September 9, 2000
Social Issues: School and Daycare
Question from Pahoa, Hawaii, USA:
My four year old son has type 1 diabetes and autism. He in a special education preschool, which is within a regular public elementary school. Because he has a severe language delay and lacks communication skills, it is very difficult to control his diabetes and we often have to use glucagon. The school will not check blood sugars or administer glucagon. Therefore, I go to school with him and sit in his classroom. I don’t feel this is a free education, since I have to be there. I often end up helping with the other kids simply because they come up to me (my son has a therapeutic aide with him as well). If I wasn’t there and he had a severe reaction (which he does a lot, since he many times does not reveal symptoms until it is too late), they can only call 911 and wait for an ambulance, which is a minimum 10 minute wait. Can I compel them to have someone available to do blood checks and glucagon? Of course, he can do neither himself.
Answer:
f your child is in a public school setting, that facility, is required, by law to implement a 504 plan (see School Bill of Rights for Children with Diabetes). Under the Children with Disabilities Act, any child with a disability, in this case, autism and type 1 diabetes, must have a plan in place that allows that child to safely participate in all elements of the school program. The school, under law, cannot mandate that you perform blood sugars checks, etc. They must supply adequately trained personnel to perform these tasks.
On the other hand, your need to use glucagon frequently is of great concern to me. Perhaps, for the time being (i.e., until we have continuous blood glucose monitors readily available) you should discuss that possibility of “loosening” your control criteria for this child. While not ideal, a target range of 100 to 180 mg/dl (5.6 to 10 mmol/L) might be more realistic and prevent severe hypoglycemia requiring glucagon.
SS
