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Health Update

Diabetes care needs a boost in many schools

Many states have laws that protect the rights of students with diabetes, but they vary greatly
The American Diabetes Association’s Safe at School program educates parents and district staff about students’ rights to school services.
The American Diabetes Association’s Safe at School program educates parents and district staff about students’ rights to school services.

A number of schools fail to provide routine care such as blood sugar monitoring and insulin shots for a growing number of diabetic students—in violation of federal law, health experts say.

Since 2011, parents have filed nearly 400 federal complaints nationwide alleging that schools declined to provide proper care for students with diabetes—which is typically given by a full-time qualified nurse or trained staff member.

But the problem is likely more far-reaching, says Crystal Crismond Woodward, director of the American Diabetes Association’s Safe at School program, which educates parents and school staff about students’ rights and provides legal aid.

“Discrimination at the administrative level and school nurse level is all too common,” Woodward says. “Unfortunately, many children across the country are placed in dangerous and potentially life-threatening situations when they are denied access to insulin or glucagon at school and school- sponsored activities.”

School diabetes management

The American Diabetes Association recommends the following school diabetes management tenets:

  1. School staff are allowed to volunteer to be trained to administer insulin and/or glucagon.
  2. Capable students are permitted to self-manage diabetes anywhere, any time.

Twenty-nine states and the District of Columbia now meet these three tenets either through legislation, regulation or statewide policy.

In some cases, students were transferred to schools that have full-time nurses outside of their neighborhood, or barred from attending field trips or participating in extracurricular activities. The most widespread example is perhaps Alabama, where in 2013 the Department of Justice found the state systematically discriminated against students with diabetes by banning them from field trips and sports practices.

Students with Type I diabetes require blood sugar monitoring and insulin administered via injections or a pump before meals. If a student’s blood sugar remains unregulated, they may face serious complications over time, including blindness and kidney damage. If blood sugar levels drop extremely low, students with Type I diabetes may have seizures or die.

The prevalence of Type I diabetes increased 21 percent among children under 19 in recent years, according to a 2014 study published in the Journal of the American Medical Association. Some 200,000 children under the age of 20 live with the disease.

Legal rights

Diabetes is considered a disability under federal law. Therefore, students with diabetes are protected by the Americans with Disabilities Act, the Individuals with Disabilities Education Act, and the Rehabilitation Act of 1973.

All students with disabilities are entitled to an equal opportunity to participate in academic and non-academic activities, says Catherine Lhamon, assistant secretary in the Department of Education’s Office for Civil Rights.

Many states have laws that protect the rights of students with diabetes, but they vary greatly. A number of the laws follow the requirements of ADA or the Rehabilitation Act, and others specifically address responsibilities for diabetes care in schools, Woodward says.

School-based care

The school nurse is usually the key provider and coordinator of diabetes care in districts. However, with budget cuts in recent years, most schools do not have a full-time nurse, Woodward says.

It’s crucial to have a small group of school staffers who are trained to administer insulin to students who are too young or cannot do it themselves, Woodward says.

Twenty-nine states and the District of Columbia allow trained school staff members to administer insulin, or in an emergency situation to provide a glucagon injection. In other states, administrators may fear liability—but most states have laws that protect school employees, Woodward says.

To ensure all students’ needs are met, district employees should be trained to provide diabetes care and to learn their legal obligations, Woodward says. A care plan should be created for each student who has diabetes.

“It truly takes a team effort to ensure the health and safety of the student with diabetes, and to support the student’s academic progress, normal growth and development, and gradual independence in the management or his or her diabetes,” Woodward says.