Our 11 year old daughter, who has had type 1 diabetes for seven years, usually has blood sugars in the normal range at home, but when she is in school, they are not. She eats her meals and snacks at the same time every day whether in school or at home. We do carbohydrate counting so she is allowed to have the same foods everyone else eats. (We do not allow her to have candy, ice-cream, non-diet pop, etc., but she is allowed to have a piece of cake or cookies provided they are counted in the total carbohydrates for that meal or snack. ). This has worked very well for seven years, and her last A1c was 6.7%.

To make a long story short, the school nurse has decided that our daughter’s high blood sugars at school are because of the snacks she is having, while we feel the high blood sugars at school are because of the stress the nurse is putting on her. The nurse goes so far as to pull our daughter out of class every day to discuss (lecture) her about what she has brought for a snack that day and will even go to her locker and see what she has brought. We have tried going to the school principal with this problem but have not gotten anywhere. We are at our wits ends. The stress this woman is causing is starting to affect home life as it seems to be all we talk about.

I’ve made copies of the ADA’s published revised guidelines for food and diet that states, “Key among the new guidelines is the acknowledgement that the overall amount of carbohydrates is what matter, not the source. This change puts into policy what many have been practicing for some time, namely integrating sweets into meal plans”, and I’m sending it to school tomorrow. I can’t find what I’m looking for when it comes to stress and the role it plays on high blood sugars. Can you please explain this so I can make a copy to send to the school nurse?

First, you should be very proud of yourself for how well you are advocating for your daughter. It’s very hard to keep an hemoglobin A1c under 7%, so you know that her blood sugar control is excellent.

Giving the school nurse the new ADA Food and Diet Guidelines was a very important start. I wonder if she’s actually read it. That paper is very clear cut and discusses that a carb is a carb no matter what the source. Some school nurses are hard to convince that the diabetes diet has become more liberal over the years. Often, this is because they were trained many years ago (usually) and have not been exposed to the new education for diabetes. Our team dietitian has to talk to several school nurses per year for the same issues that you have raised. Sometimes having a real, live person teach them is more effective than asking them to read the position paper. Is it possible for your daughter’s dietitian to speak with and/or teach the nurse?

As far as your daughter is concerned, please “fire” her from worrying about or taking responsibility for this nurse’s behaviors or questions. Help her learn ways to be polite, but to ignore this nurse. This nurse should never be allowed to pull her out of class to discuss diabetes. She is not this child’s parent, nor is she her diabetes care provider. This nurse is causing your child to miss school and to be seen as different than her peers (even embarrassed and stigmatized) by the nurse pulling her out. That means the nurse is impeding her ability to learn in the classroom for no other reason than that she has diabetes. This is discrimination, and is against the Americans with Disabilities Act.

I think you need to first turn to your diabetes team for help/support. If that does not work, you may need to find an educational advocate with some familiarity with the American’s with Disabilities Act to help you.

JWB

[Editor’s comment: See The Law, Schools, and Your Child with Diabetes. You might also want to search PubMed for articles about stress and diabetes. I also suggest you contact you local American Diabetes Association affiliate if you need further help with this matter.

SS]