← All practice cases
Challenging · Advice / information · Nursing
Back to school with new type 1 diabetes
This case practises: Plain words for a non-clinical reader · Leaving out what the reader doesn't need · Keeping the meaning of the notes exact · A specific request
Writing task
Today's date: 7 December 2026. You are the children's diabetes nurse on the Children's Ward, Oakfield Hospital. Write a letter to Ms Fiona Reid, School Nurse, Oakfield Primary School, Church Road, Oakfield, who will share the information with Noah's teachers, to prepare for his return to school and request a care plan meeting. Write in full sentences, not note form, using letter format. Aim for a body of about 180–200 words.
Case notes
In the test you get 5 minutes to read, then 40 minutes to write.
Patient details - Noah Ibrahim, DOB 02/03/2017 (9 y.o.), Year 5, Oakfield Primary School - Parents: Mr Yusuf and Mrs Leila Ibrahim - Admitted 28/11/2026; discharged home 05/12/2026; returns to school 14/12/2026 Social background - Father works as a bus driver (shifts); mother part-time at a bakery - Older brother (13) at secondary school - Plays for under-10 football team on Saturdays - Family attends mosque on Fridays - Loves dinosaurs and drawing - Grandmother lives with family, speaks little English Medical history - Asthma, mild - salbutamol inhaler PRN (rarely used) - Allergy: penicillin (rash) - Tonsillectomy 2022 - Born at term, 3.4 kg; immunisations up to date - Dental check 09/2026 normal Admission - 2 weeks thirst, passing urine often, weight loss 3 kg, tired - 28/11: drowsy, vomiting - diabetic ketoacidosis (pH 7.12) - PICU 1 night; IV insulin and fluids - 29/11: ketones cleared; moved to Children's Ward - HbA1c at diagnosis 108 mmol/mol - Weight 27.0 kg on admission, 28.5 kg on 05/12 - Dx: type 1 diabetes Diabetes treatment - Glucose sensor on upper arm (reads to parent's phone + school phone app) - Long-acting insulin (glargine) 8 units at 20:00 - at home - Rapid-acting insulin (aspart) with meals - pen; dose from carbohydrate - 30/11: ratio 1 unit : 20 g carbohydrate - 03/12: ratio changed to 1 unit : 15 g (glucose high after lunch) - Lunchtime: Noah counts carbs with an adult; adult checks dose and supervises injection Hypoglycaemia (glucose below 4 mmol/L) - Signs: shaky, sweaty, pale, irritable, confused - Give 15 g fast sugar (e.g. 150 mL fruit juice or 4 glucose tablets); recheck in 15 min; repeat if still below 4 - Then snack (e.g. 2 biscuits) if next meal more than 1 h away - Never send him anywhere alone when low - If unconscious: recovery position, nothing by mouth, call 999, then parents High glucose (above 14 mmol/L) - Water, allow toilet; check ketones if unwell; call parents PE and activity - Check glucose before PE; extra 15 g carbohydrate if below 7 Plan - School nurse: individual healthcare plan meeting with parents and diabetes nurse before 14/12 - Train class teacher, PE teacher and lunchtime staff - Hypo kit kept in classroom and taken on trips - Diabetes clinic 21/12/2026; diabetes nurse phone contact available on school days
Write your letter
Paste your full letter to continue (0/300 characters).
By grading you agree to our Terms and Privacy Notice. Use practice case notes only, never real patient details.
Model answer Try writing your own letter first
Ms Fiona Reid School Nurse Oakfield Primary School Church Road Oakfield 7 December 2026 Dear Ms Reid, Re: Noah Ibrahim, DOB 02/03/2017 I am writing to let you know that Noah, a Year 5 pupil, has been diagnosed with type 1 diabetes and returns to school on 14 December, and to request a healthcare plan meeting with his parents and me, and staff training, before then. Noah wears a sensor on his arm that shows his blood sugar on a phone. At lunchtime, an adult should help him count the carbohydrate in his meal, check his dose (one unit of insulin for every 15 g) and supervise his injection. Before PE, his sugar should be checked, and he needs an extra 15 g snack if it is below 7. If his sugar falls below 4, he may become shaky, sweaty, pale or confused. Please give him 15 g of fast sugar, such as 150 mL of fruit juice, recheck after 15 minutes and never send him anywhere alone. If he becomes unconscious, place him in the recovery position, give nothing by mouth and call 999. If it is above 14, give water and contact his parents. His hypo kit should stay in the classroom and go on trips. I am available by phone on school days. Yours sincerely, Children's Diabetes Nurse Children's Ward Oakfield Hospital
What the reader needs
- New type 1 diabetes; returns to school on 14 December
- Lunchtime insulin by pen, dose worked out from carbohydrate (1 unit per 15 g), with adult supervision
- Glucose sensor that can be read on a phone
- Low glucose (below 4): signs, give 15 g fast sugar, recheck after 15 minutes, never leave alone
- If unconscious: recovery position, nothing by mouth, call 999
- Check glucose before PE; extra snack if below 7
- Request: healthcare plan meeting with parents and diabetes nurse before 14 December; train class, PE and lunchtime staff
Details to leave out
- Parents' jobs
- Brother, football and mosque
- Tonsillectomy
- Intensive care stay and blood pH
- Evening long-acting insulin given at home
- The earlier carbohydrate ratio (1:20)
- Symptoms before diagnosis
- Hobbies and grandmother
- Birth, immunisation and dental history
- Ward details, HbA1c and weights
One good way to write this letter, not the only one. Written by Kurippu; awaiting nurse review.