Arizona Law Sets National Example in Giving Students Greater Monitoring Control

In some schools, type 1 students must trek to the nurse

| May 23, 2008

In the current era of “zero tolerance,” public school students who have diabetes have been caught in a frustrating crossfire.

On one hand, students with diabetes need syringes for injecting insulin and lancets for testing their blood glucose levels.

On the other hand, many schools, wary of inadvertently encouraging or abetting illicit drug use, have set often harsh or impractical regulations in place to govern how students with diabetes may test or self-medicate.

In some schools, type 1 students must trek to the nurse’s office and give themselves injections while being observed. Both type 1 and type 2 students have to go to the nurse’s office to carry out even a finger stick test to determine their blood glucose level.

At the very least, this routine is highly disruptive, both for the student with diabetes and for those around them. Students and teachers are distracted by the comings and goings of classmates who may have to visit the nurse’s office up to 10 times a day.

For the students with diabetes, the constant interruptions take away from the time they spend learning. These rules single out the students, both for their disease and because there is an unspoken accusation that they could abuse the equipment used to control their diabetes.

Arizona Injects Some Common Sense

That’s why the recent news out of Arizona is so refreshing: Governor Janet Napolitano has signed a law that allows public school students to independently monitor their blood glucose levels in class up to 10 times daily and to use the necessary needles and lancets.

The impetus for the law came from a 2005 federal lawsuit in which a couple sued an Arizona high school for refusing to allow their son to carry monitoring equipment. In the suit, which was later settled out of court, the plaintiffs alleged that the school forbade the use of monitoring equipment under its zero-tolerance policy governing needles.

As well as relaxing the stringent regulation of diabetes-related needles and lancets, the new Arizona law allows volunteers and non-licensed school personnel to administer glucagon in emergencies when students have adverse reactions to insulin.

States Vary, But Federal Rules Set Some Guidelines

Nationwide, there is no uniform set of guidelines governing how public school students with diabetes may monitor or medicate themselves. States and individual school districts set their own policies.

However, federal guidelines do set a minimum standard of conduct, in which schools must accommodate the needs of students with diabetes in some fashion.

The first guideline is a Diabetes Medical Management Plan (DMMP), which describes the medical treatment that the student’s doctor and family have developed. A school may ask questions or offer suggestions about a DMMP, but the plan is basically the doctor’s and family’s call.

Section 504 of the Federal Rehabilitation Act bans school districts that receive federal funds from discriminating against students with disabilities. A Section 504 plan outlines how a school will accommodate or provide services to a disabled student.

Both plans work together: The DMMP describes what must be done, and the Section 504 plan describes how the school will allow it to be done. For example, if a student needs to self-test five times a day (DMMP), the Section 504 plan will list where and when those tests will be carried out.

In most cases, school districts insist on closely monitoring what actions students with diabetes may take. Arizona’s step toward softening previously strict regulations may set an example that other states will soon follow.

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Categories: 504 Plan in School, Blood Glucose, Diabetes, Diabetes, Insulin, Type 1 Issues, Type 2 Issues

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Posted by Anonymous on 23 May 2008

Janet Napolitano for Vice President! Excellent school policy.

Posted by Anonymous on 23 May 2008

As a school nurse, there is both pros and cons to allowing self monitoring in the classroom. I believe the school nurse should assess a level of compentcies in the development plan to ensure the students uses approproate technique, follows need stick avoidance guidelines, and understands the resources in school for assistance should the student have a level that is out of range. I use each opportunity as a teaching moment to cover important topics such as nutrition, carb counting, and lifestyle impacts on blood glucose levels to name a few. The developmental age of each student needs tobe considered. I work in an elementary school and try to test in the classroom rather than have the student miss instruction. This also allows me to interact with the teachers so they understand the impact of blood sugar on learning.

Robert Mehl, RN Maryland

Posted by Anonymous on 23 May 2008

That is refreshing news! Very sad that all states can't use a little common sense in handling these issues. There is nothing "recreational" about taking insulin, and how could you actually do any serious harm to others with the tiny needles on lancets? I hope all states follow suit! Thank you.

Posted by Seymour on 23 May 2008

Why does the school and the school nurse feel like they are even partially qualified to supercede the Dr and the Family's treatment plan. Thankfully someone in Arizona finally recognized this.

Now if we can just get the school out of the picture unless they are requested to help or to administer emergency aid just as they would for any other medical emergency we will have truly progressed.

