As the new school year begins, children with diabetes and their parents have much more on their minds than first-day outfits and stocking up on school supplies. The back-to-school checklist is different for families of children with diabetes, and back-to-school can be overwhelming, particularly when a child has been newly diagnosed over the summer. A certified diabetes educator (CDE) can help families of children with diabetes adjust to the new school year in a number of valuable ways.
Help Students Plan and Prepare
Students with diabetes can thrive in the school setting, but preparation is required. Every student with diabetes should have a written Diabetes Medical Management Plan (DMMP) provided by the child’s doctor before or at the start of the school year. Among other things, the DMMP specifies insulin doses, management of hypoglycemia, and authorizes the child to self-manage, when appropriate. Under the Rehabilitation Act of 1973, students with diabetes are eligible for a 504 Plan, which can be requested in writing by the parent or guardian in an email to the school principal or guidance counselor. The 504 Plan defines how an individual student’s diabetes care will be provided at school, for example outlining how the child’s diabetes will be managed during standardized testing or during a school lockdown, and specifying who will supervise glucose monitoring and insulin administration at school and on field trips. Finally, school staff who interact with the child should have training on how to identify diabetes emergencies, and know who to contact for help.
Know the Guidelines
The American Diabetes Association (ADA) has published updated guidelines on the management of diabetes in the school setting and in the childcare setting, with specific focus on children ages five years and younger. Likewise, the American Association of Diabetes Educators (AADE) published updated guidelines in 2016. The ADA revised its position statement on type 1 diabetes in June 2018, and the American Academy of Pediatrics published a position statement on the management of type 2 diabetes in children and adolescents in 2013. These guidelines should be familiar reading to all CDEs who assist students with diabetes in the school setting.
Share Resources
Diabetes educators have knowledge about and access to important resources that can help students with diabetes and their parent or guardian caregivers navigate the school environment. These resources are also helpful to school staff. Some examples include the National Diabetes Education Program’s Helping the Student with Diabetes Succeed: A Guide for School Personnel, that includes a list of actions for school staff, parents, and students. The guide also includes a list of supplies the student’s family should provide to the school. The ADA has online resources targeted to parents, including a pre-recorded 2018 Back to School webinar, as well as resources targeted to school staff, including links to sample DMMP, Emergency Care Plans, and other helpful forms and documents. Finally, many states and pediatric endocrinology clinics include important information on their websites (for example, see ColoradoKidswithDiabetes.org). CDEs should familiarize themselves with national, state and local resources and be ready to share them with student families and school staff.
Train School Personnel
CDEs can optimize care for students with diabetes at school by providing training to the school nurse and other school staff. In person training is always best, but CDEs can also share expertise via webinar and videoconference. Consider reaching out to the local school board or health department to set up training for a large group of school nurses at a monthly in-service. Share information about the ADA’s Diabetes Care Tasks at School, a free online curriculum that includes with 18 modules ranging from Diabetes Basics to Continuous Glucose Monitors at school. If the school nurse or staff require training on a specific diabetes technology, the CDE can schedule a visit with a representative from the device manufacturer for hands on training.
Advocate for Students and their Families
Students with diabetes are protected by federal and state legal protections, and the CDE should assist the student’s family if there is any concern of discrimination. Common examples include a student who is told that they cannot attend field trips unless a parent also attends to administer insulin, or that the child “doesn’t qualify” for a 504 Plan.
Children and adolescents with diabetes spend a significant amount of time at school and at school-sponsored extracurricular activities. With planning and support, diabetes educators can help students with diabetes make the most of their educational experience.
By: Anastasia Albanese-O'Neill, PhD, ARNP, CDE, Assistant Clinical Professor
Director of Diabetes Education and Clinic Operations, Division of Pediatric Endocrinology, University of Florida