Q: Our recently diagnosed daughter goes to a small private school, and an actual school nurse is only on site two days a week. How will this affect our child's type 1 diabetes management? Should we change schools to one that has a nurse present all week long?
A: In this day and age, it's becoming increasingly difficult to find schools with a full-time nurse employed -- and when you do, one nurse is often expected to serve hundreds of students. Partly in response to these realities, the American Diabetes Association has come to support a model of type 1 diabetes management in which the school nurse's role is to coordinate care for the child with type 1 diabetes, but not necessarily always be the one who actually provides the care. Rather than relying on one person, we think it's essential that a small group of staff members become trained to administer insulin and treatment for severely low blood sugar, carry out blood glucose checks and know how to recognize and handle hyperglycemia and hypoglycemia.
What does this look like over the course of a typical school day? It might mean that a trained secretary in the office becomes responsible for daily insulin shots (or shares this responsibility with the nurse during the week). Your child's teacher may perform the after-snack and after-lunch blood sugar checks. And all school staff and teachers that your child comes in contact with over the course of the day are on watch for behaviors that signal high or low blood sugars.
Sound good? To get this team-centered approach started, the first step is to call a meeting with the principal or administrator and the school nurse to devise a formal plan for daily care. Name specific staff members who are willing to undergo diabetes care training and the details of their duties. Putting this in writing is critical. Since your daughter is attending a private school, it's a good idea at this meeting to ask whether the school receives any federal funding. If so, certain rules, including the writing of a 504 Plan, would apply. Check out the American Diabetes Association's Safe at School initiative for more on legal obligations of schools to care for children with type 1 diabetes.
It is the school's obligation to obtain appropriate training for staff members, and you should check in to make sure this training is being carried out. Passing along the name of your own certified diabetes educator (CDE) to perform training is popular with parents because this person is qualified to explain your child's unique needs. (In most cases, however, the school nurse will conduct training.)
During the training process and afterward, stay in close communication with the school's type 1 diabetes care team. If you need to shadow for the first few days when it's time for insulin injections or blood sugar checks, then do so. Part of your child's success at school depends on everyone -- including you -- feeling confident that appropriate care is being provided. Be adamant that a daily log is kept, detailing insulin shots and blood sugar checks. To make it easier for everyone to keep in touch, look into the new wave of online tools for type 1 diabetes management -- your CDE may have some software recommendations.
We've heard from so many parents that school is right up there with friends and family as a source of untold support when a child is diagnosed with type 1 diabetes. However, on the other side of the coin, there can also be deeply frustrating situations where it just doesn't seem like a school is willing to meet a child's needs. We hope you don't find this to be the case, but if it ever seems like your child is being discriminated against because of type 1 diabetes, regardless of whether it's a public or private school, don't hesitate to reach out to the American Diabetes Association's legal advocacy staff by calling 1-800-Diabetes.
--Crystal Jackson is associate director of Legal Advocacy at the American Diabetes Association's national office in Alexandria, Virginia. She is also the mother of a child with type 1 diabetes.
Disclaimer: The information in these articles is not intended as medical advice. Families should check with their healthcare professionals regarding individual care.
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