ACCOMMODATIONS FOR STUDENTS WITH DIABETES

On October 1, 2009, Governor Corzine signed into law N.J.S.A. 18A:40-12.11-21 which addresses the care of students with diabetes in school. This law updated the 1999 guidelines and requires district boards of education to ensure that students with diabetes can balance food, medications, and physical activity while at school or school-related activities, so their health is not compromised as they access their education. It’s based in the knowledge that students with chronic illnesses require the knowledge and support of a multidisciplinary team including staff from school health services, food services, counseling, physical education, health education, and transportation. The law centers the school nurse as the coordinator and overseer of the student’s care while in school. The school nurse is the most appropriate person in the school setting to provide care for a student with diabetes because the school nurse can coordinate care and educate school staff in the monitoring and treatment of symptoms, develop an individualized health care plan and an individualized emergency health care plan, and consult and coordinate with a student’s parents or guardians and health care provider to establish a safe learning environment.?

What is diabetes??

There are several types of diabetes, but the one we see most often in school-age children is Type 1 Diabetes. If you have Type 1 Diabetes, your pancreas doesn’t make insulin or makes very little insulin. Insulin is a hormone that helps blood sugar enter the cells in your body where it can be used for energy. Without insulin, blood sugar can’t get into cells and instead builds up in the bloodstream and can be very damaging to the body. Type 1 Diabetes (previously called insulin-dependent or juvenile diabetes) is usually diagnosed in children, but it can develop at any age. Diabetes is a serious chronic disease that impairs the body’s ability to use food and must be managed 24 hours a day to avoid the potentially life-threatening consequences of blood sugar levels that are either too high or too low. To manage their disease, students with diabetes must have the ability and support to balance food, medications, and physical activity while at school and school-related activities.

What needs to happen at school?

First, the parent or guardian of the student must inform the school nurse that the student has Diabetes. Then, the school nurse together with the parent and student’s doctor (usually an endocrinologist) must develop an individualized health care plan and an individualized emergency health care plan for the student.?The “individualized health care plan” must be consistent with the recommendations of the student’s doctor to set out the health services needed by the student at school, including safe blood sugar levels, timing of meals and snacks, how to calculate carbohydrates and appropriate insulin dosages, and student-specific symptoms of low and high blood sugar levels.?The?“individualized emergency health care plan” is a set of procedural guidelines that provide specific directions about what to do in emergency situations, including fire drills or lockdowns, and should include how the student will retain access to their medications, food, and water. Both documents should be updated every school year or as often as the student’s medical needs change.?

Health Care Plan Specifics

Each individualized health care plan must include, and each individualized emergency health care plan may include the following information:

???(1)???the symptoms of hypoglycemia for that student and the recommended treatment;

???(2)???the symptoms of hyperglycemia for that student and the recommended treatment;

???(3)???the frequency of blood glucose testing;

???(4)???written orders from the student’s physician or advanced practice nurse outlining the dosage and indications for insulin administration and the administration of glucagon, if needed;

???(5)???times of meals and snacks and indications for additional snacks for exercise;

???(6)???full participation in exercise and sports, and any contraindications to exercise, or accommodations that must be made for that student;

???(7)???accommodations for school trips, after-school activities, class parties, and other school-related activities;

???(8)???education of all school personnel who may encounter the student about diabetes, how to recognize and treat hypoglycemia, how to recognize hyperglycemia, and when to call for assistance;

???(9)???medical and treatment issues that may affect the educational process of the student with diabetes; and

???(10) how to maintain communications with the student, the student’s parent or guardian and health care team, the school nurse, and the educational staff.

There are more requirements, but the development of these plans and training staff to implement them are the primary legal responsibilities of school districts.?

Who Besides the School Nurse Is Involved In Student Care?

Ideally, schools will develop a “school health team.” Some schools may already have a dedicated group of staff that focuses on nutrition and physical activity policies. The school health team would be an expanded version of that group. A school health team is not mandated by law, but New Jersey considers it a best practice because having a team in place to address all school health and wellness issues is generally going to be more efficient than using a more fragmented, issue-driven, or purely student-specific approach. We’ve established that the school nurse is central to effective diabetes care in schools, and the law mandates several actions on the part of the school nurse, but other school personnel play a pivotal role in the student’s ability to manage their disease. Here’s a breakdown of everyone who should be involved.?

