Diabetes

Healthcare services must be provided in the school setting to students with diabetes to meet requirements of federal laws and ensure the safety of the student with diabetes in the school setting. Effective and safe management of diabetes is complex and requires careful planning by a licensed professional school nurse. Individualized healthcare planning is a nursing responsibility that is regulated by State Nurse Practice Acts. The school nurse is the qualified person to coordinate and implement the plan of care for school, which is unique to the nurse role. The 504 Plan, IHP, or IEP for the student with diabetes integrates management strategies preferred by the student, family, and health care provider. School nurse assignments, directed by the school district, may prevent the nurse from being consistently available to the student with diabetes in the school setting. School districts are responsible for having policies in place that address the needs of students with health conditions at school. State laws and nurse practice acts will determine the extent to which school nurses can delegate nursing tasks such as insulin and glucagon administration to other school personnel in the absence of the school nurse. If diabetes care is delegated to LPNs or UAPs, the school nurse needs to be immediately accessible to provide direction.

Diabetes is the second most common disease in childhood, with an increasing number of children being diagnosed with both type 1 and type 2 diabetes. Approximately 8% to 45% of all new diabetes diagnosed in youth is type 2 diabetes. The increase in type 2 cases among children has been attributed to an increase in overweight and obese children, a decrease in exercise among children, and environmental factors. It is estimated that of the children born in the year 2000, one in six girls will develop diabetes and one in eight boys will develop diabetes in their lifetime. Both high and low blood glucose levels affect the student's ability to learn and can endanger the student's health. Glucose levels should be as close to the desired range as possible for optimal learning and testing of academic skills. Recent research indicates that maintaining the glucose levels within a goal range can prevent, reduce, and reverse long-term complications of diabetes.

Many more students are taking diabetes medications and monitoring their glucose levels frequently in the school setting.

Each student with diabetes is unique in regard to his or her disease process, developmental and intellectual abilities and levels of assistance required for disease management. Schools must ensure the students' rights to full participation in academics and extracurricular activities. The goal of diabetes medical management is to maintain blood glucose levels at or near normal range. Poorly controlled diabetes can lead to long-term complications such as retinopathy, macro vascular and micro vascular cardiovascular disease, and nephropathy as well as cause immediate concerns because fluctuating blood glucose may affect academic performance. The school nurse can be instrumental in preventing and managing emergency conditions that can result from glucose fluctuations by instructing the entire school team on basic diabetes information and management. Emergency conditions are not necessarily the result of a lack of management and may require nursing interventions even in those situations in which the student is skilled in handling his/her own care. Factors such as illness, hormones, or stress may cause a student who closely follows his or her diabetes plan to experience an emergency situation.

Hypoglycemia is the immediate concern with students in school. This condition can be treated easily if it is identified early, or it can be a life-threatening event if left untreated. Despite a quick and favorable response to treatment for low blood glucose, cognitive ability can remain impaired for several hours. Untreated hypoglycemia can lead to increased confusion, unresponsiveness, and seizures. An Emergency Plan developed by the school nurse