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January 30, 2003

School and Daycare

Question from Georgia, USA:

I am a school nurse, and I have a parent whose fifth grade child has diabetes. The mother is expecting the lunchroom to make the decisions on diet based on prior glucose reading. I do understand that they are to provide suitable diet. He is told to eat certain items per the nurse monitoring him, and lunchroom personnel allow child to pick his own lunch. It is not high in sugar, as most people know what he should eat, but often he chooses more carbs than he should be having. Whose job is the carbohydrate monitoring up to at school?


This is not an easy answer and my response is predicated on the fact that I do not generally support that insulin doses or meals be modified by the current glucose level.

You did not indicate the child’s usual insulin regimen. Since he is not on a pump and based on your description, am I to assume that he does not “count carbs” and give a dose of fast-acting glucose based on his food consumption? If he does do carb counting this way, then he is providing a “basal/bolus” insulin regimen. If he has split doses of NPH (or Lente) and fast-acting insulin (Humalog, NovoLog, or Regular), then perhaps his home doses need to be changed.

Ultimately, the person in charge of his diet is the patient. Assuming normal development, a fifth grader should be able to grasp appropriate concepts, but your statements of his diet are incongruous — you say you know for him to “avoid sugar” but he then picks out “high carbs, pizza (carbs and fat) and corn”. All of these are carbohydrate rich. What is sugar? A carbohydrate!

I would suggest that for your benefit, the patient’s benefit, and the school’s benefit, that you suggest that the family complete a 504 plan to outline meals and the responsibilities of the various persons. I would also suggest that you seek permission to contact the child’s diabetes team member who helps guide his diet. That person hopefully is a dietitian. Perhaps you and the school would benefit for a member of the diabetes team come to the school to in-service you and staff and get an update on diabetes care.


[Editor’s comment: See The Law, Schools, and Your Child with Diabetes.