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Managing diabetes at school

Alan Levine

Many students only see their school nurse when they are faking a headache to get out of class, but some of their classmates rely on the nurse to manage their health throughout the day. School nurses play a vital role in assisting students with Type 1 and Type 2 diabetes through the day, especially as Type 2 diabetes in on the rise as childhood obesity rates increase.

Margaret Pellizzari is a diabetes educator and registered nurse who joins us on "Take Care" to discuss how childhood diabetes is managed in school.

There are two types of diabetes and both affect children. Type 1 is more commonly known as juvenile diabetes and is an autoimmune condition where the body’s immune system attacks the cells in the pancreas that are responsible for insulin production. Type 2 diabetes, which is usually more common in adults, is insulin resistance usually due to obesity and genetic factors.

More kids are being diagnosed with Type 2 and depending on their treatment plan, need to rely on assistance from the school nurse to manage their symptoms. To ensure treatment regardless of diabetes type, school nurses and teachers are made aware of the changes in diabetes care.

“Well, I know at the New York state level they are providing education to the school nurses and to other personnel, teachers, to make them aware of what is diabetes and what is diabetes management for those children at school,” said Pellizzari.

Each student is different in their plan to manage diabetes. Children that have been living with diabetes for a long time may be able to self-manage. This means they are allowed to check and administer their own insulin as they feel they need it, without going to the nurse. With new technology, parents can monitor how their child is doing, without them seeing the nurse as often.

“A lot of the students now are on continuous glucose monitors and they use their phone, they need their phone as the receiver of that glucose data,” says Pellizzari. “And with the technology, this information of the glucose data in real time goes up in the cloud and their parents are then able to see on their phones or their iPad what their child’s glucose levels are.”

Some students though, especially ones recently diagnosed with Type 2, have a harder time managing on their own. They may require more help recognizing the signs and symptoms of low or high blood sugar levels. Getting a classroom aide as well as educating teachers and nurses on what low blood sugar looks like can help a child get used to taking care of themselves in the classroom.

A challenge with managing diabetes in school is knowing how much the child actually eats in a day. Insulin doses are based on how many carbs the child eats during that meal. While school lunch information is usually available to the parent, it is hard to know if the child is going to eat all of the food they get, and if they don’t, the insulin dose could be mismatched. Pellizzari recommends packing a lunch at home to combat this.

“Make a lunch. Make a sandwich and give a piece of fruit where you can weigh the fruit, know how many grams of carbs. Put that in a brown bag with the amount of carbohydrates in that lunch bag,” says Pellizzari. “And then all the nurse would need to do is figure out the dosing based on the blood sugar and take into the consideration the carb count in the lunch that’s provided by the family.”

Another challenge with managing diabetes in school is not having qualified personnel to help manage and administer medication. States like New York don’t allow unlicensed school personnel to administer insulin. This means that schools are relying on students using self-care, and coming up with alternative plans for these students.

“In the event when there are no school nurses it is very concerning because the individual certainly with Type 1 diabetes needs to have insulin to live and so they have to come up with some special of solution,” said Pellizzari.