Taking Diabetes to School
Sending your child off to school for the first time is particularly tough for parents. In addition to all the usual parental worries, you have your child's diabetes to think about. The good news is that many, many others have gone before you and have blazed the trail, so to speak, for your child's rights in the classroom. If you face an uncooperative school staff, there are specific legal protections in place to ensure that your child gets appropriate medical care and fair, nondiscriminatory treatment while in the classroom.
Dealing with Discrimination
Every child will probably have to deal with some form of discrimination in her life, and those with diabetes have to confront ignorance of what type 1 diabetes is all about. Discrimination can be as simple as denying a child a cookie in the cafeteria, or as overt as denying self-monitoring for a child who is capable of performing it.
If your child goes to a public school or a private school that receives federal funding, she has specific educational rights under several federal laws. Section 504 of the Rehabilitation Act of 1973 allows you to develop two important documents that ensure your child's medical needs are met while she is at school — a Section 504 plan and an individualized education plan (IEP). A Section 504 plan outlines a child's basic medical needs (e.g., a source of fast-acting glucose if she is low), while the IEP outlines the specific actions your child should be able to take in light of the 504 (e.g., free access to her locker or bag to treat a low and the right to eat in the classroom if needed).
To qualify under Section 504, you need to provide a record of medical impairment, which can easily be provided by your child's physician. You also need to prove that if not treated effectively, diabetes can affect your child's educational performance, again something your doctor can verify.
Along with the Americans with Disabilities Act and the Individuals with Disabilities Education Act (IDEA) of 1991, Section 504 also ensures that your child isn't unnecessarily restricted from participating fully in activities she is capable of joining, such as school sports, and that things like diabetes-related absences don't negatively impact her school record.
Essential
A federally funded school cannot legally refuse to administer medication to your child. In fact, the school could lose its funding if it does so. If you have problems with your school or school district complying with your child's IEP, the American Diabetes Association (ADA) is a great place to turn to for advocacy and support. Contact the ADA to find out your options.
A Section 504 IEP should cover at least the following areas:
Blood glucose monitoring requirements. Spell out how often checks should occur, under what circumstances extra checks might be required (i.e., exercise), logging procedures, and how the meter and supplies should be stored.
Insulin requirements. List insulin doses, when they should be taken, how much insulin is required for specific glucose values or for covering a meal, and how to properly store insulin. If your child uses an insulin pump, include information on that as well.
Meals, snacks, and fluids. A dietary plan for meals eaten at school should describe your child's recommended carb intake for lunch and snacks, when he should eat, and also how to handle special occasions (i.e., birthday cakes at school).
Recognizing and treating highs and lows. The plan should explain the signs of both hypoglycemia (low blood glucose) and hyperglycemia (high blood glucose), and how to promptly and correctly treat both. Explicit directions on the administration of a glucagon shot should also be included, and staff should be trained in its use as well.
Ketone testing. Explain when ketone testing is appropriate and how the procedure works.
Contact information. This probably goes without saying, but make sure your IEP includes your full contact information, a backup emergency contact, and a backup for your backup. Someone should be reachable at all times.
Educating the Educators
If your child goes to a school that receives federal funding, the school itself is legally required to provide necessary diabetes training to educators and other personnel. However, it's in your best interest to get involved in the process early on. Ask to attend any teaching sessions the school sets up to ensure their accuracy and provide practical input on how the information specifically applies to your child.
Alert
If your child's school has a nurse on duty who will help your child with his diabetes care, schedule a meeting with her to go over your child's particular treatment needs and to ensure that she knows exactly what to do in case of an emergency. The nurse should also attend any diabetes training sessions.
Your child's school may ask you for input or assistance in coordinating teacher training. This is a good opportunity to get your diabetes educator in to meet with all the teaching staff and support personnel (i.e., bus driver, cafeteria workers, playground personnel) your child will have contact with in order to make them aware of his medical needs and to provide them with an accurate, working knowledge of type 1 diabetes. It may also be a good idea to have the educator speak to the students in your child's class if your child is comfortable with this scenario.
School personnel who have contact with your child should be trained in key aspects of essential and emergency diabetes care. Even the most competent child may have situations in which his blood glucose drops too low and he needs assistance with a check and/or a quick fix of glucose.
Essential
Coaches or instructors of team or individual sports that take place outside of the school setting also need proper education about your child's medical needs. If you can, consider volunteering to coach or help out with the team to make the learning curve a little easier.
Treatment in the Classroom
Your child's school is not legally obligated to allow blood glucose testing in the classroom, and your son or daughter may be required to go to the nurse's office or another place to check glucose levels. However, for older children who are both capable of doing a check themselves and comfortable with doing it in class, it is usually in the best interest of all involved if the child is allowed to do checks right in the classroom. Your child will miss less class time — if she is feeling low, she won't have to use up precious time traveling to the nurse's office — and it is less disruptive to the entire class if she can discretely check without leaving the room.
There should always be a fast-acting glucose snack available in your child's classroom for her immediate use. You will have primary responsibility for keeping an adequate supply available for her, as well as keeping unexpired meter strips and supplies, insulin, and everything else she needs in stock. The school should have a separate, dedicated meter for their use, along with a separate logbook they can use to record results. Request to have a photocopy of your child's readings sent home with her at the end of each day.
School Sports
Sports are another area where children may be treated differently because they have diabetes. Kids who want to get involved with team or individual sports should not be dissuaded or automatically excluded based on their diabetes alone. With appropriate precautions, your child can excel in just about anything she wishes.
If your child is participating in school sports, her coach should be involved in diabetes training along with other educators. It's particularly important that coaches realize the signs of hypoglycemia, since exercise may induce a low, and know how to treat it appropriately.
