Diabetes Management

Diabetes is one of the most common chronic diseases in school-aged children. Registered, professional school nurses are recognized in the Newtown Public School District as the school staff member who has the knowledge, skills and statutory authority to fully meet the healthcare needs of students with diabetes in the school setting (NASN). Our daily management of students with diabetes is unique to each student’s needs while adhering to national and state recommendations that are evidence based, best nursing practice. School nurses are aware that management of students' diabetes is a 24/7 job that doesn’t go away at school.

The goal of effective diabetes management in school is to control blood glucose (BG) levels by keeping them within a target range that is determined by the provider for each student. Target BG control helps to promote normal growth and development and allows for optimal learning. Effective diabetes management involves a careful balance of food, exercise and insulin, or medication, and is needed to prevent the immediate dangers of BG levels both too high and too low (CSDE). 

• Managing Diabetes at School | Diabetes
• Helping the Student with Diabetes Succeed: A Guide for School Personnel
• Joslin Diabetes Center – World Leader in Diabetes Care & Research 
  

Diabetes management is an evolving science. Experts in the field and advancing technology enhance the ability to manage diabetes at school, thus improving quality of life. We are prepared to continue to learn and adjust as each student’s diabetes management plan evolves. We look forward to working collaboratively with parents and health care providers to set each student up for success.

Each student with diabetes is unique in his or her disease process, developmental and intellectual abilities, and levels of assistance required for effective disease management. We understand that students of the same age and diagnoses may be at completely different levels when it comes to self care and understanding of the disease process. These age/grade level acknowledgements are subject to change according to an individuals needs. In general: 

It is our goal that each student will learn to become an active member in the care and management of their diabetes, with consent from their parent/guardian. Diabetic self-care in students is variable. The range in the student’s capacity to take part in their diabetic care will be coordinated by the health care provider, school nurse, school personnel, and parent/guardian. The student’s capacity and readiness to provide self-care will be acknowledged and encouraged. The school nurse will continue to educate and encourage diabetic self-care in the Health Office (HO).

Students can not attend school prior to meeting with the school nurse each year for student’s safety. Our intent for this meeting is to familiarize ourselves with your student’s unique diabetic needs. Please be ready to discuss:

• Provider order for diabetic care in school (Diabetic Management Plan)
• A “go to” bag carried by the student throughout the school day. The bag should contain the glucometer, testing strips, glucose tabs and snacks as needed.
• Extra supplies for the health office; for example, ketone strips, insulin, and extra pods.
• Snacks for the health office to keep and distribute to classrooms and specials- such as gym, library, art, and recess. We will request restock as needed.
• Snacks and lunch times. We will coordinate according to what carbohydrates (CHO) the student is eating.
• Bringing lunch from home. It is helpful to write out CHO’s, and send the list in their lunch bag OR to create an ongoing list of foods your student will likely eat and their respective CHO count. This is helpful to get student back to class or lunch in a timely manner.
• Lunch bought at school. Please familiarize yourself with our school menu website that includes the calendars & CHO count. The school nurse also has access to this Menu in case of any changes made to students' meals. Nutrition & Lunch Menus
• Plan for both hypoglycemia & hyperglycemia. We will notify parent/guardian if the blood sugar is out of range if requested. If the parent/guardian has concern, please contact the school nurse. We will have yearly 504 meetings with school staff or IEP depending on the needs of the student.

Always remember, we are in this TOGETHER! 

Diabetic care at this stage is an extension of the grade K-4 expectations. Diabetic management continues to be a collaborative effort. It is based on a student's individual ability to properly care for their diabetic needs at this age and stage of development.

A comfortable, safe, and tailored approach is provided to each student as they become familiar with their new school environment as they advance in the district.

We expect our diabetic students from grades 5 and beyond to get to know their school schedule and discuss with the school nurse the best times and places for diabetic care, meals, etc. in order to foster trust, growth, and independence.

We continue to encourage each student/family to fill out the above questionnaire which will help us get to know your student better prior to the start of a new school year or with a new diagnosis.

We expect to meet with parent/guardian and student prior to the beginning of each school year or with any new diagnosis to discuss students' individual needs and diabetic care. (DMP, supplies, level and mode of parent/guardian communication, emergency contacts, and overall health to be discussed)

In grades 5-8, we will continue to promote and encourage independence and self-care, consistent with the student’s ability, skill, maturity, and developmental level. We aim to see student goals met and surpassed, with growth in all areas, and having confident, healthy students move on to the next level.

We continue to be here for you, we are in this TOGETHER! 

