As we head into fall, children of all ages are returning to school. This means that the freedom of summer and lack of routine changes to a more structured daily list of activities. Parents “hand over” the lives of their children to teachers, principals and school nurses to not only provide the child with instruction, but also the opportunity for physical activity and food during the lunch hour. For children with diabetes, this can be a challenging area and has the potential for added frustration.
The child who has a deeper understanding of his/her diabetes and the importance of regular blood glucose checking has a starting advantage. But have you noticed, even the most “compliant” children find multiple distractions when they are with their friends? Checking blood glucose values and giving bolus doses for lunch are often not part of the “to do” list.
Over the last two years, the endocrinologist that I work with and I have started a before school clinic day. It’s really a tune up and is the “diabetes physical” prior to the start of school. We ask the children to come to the clinic and to have their laboratory values drawn before attending. I have copies of the medical management plan to fill out, and provide them with a 504 Plan to work on with their school.
I ask parents to make an appointment with key school personnel prior to the start of the school year that will help them with the management of their child’s diabetes. We live in a rural state, and many of our schools are without a school nurse, which can make management even more challenging. I also have children set key alarms on their insulin pumps as a reminder to check blood glucose values before lunch. Teachers are often willing to watch a child give a bolus, to make sure they are entering their carbohydrate and BG values correctly in their pump.
This year, in conjunction with the American Diabetes Association, school nurses in our state will be offered a special program (H.A.N.D.S) during the annual statewide teachers meeting focused on diabetes in the schools. In Colorado, key nurses are volunteering to be the “go to” nurse with questions about diabetes from other nurses in the district. Many states and several organizations have manuals to help keep children safe at school, but the importance of having one in hand must be emphasized to the schools, or they will stay stored away on computers and in state offices.
What are you doing to help children with diabetes manage their lives at school? Please share your successes and your challenges!
If you want to read more about this issue, review AADE's position statement, "Management of Children with Diabetes in the School Setting."