School Nurse

1.?????The school nurse is legally required to coordinate diabetes care at school and ensure that appropriate staff are trained in accordance with the individualized health care plan and the individualized emergency health care plan for every student that requires them.

2.?????The school nurse also has the primary responsibility for the emergency administration of glucagon to a student experiencing severe hypoglycemia. The school nurse must also designate, in consultation with the board of education, and train additional employees of the school district who volunteer to administer glucagon in an emergency where the nurse is not physically present.?

3.?????The school nurse must obtain a release from the parent or guardian of a diabetic student to authorize the sharing of medical information between the student’s doctor and school staff.?

The Superintendent and Board?should develop appropriate?policies, ensure that necessary resources and professional development opportunities related to all aspects of diabetes management in the district and its schools and at district and school-sponsored activities are available to all staff.?

The building principal?should establish a school health team, implement emergency protocols and procedures within the school building and on school grounds, work with the?district transportation coordinator to train bus drivers transporting diabetic students to identify hypoglycemia and contact the appropriate people in an emergency, and secure enough staff, funds, and equipment to manage students with diabetes in the school.?

The school physician?should advise school administrators on health issues that impact students with diabetes, be involved in policy or procedural changes to support the health of the school community, especially students with diabetes, consult in the development and implementation of school district policies and procedures, and work with the school nurse to develop and deliver training to volunteer glucagon delegates.?

Volunteer glucagon delegates?must?complete a training program, conducted by the school nurse or other healthcare professional, to manage a specific student’s diabetes care in the event of a hypoglycemic emergency.

The student’s teacher?ensures that individualized educational plans and classroom accommodations reflect the student’s medical needs, participates in student-specific diabetes training, provides a supportive environment for the student, facilitates access to water, snacks, and the bathroom, and explains relevant procedures to other students. A teacher has a very nuanced responsibility to a student with diabetes. They must recognize that a change in a student’s behavior could signal blood glucose changes, provide classroom accommodations as outlined in the student’s 504 plan or IEP if applicable, ensure that a student can make up work missed due to diabetes-related absences, and monitor the student’s emotional well-being.??

The physical education teacher?similarly should engage in on-going communication with the school’s 504 team, IEP team, be able to recognize the signs and symptoms of hypoglycemia and hyperglycemia and respond in accordance with the student’s health care plan. They must understand that hypoglycemia can occur during and after physical activity and have immediate access to a fast-acting form of glucose such as glucose tablets, hard candy, glucose gel, or juice, and participate in professional learning opportunities to remain current about adaptive physical education programs for children with chronic illnesses including diabetes.?

Food services personnel?should understand?nutritional issues that impact students with diabetes, participate in diabetes training,?provide a menu and schedule in advance to parents along with nutrition content, learn about various kinds of diabetes meal and snack plans, recognize that eating meals and snacks on time is a critical part of diabetes management,?and be aware that hypoglycemia can occur before lunch.?

The counselor, social worker or school psychologist?should advise school leadership on social and emotional issues that impact students with diabetes and other chronic illnesses, promote and encourage independence and self-care, recognize that students with chronic illnesses sometimes discontinue all or part of their medical regimen despite their doctor’s advice, and be sensitive to the fact that some students do not wish to share information about their diabetes with other school staff or peers.?

Parents and guardians?must be in consistent contact with the school nurse, providing written authorization for the provision of diabetes care and the sharing of medical information between the student’s physician and school personnel, attend meetings of the school health team, inform the school nurse of any changes in the student’s health status, and provide supplies and equipment including blood glucose monitoring equipment, supplies for insulin administration and ketone testing, an ample supply of snacks and water, a source of fast-acting glucose such as fruit juice or honey, and an emergency glucagon kit.?

The law regulating diabetes care in schools is detailed and multi-faceted. Combined with the state’s best practices, students with diabetes can safely access their education. Unfortunately, schools are not always prepared to carry out their legal obligations, and this can prevent students from being able to attend school safely. One of my proudest moments in my law firm career has been helping a little girl newly diagnosed with Type 1 Diabetes secure the medical care she needed to start Kindergarten. If you need more help understanding this law for your child, your students, or your own clients in New Jersey, please reach out to me.??

DISCLAIMER: The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for individual advice regarding your own situation. This article’s contents, although based on federal laws that apply to all states, also contains specifics about New Jersey laws. Always check your own state’s laws to confirm how federal special education laws apply in your state.