Wednesday 14 December 2011

Insulin at School: Whose Responsibility Is It? Part 3

This is the third and final installment in my "Insulin at School" series of posts. In Part 1 I outlined the issue itself (whether schools should be responsible/trained for administering insulin to children with type 1 diabetes); in Part 2 I provided some background information into what has worked for my family, and in Part 3 I will address what I think needs to happen now.

First and foremost, in Part 2 I talked a bit about the care plan I have set up with Dylan's school. His care plan is a collaboration between me, the community health nurse, and the school, and was written when he was first diagnosed in 2005. Each September we tweak the plan a bit to reflect and recent changes, as well as goals for his blood sugar levels. This care plan is still in place now, and will stay with him until he graduates from high school. It ensures that there are always people in the school (his teacher, as well as SEAs and administration) who know how to help him if and when needed. It covers a variety of situations, and is specific to Dylan's needs, but not include the administering of glucagon or insulin. Every type 1 child needs to have a care plan in place to ensure their safety. If you don't have one, get one. And if your school is uncooperative for any reason, talk to the principal, the superintendent, the ministry, whoever you need to. In BC, an alternative to a "medical care plan" is an Individual Education Plan (or IEP), but for this you need to have your children designated as having a special need. This is a designation that stays with them through graduation and is reflected on their transcripts and university applications, etc, so it's not for everyone. For the record, we have both. Dylan is designated by the Ministry of Education as "gifted" so he requires as IEP to reflect additional learning goals. We can include diabetes goals in his IEP as well.

However, the issue at hand is not care plans. The issue is whether schools should be administering insulin to our children, either via syringe or insulin pump. I think the answer is obvious. Why wouldn't they? The only question then becomes, who does it? And while I said yesterday that I don't believe the onus should fall entirely on the teacher, the classroom teacher is the one person that sees your child more than anyone else, and for that reason, they should be trained on how to administer insulin, or, at the very least, on how to give a glucagon shot. Then there should be at least one alternate person as well, such as an SEA. Why? Your child travels throughout the school every day; their primary location is the classroom, but then there's outside time, library, gym, music, and computers, for which they may have alternate teachers. And what about field trips? The classroom teacher might be the only adult present on a field trip, so their understanding of how to use glucagon is critical. 

I mentioned in yesterday's post that Dylan does all of his own boluses, and I have no intention of changing that. I have always encouraged him to be as independent as possible with his diabetes care, in part because the idea of relying on others frightens me, and because as he gets older, he will have to care for himself more and more. But he's 11, he's had type 1 for over 6 years, and has worn a pump for over 4 years. Translation: he's not new to this. Neither am I, and neither is his school. In fact, when he was diagnosed, he was 1 of 4 children in his school of 230 kids who had type 1. He's now the only one, as the others have moved on to high school. What that means, though, is that almost every teacher in his school has had a type 1 child in their classroom at some point in the past few years, so the entire school community is familiar with the unique needs of a child with diabetes. We are very fortunate in that way.

For kids who are recently diagnosed, or who are on MDIs, or are young, or whose parents work far from the school, or can't leave work, or who, for any number of other reasons, are dependent on the school to inject their child with insulin, the school community needs to step up and ensure their child's safety. And glucagon injections, well that's a given. Someone has to be able to do it at the school.

So where do we go from here? I believe we need to ensure that members of every school are trained to administer glucagon to a child with type 1 diabetes, including the classroom teacher. As for insulin injections, they should be willing to learn, and from there the procedure needs to be decided between the parents and the school, as each child's needs are so individual.

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