may include:

Food and medication: Access to snacks, glucose-monitoring equipment, and prescribed medication when needed
Examinations and assignments: Breaks or additional time when glucose fluctuations interfere with concentration, along with opportunities to complete missed work
Physical activity: Arrangements for physical education, sports, field trips, and other school activities
Bathroom and water breaks: Permission to use the bathroom and drink water as needed
Emergency care: Clear instructions identifying responsible staff, accessible supplies, and the steps to take during a medical emergency

These measures are not privileges. They help students manage a medical condition and be able to participate fully in school life.

Every Staff Member Must Know How to Respond

Even a well-written diabetes plan can fail if the adults supervising a student do not know how to use it. An emergency might occur during a substitute teacher’s lesson, on a sports field, or at an after-school activity.

Training should reflect each employee’s responsibilities and the student’s level of independence. Designated staff should learn to recognize signs of both low and high blood sugar, which can include dizziness, confusion, shakiness, and difficulty concentrating. They should know how to follow the student’s diabetes care plan, respond appropriately to blood sugar changes, and administer prescribed emergency medication, such as glucagon for severe hypoglycemia, when necessary.

Schools should also ensure that:

Emergency supplies are accessible and medications have not expired
Staff know where to find the student’s care plan and whom to contact
Backup personnel are available when the nurse is absent
Emergency procedures cover school transport, sports, field trips, and extracurricular activities where relevant
Families and healthcare providers can communicate changes in the student’s medical needs
Ensure predominantly Black schools have staff who understand the cultural experiences and healthcare challenges that may affect students’ diabetes management

Questions Black families can ask before the school year begins

Black families should not have to wait for a medical crisis to discover whether a school is prepared. Discussing diabetes management before the school year begins gives parents and caregivers an opportunity to clarify expectations and address weaknesses in the school’s arrangements.

Useful questions include:

Who is trained to help with diabetes care if the nurse is absent?
Which staff members will supervise the child during lunch, sports, trips, and after-school activities?
Where are the student’s medication and emergency supplies kept, and how quickly can staff access them?
Does the school have an up-to-date Diabetes Medical Management Plan and, where applicable, a Section 504 plan?
How will the school communicate with the family about health concerns, missed class time, or changes in the child’s needs?

Where the evidence points and what schools can fix first

Are schools failing Black children with diabetes? The evidence does not justify a verdict on every school, but it highlights gaps in staffing, training, and the consistent delivery of care. These shortcomings can add to the challenges faced by children who already experience inequalities in diabetes management.

Parents play a primary role in managing their child’s health by ensuring their child and school staff have accurate, up-to-date information about the child’s diabetes care needs, warning signs, medications, and emergency procedures. This shared understanding helps everyone respond appropriately during the school day. Every child deserves to attend school knowing that if their blood sugar drops or another medical problem arises, a trained adult will recognize the warning signs and know how to respond.

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