Q&A: Tips for navigating use of diabetes devices in schools
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Key takeaways:
- School nurses should familiarize themselves with devices used by children with diabetes.
- Children with diabetes may need a medical exemption if they use a device that requires a cellphone.
One of many challenges parents face when their child is diagnosed with diabetes is how the condition will be managed in school, particularly if the child is using a diabetes device.
Diabetes devices, which include continuous glucose monitors, insulin pumps and automated insulin delivery systems, have enormous benefits for children with type 1 diabetes, but managing them in school can sometimes be tricky, according to Christine A. March, MD, MS, assistant professor of pediatrics at the University of Pittsburgh School of Medicine and attending physician in the division of endocrinology at UPMC Children’s Hospital of Pittsburgh. Even for school nurses and staff who have previous experience with children with diabetes, March said technology presents challenges because of differences in the way each device operates, and school nurses or other staff may need specific training to learn about each device.
Another challenge is a recent wave of school districts that are banning the use of cellphones in the classroom. March said parents should know what their school’s policy is and make sure their child has a medical exemption if they have a diabetes device requiring a cellphone.
“There are many states and school districts that are passing cellphone bans,” March told Healio. “We know about the detrimental effects of social media on mental health and the concerns about cellphones being distracting in school. The problem is many diabetes devices rely on a cellphone to be able to interface together or relay information to caregivers. ... This is something that I think is going to be a big conversation this year and next year as these bans take effect.”
Healio spoke with March about the use diabetes devices in schools, how parents of children with diabetes should navigate cellphone bans and how school staff can educate themselves about a student’s diabetes device.
Healio: What is the biggest obstacle children with diabetes face in schools?
March: The biggest and most pressing conversations that we’ve been having in the diabetes community focus on the technology. It is increasingly standard of care at this point is that children are using CGMs, insulin pumps and automated insulin delivery systems. These technologies give us a lot of information, but they also introduce some new challenges in the school setting.
An example is figuring out how to manage the device in the classroom. These technologies will alarm if your blood sugar reaches a certain threshold or if it’s changing too quickly. Some teachers and some students have difficulties navigating how to use those alarms in a way that’ll be helpful for diabetes but also not disruptive to the classroom. If this is a concern, I’d recommend talking to your health care provider for additional guidance on how to set those alarms for the school setting so that they are actionable.
Many devices need access to Wi-Fi to enable remote monitoring of CGM. This is where a student connects their CGM to their parent’s or another caregiver’s smart device so that they can see their sensor readings in real time. A lot of parents have found this to be extremely helpful so that they can see what’s happening and be proactive in managing their child’s diabetes while they’re in school. What comes with that is figuring out how to communicate. Is that parent reaching out to the student directly? Is that parent calling the school nurse or other school staff person or the teacher? Developing those plans for communication in advance can be super helpful as you navigate that new technology in the classroom.
Healio: What should parents do if their child is unable to have a cellphone in school?
March: If parents are having issues ensuring their child can access their cellphone in school for their diabetes, there are different ways they can handle that. One is that that cellphone doesn’t necessarily need to be on their person. It could be sitting at the teacher’s desk. It just has to be within a certain distance of the child based on the type of device.
Additionally, the ADA has made cards that explain why a child with diabetes needs to carry a cellphone. If the child gets stopped by a teacher or somebody else in the school, they can show that they have this medical exemption. Lastly, having access to a cell phone should be part of their written accommodations plan, like a 504 plan. If parents are still encountering barriers, I would encourage them to reach out to the advocacy representatives at the ADA for guidance.
Healio: If a student uses an insulin pump or CGM, how should school nurses familiarize themselves with the technology?
March: There’s been a huge boom in what devices we have available over the past decade, and no two devices are exactly the same. Particularly thinking about the automated insulin delivery systems, the four systems that we have on the market right now all have different types of algorithms and slightly different recommendations for how you should manage insulin dosing. Those are things that school nurses are going to need to know. The first resource for school nurses is the diabetes medical management plan, which should include specifics about the device and insulin dosing. Parents can fill in many gaps, because they have undergone extensive device training and should be able to help support the school nurse.
All of these devices have manuals online with pretty easy go-to resources. Many of them have webinars or short videos that you can watch so you can learn more.
The last option would be to seek out other formal training or resources. Many diabetes centers are offering training in some capacity, whether it be virtual or in-person workshops. There are other resources available through the ADA and National Association of School Nurses.
Healio: Other than the school nurse, what other staff members should be involved in a child’s diabetes management?
March: Anybody who’s going to be teaching or interacting with the student should have an understanding of diabetes management. That’s where the school nurse can really be helpful. They can connect with the teachers and school administrators to make sure that they have basic information about diabetes, and discuss how they are going to communicate back with that school nurse if there’s an issue in the classroom.
The other person would be anybody else who’s designated to give diabetes care in the school setting. Not all states, but many states, have laws permitting school nurses to delegate aspects of diabetes care to trained individuals who are not nurses in the school setting. So if that applies in your state and if somebody else is going to be participating in the care of your student, either if there is no school nurse or in case the school nurse is not available, then that individual obviously needs to have training in the preplanning for diabetes management in school.
References:
- American Diabetes Association. Help for Parents. https://diabetes.org/advocacy/safe-at-school-state-laws/help-for-parents. Accessed Sept. 27, 2024.
- American Diabetes Association. Help for Schools. https://diabetes.org/advocacy/safe-at-school-state-laws/help-for-schools. Accessed Sept. 27, 2024.
- American Diabetes Association. Safe at School. https://diabetes.org/advocacy/safe-at-school-state-laws. Accessed Sept. 27, 2024.
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