Posted by Anonymous on 23 May 2008

As the mother of a 4 year old diabetic, I find this refreshing. I have already been told that my daughter cannot go to school unless they have a volunteer to help her with her diabetic needs. One of us has to quit work so she can get an education. Plus she is to keep everything in the nurse's office while the nurse manages three schools and may not be in her school. Isn't it amazing that her diabetic pack goes with her everywhere so she is prepared, but cannot be where she is in school where she will spend a major part of her day. Kudos to Arizona for being proactive. I am a nurse and if anyone is aware of needle stick protocol, it is a person with diabetes at whatever age. My 4 year old knows where to keep everything and how to be safe. Plus if a person with a drug addiction wanted her needles they could steal them from the cart at the shopping center just as well as at school. This law makes common sense.

Posted by Anonymous on 24 May 2008

How can this good news be extended to type 1s in prisons? In prisons, no self testing is permitted. The diabetics are injected once in the morning period. Then they run to the mess hall to eat something before insulin shock sets in. With a diet heavy on carbs, it's common for type 1s to suffer blurred vision without anyway to bring their blood glucose down. How can we get prisons to take better care of diabetics?

Posted by Anonymous on 24 May 2008

I totally agree with Seymour....... the school nurses are just that.. support if the student needs it. Some school nurses are so controlling and think that they are the doctors and know more than the families with diabetes.

Posted by Anonymous on 26 May 2008

I personally had a hard time 10-15 years ago in school. I had been allowed to test my blood sugar in class until a classmate complained. My school nurse was at the end of our quarter-mile-in-length campus and it was a huge disruption to trek there. Even the nurse thought it ridiculous. I felt so singled out. And sometimes when you need to test, it's because you're having a problem. At that point, walking high or low a quarter of a mile is a BAD idea. Yay, Napolitano and yay, Arizona. Common sense prevails.

Posted by Anonymous on 28 May 2008

As the mother of child who went through the public school system in Maryland I find so many of their "rules" absurb. Diagnosed at age 3 with type 1 certainly the school nurses during elementary and middle schools were a wonderful support. While in high school playing varisty sports - during the day he had to go to the nurse's office to check his blood sugar, take any insulin needed. For away games he would sit on a crowded bus and be able to test his blood sugar, inject insulin, etc. What was the difference between the class room and a crowded bus - the classroom would have been a safer environment!

Posted by Anonymous on 17 July 2008

As a school nurse and a diabetic I am very much in support of a student testing in the classroom and treating as needed. Our schools keep sharps containers in all rooms with diabetics but most students would rather pack their stuff up and clean it out at home. Care with our kids depends on developmental age, doctors orders, and parental requests. Children should be allowed to take responsibility as they gain understanding of their disease and treatment. They should also be assisted if they are feeling overwhelmed and know that they have somewhere to go for help. Education of teachers is of upmost importance so that emergency symptoms can e recognized.

Posted by Anonymous on 4 August 2008

As a diabetic teacher, I have to say Brava! I work in a pretty relaxed school, and have had no problem testing in front of my students -- why shouldn't other students have that right? I had a diabetic student last year -- she and I had an understanding. By the last period of the day, her sugar was usually low. If she showed up a few minutes late with a sugary drink, I knew why. If she came up to me before class because her pump was out, or her sugar was low, or whatever, I let her go, no questions asked.

I'm glad she was so open about it (especially since the guidance office never bothered to inform me!). Forcing the students out of class in such a conspicuous manner only shames them, and it makes their diabetes seem even more unmanagable. Some kids, I'm sure, would rather risk a high/low reading just to avoid singling themselves out to go get the proper treatment. It should be okay to send a shaky kid to the nurse with a friend, but it should also be okay for that kid to pull out their tester in class and see if they just need a snack.

I agree that education of teachers is VERY important. I was only diagnosed last year, and almost all the teachers in my school were FULL of questions -- even the science teachers! If a high school bio/chem teacher doesn't understand a condition that his students may have, who will?

Posted by vicki on 26 September 2008

I am a preschool teacher and learned that if a child should need a glucagon injection in an emergency,I would do so. The training I have had for this is how to mix the solution. I am not feeling to comfortable with this. If something should go wrong, would i be liable?

Posted by Anonymous on 1 October 2008

regarding the comment by Robert Mehl, there is no need to give advice to the diabetic children and help with the techniques. i was diagnosed when i was 9 years and never needed supervision.. becuase honestly how hard is it to brick your finger and put it on a strip. And from my own experience always being told about carb counting, etc gets very annoying. Its strange though because here in australia you can do injections and pricks anywhere in school.

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