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February 24, 2002

School and Daycare

Question from Spindale, North Carolina, USA:

My 12 year old son, who also has Down's Syndrome, was diagnosed with type�1 diabetes about a year and a half ago, and he is not able to do his own shots, though he is very cooperative about getting them. We recently relocated, and his new doctor switched him to Lantus (insulin glargine) with Novolog, and he is doing great, but I am not sure what to do for his lunchtime shot at school. For now, I am not working so I can go to his school at lunchtime, but I may not always be able to do so. There is just one nurse for all the schools in this county. What is usually done when there is not a nurse to do this? Should the nurse be expected to be at his school at noon every day? Am I correct that the school must provide someone to give his shots if she can't? He already has an IEP and is in a special education class. Do we just need to re-write his IEP to include this? Any ideas about the best way to handle this?

Answer:

These are very good and important questions, and here are some suggestions, in my preference of order.:

You may indeed wish to revisit his IEP and 504 plan with the school. [ED: See The Law, Schools, and Your Child with Diabetes.] They may be willing to give him a “set amount” of Novolog (perhaps with a pen) at lunchtime if you can estimate his usual carb intake. Better to underestimate his dose, but give him some, than missing a dose.
Another option would be to discuss with your new doctor about allowing your child to get a little NPH (not pre-mixed 70/30) with breakfast. Since NPH doesn’t have a peak effect until about six to eight hours later, you can give this early in the morning anticipating that it will “cover” lunchtime and early afternoon for you, thus trying to obviate the need for your rapid-acting insulin shot at lunch.
An insulin pump is another idea, but perhaps a bit premature to explore right now.

DS
Additional comments from David S. Holtzman, Esq.:

Generally, the school is required under Federal law to provide adequate services to children with special needs. In your son’s case this would include the administration of insulin and other medications by someone qualified to do so.

The problem here is your question of who will administer the medications when mom is not able to do so. If mom regularly administers the medicine but cannot do so for a day from time to time, I do not think the school district will be required to administer on such short notice or occasional basis. The school district has no way to plan for this occasion.

If, on the other had, mom puts the school district on notice that beginning in 30 days she will no longer be able to administer the medication at school then sufficient notice has been given to the school that they will need to take over the responsibility for administering the medication. I would work closely with the district’s personnel to raise their awareness of your son’s needs.

DSH