Diabetes in the classroom:Time to be prepared - Diabete...

Diabetes in the classroom:Time to be prepared

Diabetes in the classroom:Time to be prepared

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by Peter J. Nebergall, PhD

Classroom teachers have responsibilities far more broad than just “teaching the subject.” Presiding as the only authority figure in the classroom for hours each day, the teacher is responsible for the welfare of students. There’s no buckpassing; the teacher is in the room, and the school nurse is not.

So what happens when a student has diabetes?

Hopefully the teacher has been informed. When a student is diagnosed, or when a diabetic child enrolls in school, it is the parents’ or guardians’ responsibility to let school authorities know of the condition—and what needs to be done to help keep the child from running blood sugars too low or too high. The “desire to conform,” to not stand out, may be powerful; but if a child has type 1 diabetes, or severe type 2, it can be a life and death matter—Parents must let the school authorities know!

If your child has type 1 diabetes (or “brittle” enough type 2 that emergencies can occur) it may be grounds for preparation of an “IEP” (Individualized Education Program) or a “504 Plan” (in other states that do not use the IEP). Such an individual plan is ideally worked out among parents, school administrators, and pertinent medical professionals (such as the child’s primary care physician and diabetes educator). Sometimes the school’s counselor will be involved. The plan they prepare should spell out the teacher’s role in the child’s day-to-day diabetes self-management, and that of other school personnel. Parents—you need to be part of the process here.

There are privacy considerations, described in HIPAA, the Health Insurance Privacy and Portability Act. Appropriate documents must be signed and filed before school administrators and health care professionals can legally discuss a child’s condition with anyone. This requirement is critically important.

If the child’s diabetes is significant enough that it can affect his or her safety (not to mention academic performance), it is well to remember that legally, diabetes is classed as a “disability” under the Americans with Disabilities Act (the “ADA Act”), and schools are required to make “reasonable accommodations.” Such accommodations will vary between individual diabetics, of course, and, as a diabetic child advances through the school system, may change through time as well. It is important for all to cooperate in keeping the IEP current, and following its instructions, about the student’s diet, medications, and physical activity. Parents—stay involved.

What about your diabetes knowledge? As a teacher, you are no doubt used to doing “in-service training” for most every issue; it would not be unreasonable, in a school where diabetic students are present, to schedule a workshop with a Certified Diabetes Educator (CDE) so you can learn, from an expert, how to recognize a diabetes emergency, what to do, and when you need to summon emergency medical aid. Parents, you need to keep informed too.

There are educational resources available to you. Helping the Student with Diabetes Succeed: A Guide for School Personnel is an 80-page manual published by the National Diabetes Education Program, which is a joint venture between the National Institutes of Health and the U.S. Centers for Disease Control. Any school district lacking an up-to-date plan for dealing with diabetic students would do well to make this text their primary guide and parents of a diabetic child should read it cover to cover. To obtain copies, contact: National Diabetes Education Program; telephone: 1-800-438-5383; Web site: www.ndep.nih.gov. The book may be downloaded (in PDF format) without cost.

The Children With Diabetes Web site (www.childrenwithdiabetes.com) contains answers to many of your questions, especially in its section titled “Diabetes at School.” The site even offers sample IEP and 504 plans, and has a list of states with published diabetes care programs, including Florida, Missouri, New Jersey, New York, Texas, and Washington. If you are in any way involved with a diabetic child (that includes as a parent), the Children With Diabetes site is worth your while.

The National Association of School Nurses offers their Consensus Statement: Safe Delivery of Care for Children with Diabetes in Schools. This document may be found online at: www.nasn.org/statements/consensusdiabetes.htm.

The state of Montana has developed pocket inserts for “Children With Diabetes: A Resource Guide for Schools,” described as “everything you need when a child with diabetes is coming to your school.” These may be downloaded from: http://healthinfo.montana.edu/diabetes/srminserts.pdf.

The above are just a sample. The Juvenile Diabetes Research Foundation (JDRF) and the American Diabetes Association (ADA) have their own resources. Where the diabetic student may be losing vision, the National Federation of the Blind (NFB) offers extensive resources, both directly (contact: National Center for the Blind, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314, ext. 2335; Web site: www.nfb.org) or via Voice of the Diabetic magazine.

I didn’t put this information together alone. A number of high-quality diabetes educators quickly responded to my “call for help,” and flooded me with more good resources than I had space to fit. My thanks to: Connie Kleinbeck, RN, BSN, CDE, Ann Williams, PhD RN CDE, and Anne Whittington, MBA, MSN, RN, CDE.