Diabetes Management at School- Working with School Officials
It is back to school time! The diabetes team at Children's National Medical Center is extremely busy completing school forms that enable our patients to care for their diabetes while on the school grounds and during extracurricular activities on and off campus. Transitioning to school from summer vacation is tough for students, family and staff at school. First, your daily routine changes dramatically and insulin doses need to be adjusted accordingly. Second, there is a transfer of responsibility between your family and school. Once you are a student, your safety is under the jurisdiction of the school. A student with diabetes impacts the school nurse/aide, teachers, coaches, cafeteria personnel, etc. Therefore all school staff should receive some form of training to enable them to students with diabetes. In fact, once school begins, you spend more time in school than at home.
Ideally, a school nurse will be available full time on campus. In many circumstances, this is not always possible and there is a designated aide to assist in simple medical situations. The health room staff are available to help you check blood sugars, administer insulin (if you receive insulin in school before lunch or for correction boluses), and to treat hypoglycemia. They also should know how to ask for help by calling 911 or your diabetes team in an emergency. The health room should also have duplicate medications and equipment available in case you run out of insulin, test strips, or lose your glucose meter. Ketone strips and a glucagon emergency kit should also be in the health room should you become very high or experience a severe low with an accompanying loss of consciousness or seizure.
I believe the biggest controversy in school and diabetes care is the issue of independence. Just how much you alone can care for your diabetes is a subject of great debate. Many schools allow students with diabetes to test their blood sugar discreetly in the classroom if needed and treat with glucose. Others insist that students go to the nurse's office to check blood sugars. Many schools also allow you to check blood sugars in the cafeteria and administer insulin by pens in the cafeteria without checking in with the school nurse at lunch. It all depends on the school's rules.
We recommend that you and your family meet with the appropriate school personnel before school starts to outline the responsibilities that will be shared by the student and the school. If you are responsible and comfortable checking your blood sugar and giving insulin on your own, we recommend that you be given permission to do so without checking into the nurse's office. Allowing you to care for yourself, without taking time away from the classroom will also help to avoid missing material taught in class. There is one major exception to this rule: if you feel low and are incapable of testing or consuming carbohydrate, you must be escorted to the nurse's office by a responsible colleague or teacher and not go by yourself (or have the nurse come to the classroom). In addition, you should be allowed to participate in extracurricular activities without having a parent attend. Clearly, there needs to be a school representative trained to help you in an emergency. In most cases, schools will work with you and your family to accommodate your needs. However, there are occasional situations where a law can advocate for individualized treatment in the public schools.
The 504 plan is based on a federal law (Americans with Disabilities Act). If you attend private school, the law may not be applicable. However, many of these schools will work with you to have the same privileges that are outlined in these plans. Private schools often have nurses available on campus which is helpful. You and your family need to explain the importance of allowing you to manage your diabetes based on comfort level. I would strongly emphasize that you and your family try to work together with either the public or private school in a positive, collaborative relationship to ensure that your needs are met and to avoid conflict.
The health room should have all your diabetes related information (including home regimen) available should there be a situation where you cannot leave the school campus in case of an emergency (terrorist or natural disaster situations). In these circumstances, the school must be able to care for you overnight and possibly over the next few days. It is extremely important to replenish your diabetes-related supplies and equipment regularly in case of unplanned situations.
Working with the schools and health-related personnel should be a collegial relationship enabling you to care for your diabetes based on your comfort level, ability to be independent and most importantly, your safety. The school staff should be trained to handle diabetes-related issues. Your diabetes team is always available to provide information and necessary training to enable the schools to be comfortable in helping you to help yourself.
Good luck in the upcoming school year!