Meters and Insulin at School - Advice for a Friend

Type 1 and LADA Parents of Children with Type 1 Diabetes
1

Ok, it has been a long time since I was in school and a lot has changed. I have a question for parents of T1 kids out there. A colleague of mine has a 7 yo who was recently diagnosed with T1. The school is saying that all the child's supplies (meter, insulin, etc) have to be kept in the nurses office, which is one floor down from the child's classroom on the other side of the building. This child is capable of testing independently.

While it was standard practice to keep things in the nurses office when I was in school, I DO NOT think that it should be standard practice now. We live in an urban area where schools are routinely put on "lockdown" because of various threats (according to teachers I know, lockdowns now happen several times per year). In addition, we now know that more frequent testing leads to better control. To "frequently test" this child would have to leave the classroom and go to the nurses office, which would take away from valuable learning time.

Thoughts? My advice to this parent was that she should fight to ensure that all of her child's supplies are in the same room as the child at all times. I was also concerned because it sounded like only the school's health tech had been trained to test and administer insulin and glucagon. IMO, every staff member who has contact with the child should know how to, at a minimum, test blood sugar levels and administer glucagon in an emergency.

2

Thanks, I think the issue is that the school is wanting to keep everything (including a meter and glucagon) in the nurse's office, which is a substantial distance from the child's classroom. The school is a large, old high school with several floors.

My primary concern was that in an emergency, they lock down all the classrooms (no one can leave or come in). This happens with enough regularity here (mostly just false alarms, but we've had a few real ones due to weather emergencies) that there could be a situation in which her child doesn't have access to the necessary supplies. I would think that any diabetic child should have (at a minimum) insulin, meter & test strips, glucagon, and snacks with them at all times. In a young child, highs can actually turn into emergencies very quickly too. Kids go into DKA much faster than adults and for T1 children DKA can become much more severe.

I absolutely thing that a teacher should be trained on how to administer glucagon in an emergency. For children with life-threatening allergies, teachers are trained in how to use the epi-pens. Glucagon isn't terribly different and if there is no nurse around in the midst of that emergency, what would happen?


I don't know....it just all really concerns me. I work in DC and we have had plenty of emergencies. I am always so aware to make sure that my stuff is with me at all times. If I have a meeting in another part of the building, I take my bag with me. If the alarms go off, I take a few seconds to gather all my stuff before exiting the building. I just would never feel comfortable with a T1 child not having access to these things (under appropriate supervision) during the school day.

3

I see both your points of view. I am a type one diabetic ( from the old school days, diagnosed in 1968) so insulin and testing supplies were not an issue for ME then..You did one shot a day, at home; and glucometers had not yet been invented.
Yet, I am also retired from a position in an urban school district. We also had similiar rules about testing equipment placement for diabetic kids:In the nurses office or the main office, never with the student. I personally do not feel that a little ( young elementary) child should be required to test and make decisions on his/her own. In our school district, due to liability issues, No one was allowed to administer injects of any kind to the student, not even the school nurse.
when I worked inthat school disstrict, up to June 2011, Most if the kids were on a one-day at a time routine., sliding scale dosing schedule. I never saw one kid with a pump... the middle-school and older kids tested and the observing designated medical person really was just there, for those who did not need assistance. If no nurse was present, the student went to the main office, where his/her supplies were also stored, and the child tested and treated within the supervision of the one trained medical assiatance , often the school secertary. If the kid needed a lunch pous to correct, Mom had to come in and do it. Lows where the kid was not passed out on the floor were treated at school, with the observer's observation and assistance, if needed. Seveer glucagon needing lows were for the 911 Emergency Squad)

Diabetic kids had a medical plan written out by their docs, some had a 504 as well, but still the only ones who pricked these kids finger's were the nurse, the child themselves or the child;s own mother. Teachers were not required to do this. I was astonished to find out, but most mom's of type one little ones just do not work outside the home in our school district. At least not on a day shift. Sad, but that is how it is.
Mybustedpancreas, you are an adult and can have your supplies with you at all times. I always had mine with me, as an employee. But your statement that each teacher should be trained to admnister glucagon in an an emergency as the "ideal" ' but, as Jackie says, it is just not feasible. In this time of reduced funds for public education and more time required for kids to be "taught the test" due to "Every Child's Behind Will be Left" ( what I call NCLB) regulations; That is just how it is.

