As students prepare for the start of a new school year, there is a lot of planning that must be done. Students think about courses they have to take, extracurricular activities they want to join, and school supplies they need to buy. Careful coordination and planning with the school nurse, students with diabetes, parents/guardians, and school administrators, can help keep students medically safe in the event of a diabetes-related emergency and provide an environment where students with diabetes can manage their condition effectively.

Diabetes is a complex disease that can occur at any age. Type 1 diabetes develops when the body’s immune system destroys beta cells produced by the pancreas. These are the only cells in the body that make the hormone insulin, which regulates blood glucose. To survive, people with type 1 diabetes must administer insulin via injection or pump. Type 2 diabetes usually develops when cells, primarily within the muscles, liver, and fat tissue, do not use insulin properly. As the need for insulin rises, the pancreas, over time, loses its ability to produce adequate amounts of the hormone (Centers for Disease Control and Prevention [CDC], 2014). In 2012, about 208,000 people younger than 20 years in the United States had diagnosed diabetes (type 1 and type 2) (CDC, 2014).

To maintain glycemic control and to reduce the risk for low (hypoglycemia) or high (hyperglycemia) blood glucose, a student must regularly monitor blood glucose levels, make healthy food choices and monitor food intake, engage in physical activity, take prescribed medications, and, if necessary, inject insulin or use an insulin pump (American Diabetes Association, 2012). Prolonged blood glucose extremes— where hypoglycemia or hyperglycemia occur for extended periods of time—can cause toxic conditions that may result in a diabetic coma and even death. School nurses and other school personnel (e.g., teachers, coaches, bus drivers, security guards, counselors, and school administrators) can play a vital role in keeping students with diabetes medically safe and in facilitating diabetes care in the school setting. Four major actions that school personnel can take to ensure they effectively support students are 1) learning the federal and state laws that protect students with diabetes, 2) receiving the appropriate training needed to assist students with diabetes management and emergencies, 3) working closely with the parents/guardians of students with diabetes to develop an individualized Diabetes Medical Management Plan, and 4) addressing emotional health issues that may arise and making the necessary referrals for additional support or counseling, if needed.

Federal and state laws protect children with diabetes and their families from discrimination in the school setting. These laws specify that schools have a responsibility to help children with diabetes to manage their condition, and that schools cannot discriminate against children with disabilities. Additionally, the laws state that children with diabetes have the right to engage in the same school activities as those without diabetes (American Diabetes Association [ADA], 2015a,b,c). School nurses are encouraged to know these laws to ensure that they are in compliance as they provide care for students. This paper will highlight federal laws; given that state laws about schools and diabetes care vary, school nurses and other school personnel should also review the laws in their state. For more information about state laws and diabetes, please visit: http://www.diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-at-school/legal-protections/state-laws-and-policies.html.

Children with diabetes are protected under four federal laws: 1) Section 504 of the Rehabilitation Act of 1973, 2) the Americans with Disabilities Act, 3) the Individuals with Disabilities Education Act, and 4) the Family Educational Rights and Privacy Act.

School nurses and other school personnel may also want to consider receiving training from a diabetes-trained healthcare professional (i.e., certified diabetes educator) to be prepared to assist students with diabetes in managing their disease and to intervene in the event of an emergency. Three levels of training are essential (ADA, 2012; U.S. Department of Health and Human Services, 2010):

For students with diabetes, the school nurse is encouraged to work with the parents/guardians and the student’s personal diabetes healthcare team to develop a Diabetes Medical Management Plan and an Individualized Health Care Plan (CDC, 2015; U.S. Department of Health and Human Services, 2010). The Diabetes Medical Management Plan is a document that provides the medical orders for a specific student with diabetes. It helps students and school personnel manage diabetes in the school setting and during school-related events (e.g., field trips, sport events). It provides detailed information about:

■ the date of diagnosis,

The Individualized Health Care Plan, which is completed by the school nurse, identifies how the medical orders in the Diabetes Medical Management Plan will be implemented in the school setting. The Individualized Health Care Plan typically includes information about:

■ the student’s routine for blood glucose monitoring (e.g., where to check blood glucose, when it will be checked, and the student’s self-care skills),

To see examples of a Diabetes Medical Management Plan and an Individualized Health Care Plan, please visit: http://www.ndep.nih.gov/media/sample-diabetes-medical-management-plan-508.pdf and http://www.ndep.nih.gov/media/sample-template-individualized-health-care-plan-508.pdf.

In addition to developing the above-mentioned healthcare plans, the school nurse can also help the student with diabetes by creating an emergency care plan for treating hyperglycemia and hypoglycemia and identifying the trained school personnel who can assist in the event of an emergency. These plans are usually made available to all school personnel who have responsibility for students with diabetes, including personnel in the school setting and those with student contact during extracurricular activities (U.S. Department of Health and Human Services, 2010). Federal laws, such as FERPA, permit schools to disclose personal information from education records to appropriate parties, if the knowledge of such information is needed in the event of an emergency and to protect the health or safety of the student with diabetes (U.S. Department of Health and Human Services, 2010).

Having diabetes can be emotionally difficult for students (Owens-Gary, Shea, & Lewis, 2010). