For families of children with diabetes, returning to school involves more than buying supplies and adjusting to a new schedule. Parents must also ensure their children can manage their condition safely while receiving the same educational opportunities as other students.
That was the focus of a recent Diabetes Day by Day podcast featuring Dr. Neal Skolnik, professor of family and community medicine at Sidney Kimmel Medical College of Thomas Jefferson University and associate director of the Family Medicine Residency Program at Jefferson Health Abington; Lucia M. Novak, a nurse practitioner board certified in adult health and advanced diabetes management; and Crystal Woodward, vice president of legal advocacy for the American Diabetes Association (ADA). Woodward, who leads the ADA’s Safe at School program, said diabetes management should be tailored to the individual child.
“Back in the late 1990s and early 2000s, there was some resistance from schools to allow students to check their blood glucose level (BGS) in the classroom. Back in those days, it was a good old fashioned finger stick meter,” Woodward said. “There was also resistance to training non-clinical school staff to provide diabetes care as there are many schools that do not have a full-time school nurse. Unfortunately, diabetes is a 24/7 illness, and it does not take a break when a child gets on a school bus.”
Woodward explained that every school has a backup plan for students who have diabetes. The federal Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA) require public schools to provide necessary care, including allowing blood glucose monitoring and insulin or glucagon administration with easy access during school hours. Under the federal law, children with diabetes are legally entitled to an individualized Diabetes Management Plan (DMMP) and a 504-plan outlining care at school.
“Children are now wearing continuous glucose monitors, or CGMs,” Novak said. “They may also have an automated insulin device pump. Even the way we deliver glucagon for emergencies has changed significantly.”
Novak asked what parents can do to make sure there are no barriers to the methods used to test blood sugar or administer insulin.
“Diabetes in the school setting should be individualized for each student,” Woodward said. “Every student is different in terms of their independence, the health help they need, the insuli delivery service they use, CGM, so that care needs to be individualized for each child. There are different accommodations for a five-year old who is newly diagnosed and an older child who was diagnosed many years ago who does not need hands-on monitoring.”
Woodward explained field trips can be difficult to manage which is why those should be included in the individualized plan. Another issue is cell phones as many schools are banning the use of them during school hours.
“The ADA has developed a very comprehensive diabetes card that children can put in their backpacks,” Woodward said. “That way, if they are questioned about looking at their phone, they have this card to show what they are doing.”
Woodward explained that any parent of a child with diabetes who is getting resistance from the school regarding accommodations should reach out to the American Diabetes Association for assistance. They have templates available for 504 plans that can be created and taken to the school for review. There is also information on the Safe at School program.
