Click here to read the Cover Story, "Communication, careful planning ensure students with diabetes can succeed at school."
Federal law requires that public schools accommodate children with type 1 diabetes by providing a staff member who is trained to meet their medical needs.
Schools need someone who is trained in how to administer insulin and how to look for reactions — both hyperglycemia and hypoglycemia — and is prepared to respond. Unfortunately, approximately 50% of public schools do not have a full-time nurse on duty, so a nonclinical, trained school staff member is the best solution.
I have had mixed circumstances with my own children in school. When they were newly diagnosed and there was not a full-time nurse at their school to meet their needs, my husband and I would take turns working from home 1 day a week, and we employed a full-time babysitter to assist with their diabetes care in school. We were fortunate to be able to take that time, but that is not the reality of many families who don’t have that flexibility.
Once our children moved on to grammar school, they did have a full-time nurse at their school, but back-to-school time always creates anxiety. In our case, a gym teacher personally volunteered for training in glucagon administration. There are those exceptional teachers who want to do that, but it does not have to be a classroom teacher who volunteers. It can be any nonclinical school staff member, an administrator or an aide. None of us who are caregivers of children with type 1 diabetes are medically trained. We live this every day, and we have trained many others, whether it’s a travel coach or a volunteer, in how to administer insulin and glucagon. It is something that can easily be done.
At JDRF, we have worked hard to help equip parents with tools to help them advocate to create a safe environment with teachers and other school staff members. We feel that it is ideal to have someone who is trained and someone who serves as a backup in the administration of insulin. Children with type 1 diabetes are no different than any other child at the end of the day in terms of their wants, goals and aspirations. These children need to be accommodated to make sure their health is taken care of, and that they are safe in the school setting. Every school should have a nonclinical adult and backup volunteer trained in the administration of insulin and glucagon.
Alisa Norris is chief marketing and communications officer for JDRF. Disclosure: Norris reports no relevant financial disclosures.
Inappropriately administered insulin can put students at risk.
A student with type 1 diabetes has needs that change daily as his or her blood glucose fluctuates. A child experiencing hyperglycemia 1 or 2 hours after breakfast, for example, could be ill (illness or stress can trigger high blood glucose) or simply not following the eating plan that morning, and requires individualized adjustments to insulin dosing. These are changes that a licensed school nurse is professionally trained to address.
A nonclinical staff member is not trained to interpret a physician’s orders. If a student’s insulin to carbohydrate ratio changes, a teacher administering insulin may have difficulty understanding and interpreting those changes. In addition, illness, skipping a meal, extra exercise, stress and other changes in routine — which can happen on a daily basis in the school setting — can all affect a student’s insulin to carbohydrate ratio. A school nurse should be there to initially recalculate or demonstrate for the teacher how to recalculate.
I understand the viewpoint of the American Diabetes Association — and of parents — who want a nonclinical staff member to give insulin to a child with diabetes when a school nurse isn’t available. I am the nurse for three schools, and I have had students with diabetes at those schools. As a nurse, you go to where the needs are for the child. This can be tricky when there are students with diabetes at two or more schools. Depending on the age of the student, some can self-manage their diabetes. When a student cannot safely self-manage, in our county, we have hired an LPN, who works under the school nurse, to assist in the care of students with diabetes. In West Virginia, an LPN is paid an aide’s salary. Of course, each school district will need to go over their state’s law on this issue, which varies, but this is a solution we have used because we just don’t have enough school nurses.
The most important thing to keep in mind is a student’s safety. Before administering an insulin dose, there is a calculation procedure that must be done, and many factors can affect dosing from day to day. Many teachers or other nonclinical staff members do not want to assume this responsibility. We should not expect a teacher to juggle classroom management while at the same time tending to a student’s insulin needs. It’s a bad idea.
Lydia Gordon, RN, BSN, CSN, is president of the West Virginia Association of School Nurses. Disclosure: Gordon reports no relevant financial disclosures.