Diabetes, state law curb school choice
OK for volunteers to give shots, but not prick fingers
By JENNIFER LAWSON, firstname.lastname@example.org
August 25, 2003
Five-year-old Robert Cantrell would be experiencing his first weeks of kindergarten at Bearden Elementary School if he did not have juvenile diabetes.
But because he has Type I diabetes and cannot test his own blood sugar, Bearden is not an option. The school lacks a full-time nurse. To attend a Knox County school, Robert would have to transfer to another elementary school.
His parents, Robert and Beth Cantrell, don't think that's fair.
They raised the matter Aug. 18 with Knox County school board members at a workshop. Board members have indicated a willingness to pursue staff training that would at least help when a diabetic child faces an emergency.
At issue are two divergent state laws and a budget crunch that means a shortage of school nurses. Of 77 Knox County Schools, 12 have site-based nurses, while the other schools share nurses. Nearly 170 diagnosed diabetic children attend schools in Knox County.
"Are you telling me that because my son has diabetes, he has to transfer to a different school?" Beth Cantrell asked the board. "Not if the school board will clarify the law to administrators. If not, this is discrimination."
Cantrell was alluding to federal guidelines issued to school systems about dealing with Type I diabetes. The guidelines are much more flexible than state law about who may perform monitoring. Because of those guidelines, the Cantrells thought Robert would be better off in a public school than in a private one.
That was before they discovered the nursing shortage. In the meantime, the couple is sending Robert to the private Tate School of Discovery.
Tennessee law does not allow school nurses to train lay people to prick a child's finger and test a tiny drop of blood for sugar. To do so is to risk a nursing license, said Knox County Schools Nursing Supervisor Aleece Stewart.
However, a new state law allows trained volunteers to administer an injection of Glucagon. The emergency shot can save a diabetic's life when blood sugar drops to a critically low level.
"Our teachers need the right to use the blood-glucose monitoring system and Glucagon emergency kit," Beth Cantrell said.
Cantrell also wanted to know why state laws can't be as flexible as federal guidelines. Deputy Law Director Susan Crabtree said she would search for a legal way to justify performing the tests.
Cantrell and another mother, Rosemary Elkins, urged the board to allow the Glucagon training while lamenting that school staff cannot help students test their blood sugar before they reach the point of needing a Glucagon injection.
Elkins said her 17-year-old son sometimes becomes so shaky when his blood sugar is low that he can't steady his hand enough to place the droplet on the test strip.
Robert has never needed a Glucagon injection in the three years since he was diagnosed because his blood sugar is tested eight to 10 times a day, Beth Cantrell said.
Elkins said she and other parents of diabetic children have had to "resort to finding a teacher or teacher's aide who has a diabetic parent, sibling or even a pet dog." Teachers are willing to help, she said.
Stewart told the board that up until 1996, school personnel who volunteered for training were allowed to perform the "finger sticks," along with other medical procedures such as tube feeding. Then the Legislature passed a law that prohibited nurses from "delegating" procedures such as sugar monitoring, tube feeding and catheter maintenance.
Many school personnel are trained to spot the signs of low blood sugar, Stewart said. They may give the child a juice box to provide fast-acting carbohydrates. No child has required a Glucagon injection in two years, Stewart told the board.
"We want to make it safe for our children and we do it any way we can," Stewart said Friday.
The only step missing in the protocol is the blood test, she told board members. And without the test, school officials can't tell for certain if a child is experiencing a high-sugar episode or a low-sugar episode.
School board member and former principal Jim Williams is a diabetic.
"I can tell when mine is going low, but a 5-year old, even if they can tell, they can't do anything about it," Williams said. "I know a diabetic's parents live from day to day, wondering what's going to happen to my child today? Will he have a reaction?"
Stewart consulted with Knox County Health Department physician Stephanie Hall. Hall told the board giving Glucagon to a child with high blood sugar would do less harm than not giving it to a child whose brain was dying for lack of glucose. Stewart added that paramedics are called whenever Glucagon is administered anyway.
Because the Aug. 18 meeting was a non-voting workshop, school board Chairman Sam Anderson said he would direct the school staff to begin Glucagon training and the board would vote on the action at its September meeting. Stewart said Friday that training had already begun.
Cantrell said she knows many parents don't have the means to send their child to a private school. She recently asked the parent of a diabetic child what parents do who don't have a choice.
"They hold their breath," she recalls being told. "I'm not going to live like that."
Jennifer Lawson may be reached at 865-342-6316.
Copyright © 2003, Knoxville News-Sentinel Co. Reprinted with the permission of the author, Jennifer Lawson.
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