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School should help with boy's insulin pump, mom says

herring_RN specializes in Critical care, tele, Medical-Surgical.

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So should parents of diabetic children have to become RN's before caring for their children? Parents are trained on the use of an insulin pump in several classes. Believe me, teaching how to bolus insulin via the pump would take only a fraction of one of those classes and could be taught to a teacher in no time at all. It is simple and there is little room for error. You enter the carbohydrate amount (as the parent provides) and the pump calculates how much insulin the child needs as pre-programmed by the endocrinologist's determined settings. If the teacher can't tell the difference between in-putting 30g and 300g of carb then I'd be very concerned about their teaching ability.

I live in Australia and most schools do not have nurses. Many teachers successfully manage children's insulin pumps in the school setting. With a little education by the parents and a good health plan outlining procedures in the case of high and low blood sugars, this can be done safely for all concerned. The parent can always be contacted if the teacher has a question. Assisting with bg checks and bolusing through the pump would not take much time out of the teacher or even secretary's day. I don't think its too much to ask for a child to have an equal education to other children.

Correct me if i'm wrong...but in order to be a candidate for a pump isn't the child supposed to be OLD ENOUGH to manage the pump himself...?!?!? Seems to me like this pump was handed out in error.

Newborn babies with neonatal diabetes use insulin pumps due to their ability to dose minute amounts of insulin impossible to with syringes. I'm pretty sure they aren't capable of operating their own insulin pump.

yes, just pushing a couple of buttons on my patients IV pumps incorrectly would kill them! We have a two nurse check system on insulin in our ICU for crying out loud! Hell, we are turning into a socialist country anyway,let us taxpayers send the boy a personal nurse to school with him everyday:grn:

frann specializes in medical/telemetry/IR.

when my dd was dx with type 1- 5 years ago, we got a crash course in diabetes. (thankfully I had gotten my foundation in nursing school) We were sent home with a book to read. We learned everything pretty much overnight. and thankfully we didn't kill her.

What is the alternative? busing him to another school that could be 1 hr away? the bus ride was the scariest for me. Our bus drivers here do recieve diabetes training. try putting your kid on a bus with a stranger that barely knows anything about diabetes. thankfully our ride was only half hour. and she was way more mature at 9

According to federal law the school must accommodate him.

its really quite easy learning the insulin pump. the mothers are always a phone call away. Someone at each school has to be in charge of medical problems? what do they do when someone has asthma attack? who gives out there daily meds?

I am so thankful I live in a district that has a nurse in each school and my dd was dx at a "good" age.

So, what's the alternative? Aren't schools supposed to provide for an education for disabled children, without the parents' direct daily supervision?

Is this mom supposed to quit her job (and maybe lose much needed health insurance) because her son has diabetes and NO ONE in the school is able to adjust his insulin? This scenario happened to a friend of mine...her son was diagnosed with type one, and the school told her that since they didn't have a nurse available full time, she was responsible for coming and checking his blood sugar and administering his insulin. She had to drop out of her grad school program and quit her part time teaching job in order to be available to do this. Fortunately her family had health insurance through her husband; but what if they didn't? I recommended she contact the administrative offices and discuss her options, but she didn't want to make a fuss. Make a fuss? It's not making a fuss to demand services that schools are legally obligated to provide.

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From children with DIABETES - The Law, Schools, and Your Child with Diabetes

Section 504 of the Rehabilitation Act of 1973

According to this law, parents of qualifying children have the right to develop a Section 504 plan with their child's school. To qualify for protection under Section 504, a child must have a record of such impairment, or be regarded as having such impairment. Schools can lose federal funding if they do not comply with this law. Parents can use these laws to ensure that, while at school, their children with diabetes can fully participate in all school activities, while at the same time caring for their medical needs. This means that the school cannot: refuse to allow a child with a 504 to be on the honor roll, deny credit to a student whose absenteeism is related to diabetes, refuse to administer medication (a school cannot require parents to waive liability as a condition of giving medicine), and determine sports/extracurricular participation without regard to the student's diabetes. Any school that receives Federal funding must comply with IDEA and Section 504 laws. A child need not require special education to be protected.

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I think it is not unreasonable of the mother to expect the school system to be able to reasonably accommodate her son's disability while he is in school, and that means that someone in the school needs to learn how to deal with this insulin pump. We mainstream here, people. Children in wheelchairs, with trachs; children with severe mental and physical disabilities; children with health conditions that require daily nebulizer treatments, injections, and monitoring of conditions mainstream in our schools. That is how our system is set up. Some countries have systems where those kids are in separate schools, or parents are responsible for providing any sort of medical, physical, or emotional support, but not here. We've done things differently in the US.

I'd lawyer up, too, if I were this mom.

Edited by BluegrassRN

lifelearningrn specializes in School Nursing.

