Children, Insulin, and Schools

There is an issue that has been in the courts for a number of years. Essentially the question is as to whether a not health care professional should be allowed to administer a preset dose of insulin to a child with diabetes in a school setting. If there is a nurse on site the question is moot. Many forces bear down on this issue. The appropriate union wants to have a nurse at every site and decries an alternative. There are implied liability issues. Ultimately the question really comes down to what happens outside of school. If you think about it, well over 95 percent of all insulin injections are administered by lay people. It may be the child, a parent, a sibling, a grandparent or someone else in the home who has learned what to do.

The American Diabetes Association has been the advocate for trained lay people performing this function and I agree. One of the main goals of treatment of diabetes is to allow life to flow as normally as possible, especially in children. Making an insulin injection a major interruption conflicts with this philosophy. In today’s world children learn to test their blood glucose and administer insulin based on a prescribed algorithm. A designated lay person who is willing to take on the role can ascertain that the child’s hands are clean and they or the child can perform a finger stick glucose test. The algorithm (presented by parent or physician or educator) based dose can be administered as suggested. This would be before or even after the midday meal. Very abnormal values can be discussed with responsible parties.

The use of the insulin pen requires only the simple dialing up of a dose of insulin and injecting. It takes away the mystique of the syringe.  People are easily trained to use the pen. Given the increasing number of children with both kinds of diabetes this will be a necessity. Most children who require insulin mature and figure it out at an early age. Larger questions arise with the preschool group. Of course parental cooperation is essential and a parent may elect to come to school to administer insulin daily. Rather than such an adversarial process the various factions should be finding a solution.

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