Upon entering high school, independent self-management of a student’s diabetes is the ultimate goal. Recognizing that students mature at different rates and have varying intellectual abilities to understand and manage their diabetes, an individualized plan is created with the nurse, parent/guardian and student that meets the student’s needs at the high school level. This plan will be modified throughout the student’s high school career as maturation and intellectual development occur, again, with independent management as the goal.

There are two significant differences in diabetes management at the high school level. The first is that students are not required to come to the health office to check and/or report their BG unless this is a part of their individual plan. Students typically come to the health office on an “as needed” basis if experiencing signs or symptoms that need to be addressed. Secondly, the high school health office does not have an ipad that tracks student’s BG levels throughout the day. Both of these changes reflect the students increasing ability to self manage their diabetes at this stage of development.

The role of the health office becomes more of a supportive one as the student enters 9th grade and navigates high school. We hope to see the student healthy, thriving, and fully engaged in learning and other activities as they progress through this stage. In fostering this level of independence our hope is that at the end of four years students are prepared to successfully transition out of high school and on to the next chapter of their lives. 

Review the student’s individualized Diabetes Management Plan (DMP), enacted by the medical provider.

Meet with parent/guardian and student to go over all aspects of the care plan set in place. (Ideally meet prior to the start of the new school year, especially when changing schools.) The DMP should be updated yearly or more often if treatment changes. A clinically sound, agreed upon DMP, which can be reasonably implemented in a school setting, is a must in caring for students with diabetes in the school setting.

Review or initiation of students 504 or IEP plan set in place by The American’s with Disabilities Act, Section 504 of the Rehabilitation Act of 1973, and the Individuals with Disabilities Education Act. Under these laws, diabetes is considered to be a disability, and it is illegal for schools to discriminate against students with this diagnosis. A 504 or IEP plan defines aids and services and modifications needed by eligible students to enable the student to have full and safe access to all school activities while meeting diabetes management needs. Appropriate and best practice care must be provided at school and all school funded activities.

Effective communication, cooperation, and coordinated planning among the student, parent/guardian, school staff, and the student’s provider are critical to ensure that the student receives optimal care and remains an active participant in school activities.

The school nurse will conduct a nursing assessment of the student and develop an Individualized Health Care Plan (IHCP) that incorporates the student’s diabetes care regimen as prescribed by the DMP and health care orders. An Emergency Care Plan (ECP) will also be created. This plan incorporates the IHCP and DMP and directs appropriate actions for school personnel in the event of a diabetic emergency. A copy of the EHCP shall be given to all staff members who have responsibility for the student throughout the school day (teachers, counselors, lunch staff, bus drivers, administration, and substitute teachers).

Obtain materials and medical supplies necessary for diabetic care from the parent/guardian, and arrange for the best system to notify them when supplies need to be replenished. Consider placing supplies in different areas of the school for easier access in case of emergency. Confirm emergency phone numbers in case of contact needed throughout school day.

Plan and implement diabetes management training for appropriate staff (including glucagon administration for identified staff).

Participate in diabetes management training and professional development to keep up to date with changing technology and best practices.

Assist students with blood glucose monitoring through traditional BG testing or through use of CGM that may display data on pump, a dedicated receiver, or a smart phone app. Universal precautions and infection control procedures will be maintained during all student encounters.

Perform routine and emergency diabetic care tasks including: BG monitoring (fingerstick or CGM), urine ketone testing, insulin administration, glucagon administration, and thorough student assessment.

Maintain accurate documentation of contacts with students and family members as well as any collaboration with school staff for student safety (ie. food service, bus transportation). Communicate to parent/guardian any concerns about the student’s diabetic management or health, such as acute hypoglycemic episodes, hyperglycemia, general attitude and/or emotional status in school.

Respect the student’s confidentiality and privacy at all times.

With parental permission, act as liaison between the school and the student’s health care provider regarding the student’s self-management at school. 

Inform your school nurse and other appropriate staff that your child has a diagnosis of Diabetes.

Provide accurate emergency contact information, and inform school of any changes.

Provide current DMP at the start of the school year or when there are updates during the year. Any DMP or updated documentation requires signature by a parent/guardian and health care provider and must be reviewed with the nurse.

Attend and participate in the initial and annual meeting of the school health team.

Provide current and specific information about your student’s diabetes (fill out parent questionnaire above if requested by your school). Let the health office know of any changes occurring at home, or major changes/stressors to your child's life and routine that could affect their health. Keep the school nurse updated on student’s visits with the health care provider and current A1C.

Provide and maintain all supplies, equipment and snacks necessary for implementing your student's diabetic management plan.

Inform appropriate school staff when the student plans to participate in school-sponsored activities that take place before or after school to ensure health care coverage can be coordinated.