Back to School With Diabetes

Dr. Fran Cogen Health Pro
  • It is back to school time, and my diabetes team is hard at work completing a vast number of school forms for our patients. In addition, it is also “back to worry time” as most families experience significant anxiety as their child with diabetes goes back to school. That anxiety is usually heightened if their child is changing schools or moving up to middle or high school.  The biggest concerns are regarding blood glucose monitoring and the administration of insulin in schools for children that are unable to perform self-care skills. As we are well aware, in many schools there are not enough nurses physically present to administer insulin. Thus, it is incumbent to rely on other members of the school staff to care for these children.

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    For over six years, there has been a battle in California wherein nurses were objecting to the administration of medicine by school staff that was not licensed healthcare professionals. This only makes sense if there is the a supply of licensed healthcare professionals on the school campus during school hours (and even after hours –for extracurricular activity).  However, as we noted above, there are simply not enough licensed healthcare professionals onsite in schools to provide the required care for children with diabetes or other conditions.


    Finally, the battle has ended … 


    California Supreme Court Rules Unlicensed School Staff Can Administer Insulin.

    The Wall Street Journal (8/12, A3, Carlton, Subscription Publication) reported that on Monday (8/12/2013), the California Supreme Court ruled that school staff who are not licensed healthcare professionals can administer prescription medicines and insulin to students, setting back the six-year fight waged by the American Nurses Association against the California Department of Education. Twenty-two states allow unlicensed school staff to administer insulin, as many schools have stopped staffing campus nurses.


    The Los Angeles Times (8/13, Dolan) reports that “the Disability Rights Education and Defense Fund, which represented the American Diabetes Assn. in the case, said Monday’s decision would protect not only students but also adults with chronic medical conditions or disabilities.”


    Why is this ruling so important?

    Last year, The Childhood and Adolescent Diabetes Team from Children’s National Medical Center developed and delivered a curriculum for school non-healthcare professionals in the District of Columbia Public Schools. In order to educate and support these individuals, we provided pre-workshop reading material “Back to School” from the American Diabetes Association in order to provide a background prior to our face-to-face interactions. Didactic material was provided initially, and the school staff rotated to different stations manned by our diabetes educators in order to learn about major considerations in caring for children with diabetes: insulin types and injections, blood glucose monitoring and meters, treatment hypoglycemia and hyperglycemia (and ketones), diet and carbohydrate counting and understanding technology (insulin pumps and continuous glucose monitoring). The workshops were delivered twice in order to accommodate as many non-healthcare professional school personnel as possible. It is, therefore, hoped that non-medical staff will now feel more comfortable working with our children with diabetes.


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    The school forms have now become infinitely more complex as well in order to document the more intensive forms of insulin therapy. Indeed, for those children that require insulin at school, it is important to document how to calculate insulin doses based on carbohydrate consumption and blood glucose level. Even more importantly, given the current environment, it is essential to have a “lock-down” plan so that staff can care for our children in the event of a serious emergency. Keep in mind that the school form offers ranges and guidelines that often enables a parent to make adjustments to insulin dosing that is embedded within the school form orders. These adjustments should be communicated to the all members of the school staff (medical and non-medical) that interact with your child.


    It is also the families’ responsibility to provide all the medications and supplies that are necessary to care for their children.  This means extra insulin, blood glucose test strips, insulin infusion sets (if the child is on a pump), syringes and needles. In addition, it is my view that all children require an emergency glucagon kit at school in the event of a severe low blood sugar in which the child is unconscious or seizing due to the danger of aspiration with oral glucose administration.


    Summer is almost over…let the learning begin!

Published On: August 26, 2013