School nurse


I am a middle school- school nurse. This may seem like a broad question but if you wanted the school nurse to know one thing about you (it could be anything: you, diabetes, friends, your care while in school, ....) what would it be?

I would want the school nurse to understand enough about type 1 diabetes to know how highs and lows affect the body, mind, behavior. In my experience, most know that high and low are bad, but don't really have an appreciation for the degree or consequences. Our school nurse, for example, freaks out whether Sarah is 50 or 78. If she's 78 at lunchtime, I'm just going to let her eat her lunch and not worry about correcting the low first - if she's 50, she needs to correct the low. Same with highs, understand that 200 is not ideal, but correctable, 600 is time to test for ketones and get the kid some medical help.

A kid at our school last year apparently went MONTHS in the 300-400 range with no intervention except the nurse calling the parents. The problem was, the parents were contributing to the issue because they weren't monitoring. This kid could have gone into a coma and died because no one seemed to understand the seriousness of being in this range daily. I don't know what the criteria is for calling authorities, but in my opinion a kid who is 300 or more for more than a day or two needs some intervention.

As a parent, I would want my middle school nurse to know that puberty and diabetes don't mix.  That if high numbers pop up...know it isn't always that childs "fault" or their parents "fault"  It is Diabetes fault.  Numbers are a map that tell us where to go next.  If you see a random high or low number, please don't be shocked.  The child needs to fix it...and then move on.  Stress, growth, illness, exercise...and a TON of other things affect blood sugars.  As a parent I want you to know that blood, sweat and tears went into that number...and we are unhappy it turned out the way it did too.  But, at the same time...we need to just fix it and brush it off, or diabetes will eat our family alive. 

Thanks for taking the time to ask.  You are a gem in my book! 

I would like for our school nurse to know that no matter what her degree says that I am this childs mother and what I say goes. I would also like to feel like my kids are safe medically at the school.

Awesome question! I am sure you will find lots of information just poking around these forums. Welcome to Juvenation!

That YOU should be the child's first advocate if a teacher handles something wrong related to the child's D care. If a teacher sends a kid who suspects or knows he is low to you without another student or aid to accompany him, then you need to be working with the teacher/administrator to make sure that doesn't happen again for the child's safety. It should not have to fall on the parent to complain if something that is written in the medical plan is not followed by any of the staff. I'd much rather get the update of 'Hey, this happened today, which didn't follow the plan, but I have already taken these steps to make sure it doesn't happen again."

If you work with a child and parents who have good practices that make it easier for all of you to manage care, by all means share those general methods with families that are newly diagnosed, but be respectful of how the parents want to manage it. For instance, I've established with my son's teachers - what/then scenarios that are all written down (it is about 3 sheets of paper) so they know what to do for low BG before lunch, high BG any time. I also established on 1 sheet, when they should call - call below 50 or 300, otherwise treat as laid out in the plan. I could see you suggesting to new parents that this is how other families manage it and but they can set the numbers at whatever they are comfortable with for their child.

That's wonderful to see you reaching out!! I bet a lot of parents on here wish they could clone you for their child's school. (;

Unlike most diseases, type 1 isn't a "professional-controlled" disease, like cholesterol, where the doctor tests your level, and decides to give a certain amount of medication. With diabetes, the patient and her family most make daily (really hourly!) changes to food, medications (i.e., insulin), exercise, etc. I think middle school is a time where the student should be taking more responsibility for their own care, but at the same time, due to maturity and the hormones of puberty, needs to be well monitored by parents and professionals. So, I'd think of it as a support role where you support the family and student and also a role where you act as an advocate at the school.

I also wanted to agree with the previous person who mentioned that numbers DO get out of whack, and blame never helps. Believe me, the person feels bad enough as it is due to internal guilt! I've developed an extremely Type A personality after living with this disease since 1982 and am extremely careful about my health. Yet, every single day, I have an "out of range" number (or some days more than one!). Is it because I didn't follow what I was "supposed" to do? Rarely! Maybe I miscalculated something or made a mistake. But, usually it's just a random event. When your body makes no insulin, with today's medical knowledge, it's impossible for us to achieve the same blood glucose control as a non-diabetic. So, if a number is out of range, it's important to correct it right away and then move on...

Thanks for your interest!

I think the most important thing for a school nurse to know is that there is no "set" of rules regarding a child with T1. The  childs insulin sensitivity factor, if high, will be completely different than what may be in a textbook. The instructions from the parent and the  child (depending on the age) should be what goes.

I also agree that it is the worst thing in the world to accuse a child of "cheating" when the blood sugar changes are simply due to hormones. Especially if the kid has had it for years, he/she is probably more knowledgeable than the nurse.



Read "Think Like a Pancreas; A Practical Guide to Managing Diabetes with Insulin."

This is a practical guide to dealing with the realities of dealing with diabetes and using insulin. It was not written as a medical book, but rather as a practical guide. It provides a first person and CDE view of dealing with all of the aspects and challenges of managing D with insulin.

I have had T1D for 40 years, have an A1c of  5.8 and have no diabetes complications. 

The other would be to have meet informally with the parents and possibly their children with T1D. Maybe an evening session at the school to provide a forum for the parents and possibly the kids to state what their biggest worries, challenges or successes are with T1D. Get them in a room together and you would be amazed at what comes out to help you better deal with the kids at school. 

Kudos for posting the question and being open for the info.

Thanks for this interesting information. Really helpful