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September 25, 2001

School and Daycare

Question from Marcola, Oregon, USA:

My 15 year old daughter, diagnosed with type�1 diabetes three months ago, is on NPH and Humalog three times a day (not at school), and I was told recently that I needed to leave both medications and syringes at school in case of an emergency. Due to recent current events, I'm thinking that this isn't a bad idea. However, this seems like a waste of resources since she doesn't need a second dose until dinner time. What do you recommend? What are other families doing?


I do indeed routinely ask that families have certain supplies at the school, specifically, blood glucose meter and strips, urine ketone strips, fast-acting glucose (like gel or tablets), a Glucagon Emergency Kit, and fast-acting insulin (like Regular or Humalog) with some syringes. I do not like the school to routinely give extra insulin, but if the blood glucose is greater than 240 mg/dl [13.3 mmol/L], then urine should be checked for ketones, and, if the urine ketones are moderate or more, some extra-short acting insulin may indeed be warranted. Less than moderate ketones can often be treated with just drinking extra water. However, ketones make people with diabetes feel crummy, and they signal the beginnings of DKA [diabetic ketoacidosis] which can be life-threatening, so I tend to want people to be proactive with materials at school. You want the glucose tablets and glucagon kit for use when the glucose readings are low.

You are wise to be thinking about this, but in terms of “wasting a resource,” you are really only talking about one bottle of short-acting insulin a month (since you have the other supplies anyway). That’s a great investment to stave off DKA.


[Editor’s comment: There’s usually no need to keep the NPH at the school, unless there’s a chance she might be stuck there overnight (for example, during a winter blizzard).