Are you planning to start your child on an insulin pump during summer vacation? While this may be a great time to get comfortable with a pump, the next challenge will come when the child returns to school.
What do the school nurse and the education staff of your child’s school know about insulin pump therapy? What should you tell the school system?
School nurses and other personnel who will be in daily contact with the pump user should know how to recognize and manage emergency situations. They need to know basic facts about diabetes and basic facts about the insulin pump.
The key point: Communicate!
Educate the Staff
It’s a good idea to provide fact sheets about the insulin pump and what to do if problems arise. Teachers, coaches, school bus drivers and any adults in contact with your child should know basic information about diabetes management and insulin pump management. They need this knowledge for the safety of your child.
If your child has acquired self-care management skills, give the school a list of the tasks that he or she can perform independently as well as those that require supervision or must be performed by a responsible adult. Be sure to get an extra copy of the pump user’s manual and provide it for reference.
Diabetes educators who are experienced with insulin pump management can offer education sessions for the staff. The educator from the pump manufacturer can also provide this training. Animas, Disetronic and Medtronic/MiniMed can supply educational materials or reference booklets for the school staff (see sidebar on page 68). Many school districts also provide training days for district nurses. You may want to talk to your local representative about speaking at one of these.
If your child is starting a pump before school begins, you will have many follow-up visits to fine-tune blood-glucose control and pump management.
Set up appointments for these visits with the diabetes team before school starts. Ask them to give you copies of the child’s diabetes regimen for the health records maintained at the school. Any changes in insulin therapy doses should also be given to the school health office. If the child is participating in team sports, you’ll usually need a physical examination report.
New Prescriptions to School Nurse
Many schools require signed diabetes management orders for each school year, and many also have a specific form to be completed by the physician. Be sure to get a signed copy to give to the school nurse or health office.
Details about how to manage episodes of low and high blood glucose should be spelled out in the child’s healthcare plan. This plan should also contain provisions for handling specific problems that might occur on field trips, during after-school activities and at other events away from the school location.
The school health office may have certain required forms and documentation standards. However, you might also be asked to provide blood-glucose records specific to insulin pump management. You might find it advantageous to use blood-glucose record forms approved by the diabetes team.
You’ll want to keep a supply box at school that includes the following:
- Snacks (fast-acting carbohydrates such as glucose tablets, glucose gel tubes, juice boxes or cans of non-diet soda pop)
- An insulin pen or a vial of insulin
- Insulin syringes
- Glucose and ketone test strips
- Instructions for treating both hypoglycemia and hyperglycemia
Pack or Purchase Lunch?
To help with carbohydrate counting, obtain copies of the school menu, and estimate the carbohydrate grams and meal bolus for each meal your child will be buying at school. It’s easy to place this information into vinyl page protectors that can be inserted in a three-ring notebook. For lunches that you prepare and pack, you can write carbohydrate and bolus amounts on a 3×5 index card and place the card in the packed lunch (inside a clear sandwich bag or sealed food storage bag), or you can write the amounts on the outside of the lunch bag.
Pack snacks for your child to eat before physical education class or sports activity, if needed. Consider a temporary reduction in your child’s basal rate during physical activity or use an exercise basal program, if one has been established and approved by the diabetes team.
If your child is not skilled enough to make basal rate changes independently, identify and train a responsible adult to make these changes. Don’t forget to update medical identification cards and jewelry.
Consider leaving an extra meter at school. It is one less thing for your child to remember to carry when rushing out the door in the morning.
Be sure to supply extra batteries and maintain fresh strips and control solutions. Provisions for disposal of medical waste (lancets and strips, for instance) vary by state; universal precautions for preventing infection and injury to others will apply. Check with the school health office for specifics.
Barbara A. Bradley, MS, RN, CDE, is a clinical manager for Animas Corporation in Frazer, Pennsylvania. n