Happy Saturday, and welcome back to our weekly advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and educator Wil Dubois.

This week, Wil tackles a question from a very worried D-Mom whose daughter just went back to school, and it's not clear who's really in charge of her D-management during the day. Your assignment: Read on.

{Got your own questions? Email us at AskDMine@diabetesmine.com}Ask-DMine_button


Kelly, T1D mom from Texas, writes: Hello there. I just came across your website in doing some frantic research for my 11-year-old T1D daughter. She's been type 1 for six years and her management has thus far been a near perfect collaboration with her school. However, last Monday she started her middle school career at a new campus—with a new school nurse. To put it politely, the school nurse and I are having some disagreements with regard to diabetes management and our particular management plan. 

I've been told by the nurse, who is an actual licensed RN, things like, "you need to cut the cord," "you have unrealistic expectations," and "I just don't have the time to take care of your daughter like you expect." Floored. I am floored. I've done all the research on my state laws and health and safety codes... but did I mention that my daughter attends private school? Herein lies the problem. I feel even less protected than I would fighting this battle in the public school system. I don't know where to turn from here. My daughter is not yet ready to take full responsibility for her diabetes care at school for 8 hours a day. At what point does this credentialed nurse's license take precedent over the private school system shying away from our Health and Safety Code? Thanks for any advice on where to turn to protect my daughter.

Wil@Ask D'Mine answers: Disclaimer 1: I have the highest admiration for T1D moms, really, I do, but somehow, I always manage to put my foot in my mouth every time I talk to your lot. Disclaimer 2: I'm an adult PWD, so I have it easy compared to you.

But all of that said, I do know many T1D moms and have worked with a number of you clinically, so I think that gives me a right to have an opinion—even if some may disagree.

What I really want to do today is dig deeper into who should be in control, who should "cut the cord," and when that needs to happen. But first, when it comes to money, guns, and lawyers for these kinds of fights, your BFF in the whole wide world is the American Diabetes Association (ADA), specifically their Legal Advocacy wing. JDRF also has some good resources too, so don't count them out, but I'm impressed with ADA's teeth in these kinds of fights.

A number of years ago, we had the opposite problem here in my state. The school nurses association, in my opinion, was holding T1D kids hostage to avoid cuts in personnel. They managed (also IMHO) to abuse our state's weapon laws, using them to prohibit kids from carrying their testing gear in public schools (laws intended to ban knives were used to ban diabetes "sharps"), and these sorry excuses for healthcare workers were insisting that all BG checks and injections had to happen in the nurse's office. This had the effect of taking kids that were completely self-managed and making them dependent on others. Not to mention that this was dangerous, making a hypo kid walk across campus to the school nurse's office is bad medicine in my book.

I was outraged. Well, beyond outraged. There's not a word to describe how pissed off I was. I packed my bags and went tSchool and Diabeteso war. And I can tell you, it got nasty. Really nasty. It took two years, but our side eventually won. And it was the ADA who really gave us the teeth we needed. I remember one of their lawyers telling me that if push came to shove in the state legislature, "I'll fill the room with crying angry mothers in red T-shirts." And that was before all the legal briefs were broken out. Nothing scares a school administrator more than a visit from a bunch of national lawyers with "concerns."

Now, as to the "actual licensed RN" who doesn't have the "time to take care of your daughter," go over her frickin' head. Yes, it would be nice to play friendly in the sandbox, but clearly, that's not going to happen at this point. Go to the very top, and if you don't get satisfaction, then bring the hounds of hell down on their heads.

Oh, and it wouldn't hurt to have the local TV news affiliates on your speed dial, either. Because while you are correct that at a private school you have a little less protection under the law than you do at a public school, private schools find bad PR even more distasteful than public schools do.

So hopefully, that helps with your current fight. Now let's talk about when a little T1 should take the reigns, and who's best qualified to make that decision. First and foremost, we need to acknowledge, that unlike driving, drinking, and voting, there is not a one-size-fits-all age. For one thing, any given 11-year-old T1D will not have had diabetes for the same period of time. Plus, some kids are just naturally more mature than others, and some just have more gumption than their peers.

No bull, just yesterday there were three type 1s and one T1D mom in my office at the clinic. The T1s were myself, a forty-something female, and a 7-year-old girl. My adult "sister" is on a Med-T pump with a CGM, and my little sister is on an OmniPod with a Dexcom. The two ladies were comparing gear. I'm embarrassed to admit, the seven-year-old knew her way around the OmniPod better than I do (and I'm one of their certified trainers). Of course, this is the same child that tried to re-calibrate her CGM into an artificial low so her mom would take her to Dairy Queen...

But I digress. This particular child is well on the road to the Promised Land: Complete Self-Management. I think if we can all look at T1D in kids with our minds, and not our hearts, we can admit that all of our collective efforts should lead to the goal of the child being in total control of his or her diabetes before leaving the nest. That's not going to be an issue with the child I was talking about above, but it is an area where I've tangled with D-moms in the past.

I get it. Really. I do. This is scary shit and we all want to protect our children. But from my clinical perspective (and from the perspective of an adult with the disease) the worst thing a D-mom can do is not let her children grow into their own self-management. I think the over-sheltering of T1D kids is a plague of its own. One that can have fatal consequences just like diabetes itself.

Of course, I'm not saying that this describes you. My 7-year-old patient is an exceptional human being (in the literal sense of the phrase). She's waaaaaaay ahead of the curve, and no, I cannot take credit for this in any way, shape, or form. I'm not that good. It's just the way God made her, and she's also blessed to have a mom who's had amazing judgment in letting her daughter grow into her role. I wouldn't even expect most 11-year-olds to be ready for the burden of full self-management. But you need to get from where you are today to where you need to be, in seven short years. The cord does need to be cut at some point.

But who, exactly, should be in the driver's seat in making that decision? The school nurse? Certainly not. Frankly, she's not qualified. Having "RN" after your name neither makes you a diabetes expert, nor an expert in this child's maturity and diabetes safety level. What about you, mom? Are you qualified to make this judgment? Frankly, I doubt it. You are too close, and your closets are too full of your own darkest fears.

Well then, who the hell should be "in charge" of guiding the progression from mom-in-charge to kid-in-charge?

Can I suggest a Triumvirate? In think it should be the kiddo's endo, an educator who's worked with the kiddo for an extended period of time, and diabetes at schoolparent(s), working together—with input from the kid—that makes this decision. I guess that's more of a Quadumvirate than a Triumvirate, huh?

The clinical team can't do it without the family, and the family is too close to the front lines to think straight. Frankly, for my money, the school nurse has no role here. At all. Her job is to see to it that the management plan of the medical team is followed. She doesn't know enough to make decisions, much less pass judgments.

Like you, I am floored that she would talk to you the way she did after having just met you. Now, I might have a different opinion had she been working with you and your daughter for several years. That's different. At that point, yes, a school nurse's opinion absolutely has validity—equal to that of the child's long-term educator. But that's not what we're seeing her. What we're seeing here is someone who maybe hasn't even met your daughter yet questioning a plan that is thus far working.

So long as you are moving your daughter towards self-management, at any speed that will get you there in time, then you are doing well in my book. I hope you can win your fight with the school, but moral victories don't happen overnight. It's a fight you need to take on, but more for the next mom than for yourself. Frankly, it will take time your daughter doesn't have, and even if you win, how confident will you be that a woman who has said to you, "I just don't have the time to take care of your daughter like you expect," will make the time to do a good job merely because she's been ordered to by management or state law?

Fight the good fight, but as much as I hate to suggest it, the best interest of your daughter might be better served by looking for a different school.



This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.


Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.