t’s time to head back to school, and parents/guardians all around the United States are depending on school personnel to help keep their children safe at school: children who have recently been diagnosed with type 1 diabetes, those who are knowledgeable and participate fully in their own care, and those who are struggling with diabetes management even though they have had layers of education and support through years of having the disease.
Every year in our office, we hold a “kid’s day” where children see the physician assistant (PA) and the diabetes educator to get a “well check-up” and complete medical management forms, which are provided to the parents/guardian to take to school to help develop the school’s 504 Plan or IEP.
One of the position papers for AADE, titled "Management of Children with Diabetes in the School Setting," (updated in 2016) focuses on children in the schools, and it can help you understand the recommended process for getting children ready for care at school.
The American Diabetes Association has forms that can be downloaded, printed and provided to care providers to complete, as well as a sample 504 plan.
As diabetes educators, we should ensure that every child in our care is ready for school
The medical management plan is a document that covers the present insulin dosing regimen to be used at school. For example, is the child receiving carbohydrate coverage? What is the correction dose? Are they on an insulin pump or injections? Do they need oversight in calculating their carbohydrates, or are they able to count them without help? What happens if they have a low blood glucose? What are their symptoms and how should a low blood glucose be treated? What about a high blood glucose? Should the child still play sports if the blood glucose is greater than 300 mg/dl? Do they have supplies at school and what are those supplies?
The 504 plan (or IEP if student has other educational issues that are being addressed) is completed at school with the school nurse or health representative (in small schools it may be the principal). This is an agreement with the school using the medical management plan as guidance, for care at school. It defines who will be responsible for overseeing the delivery of insulin (the school nurse is usually the choice, but with smaller schools, or nurses that have multiple schools, it may be a designated staff member). Who is responsible for providing glucagon if needed? What range should blood glucose values be prior to taking a standardized test?
As diabetes educators, we should ensure that every child in our care is ready for school. That the student, the parent/guardian, and the school have a clear understanding of how to care for the child with type 1 diabetes in the school – to promote safety, as well as to enhance their learning potential through improved diabetes management.
You are welcome to check the Montana Safe at Schools website for further forms and ideas!
About the Author:
Carla Cox is a registered dietitian and certified diabetes educator. She has been a certified diabetes educator for over 25 years, and served as an assistant adjunct professor for 14 years, teaching in areas of sports nutrition and exercise physiology. Currently she works in Missoula, Montana as a diabetes educator in both in- and outpatient settings.