btw. MybustedPancreas when is the last time you have actually been in that "large old high school with several floors", or in any public school for that matter? Honey I am not trying to be adversarial, but the realiity of the situation is that most parents of certain income levels do not have the time nor the "dukats" NEEDED TO HIRE A LAWYER to "fight for the changes" you want. Even if they get the services free, pro-bono, or can do it through non-litigious moves; such parents have neither the time to be off their night job to go to special repeated meetings for the fight. . They do not have professional positions that allow them that time. Maybe your friend does.
I was not in agreement with the teachers not being trained to take care of young type ones, I even volunteered to admnister injections, glucagon, or to help assist. But I was told I could not help because the district could be held liable if I ,as a non-designated medical personnel, did something "wrong" and the child got sick. So it is about the reverse liability of keeping the school district safe, rather than the kid. Sorry, but that is just how it is.: The children are allowed to test themselves, but only in the nurses office, or with the one other trained observer( usually the school secretary, not the teacher). I do not see that changing soon in poorer school districts with less-informed, lower income parents.
My busted Pancreas, does the mom want her little sone to oversee his/ her treatments as a result of the blood sugar result,without consultation; or to just test independently ? I do have a probelem with the former. For older kids, I would ague for keeping whatever supplies they need with them. However, it would take a lot of work to get the rules changed, here, even for type one students aged 12 and up. JMHO.

God bless,
Brunetta

4

The American Diabetes Association has been doing a lot to improve the relationships of children with diabetes to the schools the children attend. I don't know specifics, but it might be worth checking with the ADA website or talking to some ADA person to get specific information regarding how things are required to work in your state or province.

5

Actually, I talked with a friend who is a public school teacher and she confirmed that teachers are trained in our county to administer glucagon. It's a standard training that they generally receive from the nurse in cases where a child with T1 is in one of their classes. It's the same if they have a child with a severe food or bee-sting allergy; they receive training on the epi-pen. I was never questioning the administration of insulin; I agree that dealing with insulin is more than a teacher should be required to deal with. But knowing how to handle a life-threatening emergency? Absolutely, a teacher should receive training on how to deal with that. And in a lockdown emergency where insulin cannot be accessed, there should be some procedure in place to get to the insulin that is stored in the nurse's office (if that's where it is kept).

Regarding your question - I was actually in a public school not that long ago and I did work for 10 years in public schools in our county (in the special education field). So I actually do have quite a bit of experience in this area, particularly around inclusion, IEPs, and mainstreaming. The school this particular child is in is literally an old high school that is temporarily (for the next few years) being used as a combined middle and elementary school (it is three stories and quite large, about the size of a city block). Yes, I have been inside it several times over the years. It is pretty large, one of the larger public school buildings in our county.

I actually did some poking around and our state (Maryland) happens to have a "Diabetes bill of rights" for students with diabetes! I also found some sample 504 plans and videos parents put together, and many of them talk about requiring that their child have their meter and necessary supplies with them at all times!! Quite interesting stuff.

In this particular case, I was advising the mother that her child should always have a meter and glucagon in the same room. Again, this is because a school can quickly go on lock down and all the testing supplies and emergency equipment would not be accessible if it was in the nurse's office one floor down and on the other side of the building.

6

Thanks, this is exactly what I did today and discovered that our state has a "Diabetes Bill of Rights" for children with diabetes in public school. It was quite informative and had a lot of good info.

7

I agree with your advice. More to the point, though, the parent should create a 504 plan that INSISTS on having supplies kept with him, not the nurse's office. My 5-year-old's backpack contains his meter, glucagon, and test strips, and it stays in the classroom. The nurse comes to HIM to do the testing (he cannot self-test), except at lunch time. Syringes are another matter — too many opportunities for those to get misused. I would agree that those should be in the nurse's office. It's also unrealistic (as my son's teacher made clear) to expect all persons supervising the child to be trained in testing and/or administering anything other than juice. I tried to go there. It was made clear that it was a nonstarter. But as long as the school can verify that there IS a trained person who is within 60 seconds of being in my son's presence around the clock, I can live with that. Sadly... I too am a mom of a T1 who does not work outside the home. That was not of my choosing, I got laid off from a job in town last fall, but the more I learn about public schools' functioning (and sometimes dysfunctioning), the more I think the layoff was divine providence at work.

