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March 7, 2002

School and Daycare

Question from Kitts Hill, Ohio, USA:

My seven year old daughter's school nurse claims she's trained in diabetes, but said it takes two to four hours for Humalog to start working rather than 10-15 minutes. I told her she was wrong, but she claims she's the expert. She also called my daughter's endocrinologist to ask what to do in cases of hyperglycemia; whether they should call the EMS. In addition, she says that my daughter shouldn't be able to have waffles for breakfast. The school district says that she shouldn't be allowed to have sugar at all. If she is trained, shouldn't this school nurse already know what to do?


Your daughter’s nurse is clearly not correct. Perhaps she is confused over a number of things. A common point of confusion is the names of various insulins. One brand of insulin is called Humulin. There is Humulin NPH and Lente which do indeed start to work in two to four hours but have maximal effect in six to eight hours. Humulin Regular starts to work in about 30 minutes and has its peak in two to three hours. Perhaps this school nurse is simply not aware of the newer, fast-acting insulins, such as Humalog or Novolog.

There are a couple of things that you may do:

One rather non-confrontational approach is to see if anyone from your daughter’s diabetes team or one of the local pediatric Certified Diabetes Educators would contact the school and give them a review of matters. This is sometimes referred to as an “in-service.”
Certainly you can show her the package insert from the insulin bottles to show her, but remember, while egos can get in the way, your school nurse still wants to assure the health of your child. So a gentle approach may be better than an angry approach.
The school district is incorrect that the child is not allowed to have “any sugar at all.” An in-service, or specific instructions from your diabetes doctor is certainly a reasonable approach!


[Editor’s comment: I agree wholeheartedly with Dr. Schwartz that it’s obvious this school nurse needs some education. It might be helpful to simple print out this reply and give it her. Secondly, does the school nurse have your written permission to contact your daughter’s diabetes team? If she does not, she is certainly overstepping her bounds and is violation of Federal law.

If your daughter does not already have a written 504 plan in plan, it would help to have one. This plan spells out exactly what should happen at school including food and emergency procedures. See The Law, Schools, and Your Child with Diabetes.