My 6 year old daughter was recently diagnosed as having diabetes. Does anyone have information or advice concerning the role of public schools iformation or advice concerning the role of public schools in providing full time medical personnel to deal with insulin reactions and/or administering glucagon? Is this right protected by the Disabilities Act?
This question was referred to several members of the Diabetes Team, who have each given an answer:
Answer from Dr. Lebinger:I am not a lawyer, but my understanding of the Americans with Disabilities Act is that students with diabetes are covered under Section 504 of the Rehabilitation Act of 1973 which protects individuals with disabilities agains discrimination in any program or activity receiving federal financial assistance (including public schools). In addition, there is an Individuals With Disability Educattion Act (IDEA) which was amended in 1991 and lists diabetes among the chronic health conditions covered in the category of "other health impairment." This act guarantees a "free, appropriate public education" for all children with disabilities.
The Federal regulations apparently are not very specific and are left up to interpretation and implementation by the states and local school systems. You may need to ask your physician to request in writing the medical services your child needs during school time. You can then meet with school officials to discuss your child's medical needs and how they can be met by the school. You can request that a Section 504 plan be developed to accommodate the unique needs of your child. All parties involved must agree to the plan and you must sign that you agree. If you are not able to work out a satisfactory plan with the school, you have the right to file an administrative complaint with the Department of Education in your state. As a last resort, you can bring your case to court.
If you are having difficulty with your child's school, try to educate them and explain the needs of your child. Understand that different children with diabetes may have very different medical needs in school. Also keep in mind that you have to be "practical." Your child may need to have her blood sugar tested during school, but make sure the teacher has permission to give your child food if she exhibits signs of low blood sugar during class if a blood sugar reading cannot be obtained. Make sure if your child has a low blood sugar, she isn't sent alone to the nurse's office to test or obtain food. She could pass out on the way.
Keep in mind, even if you have a qualified nurse who can give glucagon, it may require more than one person to manage a child with a seizure and draw up and administer glucagon. I usually recommend that if a child needs glucagon, first call the emergency medical service, then try to give glucagon while waiting for help. Even if there is no one in school qualified to give glucagon, you may still want to leave an emergency glucagon kit in the office. In case it is necessary to call for emergency help, the glucagon can be administered by the emergency medical technicians. This is fto a young child.
Most important, you should concentrate on preventing emergencies. Make sure your child's teachers are aware of HER signs and symptoms of low blood sugar and know how to treat it. Work with the school to obtain their assistance in making sure your child eats her snacks and meals on time and finishes all her food. Make sure they have permission to give your child an extra snack before physical education or if there will be extra exercise.
If you need more information you can contact the National Information Center for Children and Youth with Disabilities, PO Box 1492, Washington, DC 20013. Telephone: 1-800-695-0285.
Good luck and I hope this helps.
Answer from Dr. Robertson:In the UK many parents have to do the same and spend a lot of time at school educating the teachers. For them the biggest problem is that when children move through the school and have different teachers, the information about their diabetes doesn't necessarily move with them.
In many centres now, including Glasgow, there are Diabetes Nurse Specialists who can visit schools and nurseries to aid the process. The British Diabetic Association produces a school pack which is quite informative. We have produced videos which have involved teachers and these help too. Teachers often tell us, quite correctly, that diabetes isn't the only medical problem they have to think about - after all asthma and allergies are much commoner. In Glasgow we have just completed the first round of general medical teaching for teachers in all grades when we discussed asthma, allergy, diabetes, epilepsy and resuscitation. By doing this we hope to improve general awareness of these problems so that specific teaching will be easier when the teachers find they have a child in their class with one or other of these conditions.
On the specific issue of blood sugar testing - this is very much up to the individual teacher. Of course older children can test themselves but a few teachers will be willing to learn to test. The general rule that we expound is "if in doubt, treat" so that hypos will not be ignored.
Answer from the editor, Jeff Hitchcock:My daughter, who just finished third grade, was diagnosed when she was 24 months old. So she's always had diabetes in school. She's attended two different schools. The first had a school nurse present for about 8 hours a week. She was allowed to test in the classroom, and my wife and I provided training to her teachers prior to school starting. We also provided several books about caring for kids with diabetes for the teachers to read.
In her current school, there is a school nurse present full time. She and the other five kids with diabetes are required to go to the clinic to test, accompanied by another student (insist on this!).
In both cases, glucagon is present if needed. Thankfully, we've never needed it. But she has been low often at school, mostly when school starts in the fall, and again when spring raises temperatures and the kids run wild at recess. Her teachers have always been very alert and sensitive to her needs. But I believe it's due in large part to the effort my wife and I make before school starts to educate them.
The bottom line is to work with the individual teachers first, and a nurse if one is present. In my experience, a full time medical person isn't necessary if the teacher is willing to allow testing in the classroom.
Original posting 8 Jul 96
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Last Updated: Tuesday April 06, 2010 15:08:52
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