Can you post a link to this diabetes bill of rights? I'd like to see it.

8

The other day I met w/ some IRL people (OMG!) and learned a local teacher *refused* a T1 kid, they ended up switching rooms or something like that. If the kid can test, they should have their meter. Anybody w/ diabetes who can test should have their meter. It's totally absurd, and countereducational for a school to take a tool out of a kid's hands who needs it.

9

Here is where I found it (I saw the term "bill of rights" somewhere else on a Maryland state page, but it's not on this page). Anyway, the document I read is the one titled, "Management of Students with Diabetes Mellitus..." I was actually impressed with how detailed it is. It does specify that the school nurse can train others (i.e., teachers and other school personnel) in the administration of glucagon. My friend who is a teacher in our county said that she has been trained in glucagon administration, as she had two T1s in her classes last year.

I like the idea of the medical staff coming to the child. When the mother of this child described to me how everything was kept in the nurses office, another thought I had was about the missed classroom time the child would experience.


Something I found REALLY helpful was this video about what one parent includes in her childrens' 504 plans. Note that the things they have included in their plans since kindergarten are access to testing supplies at all times (can have the kit with her) and that she can test her blood sugar in class (so that she doesn't lose classroom time),

10

Yeah, that was pretty much my thought. And if the only way to test is to leave the classroom and go all the way to nurses office (on a different floor, on the other side of the building), that would result in the loss of valuable classroom time.

11

I have always thought that the rule in my district , about having to go to the office, was absolutely crazy..but I was told we could not "afford" to have staff accompanying one child, when there are others left unattended. Supposedly the district could not afford to have to hire extra people to manage one child. Plus, you dare not ask SOME teachers to accomodate a "special needs" child of any kind. Classroom switching of children with disabilities and differences is not uncommon. Some teachers are just plain "skeered " and "overwhelmied" these days, and it IS best to get your child in a room where their needs may be closer to being met. But there are still all the rules to circumvent, even with a willing teacher. I know parents of special needs, physically and/or cognitively challenged kids who have "lawyered up" and received a one on one aide for their kids, or special accomodations requiring far more individual services in an IEP or 504 plan, but these are the parents who had to write, threaten and call constantly if they want it done in a time-efficient manner:the squeaky wheel does get the grease.
Mybustedpancreas. You have done an admirable job providing your friend with such grand asistance. As a special educator, you know the legalities, so she and her child are truly blessed to have you in their corner. Do you have the time to be this child's advocate? It will take a lot of time and talk and paperwork ti change long-standing rules and willful ignorance about diabetes ( I call in stupidity, for which there is NO Excuse, but then I am a little borderline low cynical this morning, off to my OJ in just 5 minutes..wink-wink)
Take Care
God bless

Glad I retired relatively early
Brunetta

12

We happen to be in Montgomery County MD (just outside of DC), one of the wealthiest counties in the country that also happens to have what has to be the highest number of lawyers per capita in the U.S. Yes, I saw many times in my old job (I no longer work in that field) how often parents would lawyer up to get what they felt their child needed. In some cases, they were completely justified, but in some cases I honestly didn't think they were.

In the case of my coworker, she is fortunate to have a job that permits her to take time off to deal with these matters, and she and her husband are your typical well-educated DC area professionals, so I am sure they will be able to handle the school system. From what she told me, it sounded more like the school was just not familiar in dealing with a T1 child, which I found a bit surprising given how large our schools are here. Also, because her family is still so new at this whole T1 thing, I don't think they always know what to ask for. They are learning as they go. I shared with her a lot of resources I found on the internet, including quite a few sample 504 plans and the video above, so hopefully that will help them know what to ask for.