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At-School Diabetes Management Plan
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By John P. Wise
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Diabetes Focus Fourth Quarter 2006
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A couple of weeks into the new school year, how are you and your child holding up? It's natural for a parent of a child with diabetes to be protective, perhaps overprotective, but following some simple steps can make your child's transition from bus stop to last bell each day manageable:
- Talk to your child.
- Talk to your child's school.
- Trust your child.
By talking to your child, you're making sure he knows how important it is to maintain a healthy balance of food, exercise and insulin. Frequent blood-sugar checks at school and careful meal planning throughout the day are critical.
And whether your child is in the early years of elementary school or getting ready to earn his driver's license, it's equally important to talk to his school. Letting teachers and administrators know how and when to check blood glucose should be at the top of the list.
"There needs to be really good communication between the parent and the school," says Virginia Zamudio, R.N., M.S.N., C.D.E. and past president of the American Association of Diabetes Educators. "Everybody has to be on the same page."
Effective diabetes management at school can yield a variety of positive results, including:
- Promoting a healthy, productive learning environment
- Reducing school absences and classroom disruptions
- Helping assure an effective response in a diabetes-related emergency
If your child is, say, a recently diagnosed kindergartner, your approach will be much different than if your teenager is a high school senior who's been managing diabetes since childhood. What will remain consistent, however, is the trust that is required on the part of the parent, hard as it may be.
"Since the school nurse isn't always in the building, other school staff members need to get involved," Zamudio says. "Even if it's a bus driver, someone always needs to be able to recognize that your kid is sweaty and needs a candy bar or some water."
In less drastic situations, a student should be made to feel comfortable taking his medication where and when her needs arise. An ideal situation is one in which everyone is on the same page, as Zamudio says, where teachers will allow a student to take her medicine or check blood sugar right there in the classroom or to excuse herself the lavatory.
Pamela Camosy, M.D., a diabetes researcher who serves on the clinical faculty at the University of Texas-San Antonio, says that effective diabetes management will allow your teenager to function like any other student without diabetes.
"If the child can manage his diabetes well, there should be no limitations," she says. "And that should serve as motivation for a teen to stay on top of managing it so he or she can play sports or drive a car."
And when your child goes off to college, the trust factor becomes no less critical.
"If your child is going to a college in another state, there could be some extra issues to deal with regarding your health plan and any emergency coverage that might arise," Zamudio says.
It's important before the school year starts for your child to not only find a doctor, but also to introduce herself to the staffs of any on-campus clinics, so that they know she has diabetes.
And make sure your child gets hemoglobin A1C blood tests at least every three months. The test allows your doctor to see if the diabetes is being managed effectively, and is a very "quick-and-easy" procedure, Dr. Camosy says.
Not sure if your child is following through with the A1C testing? "Some parents might want to have the doctor send a copy of the lab results to make sure their child is going," Dr. Camosy says.
When you talk about college and trust, you might also be wondering if your child is drinking alcohol. Regardless if you and your child speak openly about such matters, Zamudio offers a serious warning.
“It's important to note that drinking on an empty stomach can set someone up for a profoundly low blood-sugar situation several hours later,” she says. “Make sure there's food in the dorm or apartment so they can manage any low-blood-glucose incidents. And make sure any roommates know how to help when needed.”
There isn't one perfect way for every parent to help manage a child's diabetes. What may work for one family may be the least effective approach for another. But the things that stay constant in managing diabetes are communication and trust, the experts say. "Every parent-child relationship is different," says Dr. Camosy.
Some schools have a diabetes management program in place, but many do not. In either case, a management program needs to set out guidelines for the following areas:
1. How and with whom the school should communicate when there is a medical emergency or medical questions. All names and numbers must be easily available to all teachers and administrators.
2. A clear description of the school’s policies about administering and taking medications in the classroom, handling medical equipment such as insulin pumps, etc.
3. An individual action plan for each student with diabetes that outlines in detail all medical needs (testing, shots, oral medications for low-blood-sugar problems) and what will be taken during school hours. It should also explain health issues, set out dietary requirements, such as the need for snacks, and offer explicit plans for handling low and high blood sugar. The action plan needs to be signed by a parent and a physician and kept on file at the school.
4. Who will have access to and who will make sure there are emergency medical supplies available at school to deal with low- and high-blood-sugar crises.
5. You may also want to provide the teacher with a short written course in diabetes management. Experts suggest that you put together the following information: what is diabetes and how is it controlled; what are the symptoms of hypoglycemia and how is it treated; what is ketoacidosis and how is it treated; what is glucagon and how and when is it administered. In addition, you want to stress that it is important for the teacher (and fellow students) to treat the child normally, allow participation in all class activities, but also allow breaks when needed to follow the routine of snacks and insulin injection and blood sugar testing. Teachers are well advised to learn to pay special attention to your child’s behavior before meals and snacks, to avoid physical activity before eating, to keep sugar available and to bring all substitute teachers up to speed.
Sometimes you may have problems, even if you have set up a plan for teachers and administrators. Don’t give up if you aren’t getting the level of care and involvement your child needs. Stay firm and try to work together. But don’t give in to arrangements that are not in your child’s best interest. Make waves, if necessary. When there is room for misunderstanding (and that is almost always), get agreements with the school in writing. If you cannot get the care your child needs to be safe, you can complain to the U.S. Department of Education’s Office for Civil Rights.
The National Diabetes Education Program offers a handy booklet on diabetes management for school personnel, parents and kids. It includes information on diabetes, a diabetes medical management plan, an emergency form and helpful checklists. Download Helping the Student With Diabetes Succeed. |
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