I don't know if this has been mentioned but if my kid was on an insulin pump, I'd want him in a school with a full time nurse. If the wrong numbers are pushed or the pump malfunctions the quick action of a trained professional is a must.

blondy2061h specializes in Oncology.

yes, just pushing a couple of buttons on my patients IV pumps incorrectly would kill them! We have a two nurse check system on insulin in our ICU for crying out loud! Hell, we are turning into a socialist country anyway,let us taxpayers send the boy a personal nurse to school with him everyday:grn:

Quite honestly, this displays a lot of ignorance. These pumps re going subq, and are designed for outpatient use by untrained people. They're already calibrated to the boy's insulin needs. There are max bolus doses that can be set, and many fail-safes to prevent over delivery.

blondy2061h specializes in Oncology.

I don't know if this has been mentioned but if my kid was on an insulin pump, I'd want him in a school with a full time nurse. If the wrong numbers are pushed or the pump malfunctions the quick action of a trained professional is a must.

Pump malfunctions are extremely rare. The child could be sent home in that case. A type 1 diabetic can go 1-2 hours with a malfunctioned pump without serious consequence, so if it were to happen at the end of the day ,the child may even be able to go home.

If a child has mild-moderate hypoglycemia, juice is given, which certainly doesn't take an RN. For severe hypoglycemia, 911 can be called.

For mild hyperglycemia, a bolus can be given through the pump. Severe, the child would be sent home.

It sounds like a solution has already been worked out for hypoglycemia and bg testing since that wasn't mentioned in the article.

CrunchRN specializes in Clinical Research, Outpt Women's Health.

I think that if they are going to expect non-nurses to adjust the pump then they also need to release them from any and all liability.

That is the only fair way to do it.

"3. Training of school staff to manage any complex health condition (diabetes, seizures, tube feedings, etc.) is not accomplished in a "20 minute cram session." Planning begins way in advance and includes parents, students, health care providers, school nurse, administration and the individuals identified by the school to be the caregivers. Extensive plans are made. Teaching takes hours, days and sometimes weeks, under the direct supervision of the nurse."

Isn't this the point? That it is not a simple process? I think most teachers are capable of being nurses much less capable of being trained on certain conditions but shouldn't they be spending those hours, days, weeks studying things like curricula, classroom management, the latest research in educational techniques...

In the meantime, a doctor's order for tums prn by my son could not be administered any school staff other than the school nurse. If he needed it on the days she wasn't in his building, he could call and I could go in and hand it to him. This was when he was old enough to have handled it himself if he'd been allowed to have them on school grounds. If this is seriously considered, it would be nice to see some form of sense applied to the issue.

klocl specializes in Community Health, Clinical Instructor.

I am a school nurse and it is this type of downgrading of our knowledge and expertise that is leading to the demise of school nursing as a specialty across the country. The federal "ideal" ratio is one nurse to 750 students; I work in a district with one nurse to 5000 students and this is why! Our nursing organizations need to stand up for nursing everywhere. It would be unheard of to have "housekeeping staff" in a hospital deal with a diabetic insulin pump!

RN Dave specializes in Critical Care.

Ross said there's a big difference between asking a teacher to inject her son with syringe and simply punching numbers into an insulin pump keypad based on what he eats for lunch on any given day.

"I don't need a nurse to help us manage our diabetes," Ross said.

Wow! This quote from the mother frightens me. If she truly believes that all that is needed is just to push a few buttons, then her understanding of diabetes is woefully inadequate. We can teach a monkey to give an injection. That's simply a motor task. Does she not understand the ramifications of giving insulin? Monitoring blood sugar? Managing the minutia of a young child's diabetic condition? That frightens me far more than whether his care at school is managed by a nurse, teacher or paraprofessional.

I've worked as a school nurse in a district where no building had a nurse 100% of the time. We followed state BON guidelines to train unlicensed staff and faculty to manage first aid, medications, and the care of children with chronic conditions including diabetes. With motivated nurses, staff, parents and students, it can be done and it can work very well.

I don't quite understand whether this boy attends a private or public school. If it is a private school, this may be a moot point. In many instances, private schools simply have the legal right to decline involvement in the medical care of students.

In public schools, the Rehabilitation Act of 1973 and the Individuals with Disabilities Act (IDEA) require that the needs of students with disabilities be met as fully as those students without disabilities, that students with disabilities be provided with a free and appropriate public education in the least restrictive environment possible.

I think these requirements could be used to argue that the child should receive assistance to manage his condition in his current school.

As much as I hate the apparent "entitlement" attitude and ignorance of the mother regarding her son's diabetes, the law may be on her side.

It depends... California had already been thru this, letting teachers give insulin, until it was stopped by the state, because the nurse practice act in California clearly makes administering insulin the duty of a Registered Nurse, not teachers... It should make no difference if it is given via injection or pump...

So it is more expensive to provide nursing to allow the child to go to the special school that he qualified for. Well it cost more to educate the mentally handicapped why should we waste our money on those losers? What about the extra money and resources that poverty level schools require? Isn't that a waste with all the drop outs why should we try? It is very easy to say well just let him go the vanilla school. Why does he need the special school? For the same reasons any one else does. The district does not get to say that he is too sick to get the best education allowable. The school needs to provide a nurse to take care not just of this student but others who would like to go but can not under the current conditions. If it is ok to discriminate against one student why not two what about three? When doing math over human victims I was taught by an old Jewish woman that the answer is always that one is too many. Any other answer leads to a road we dare not tread.

Edited by laughing weasel
big fingers

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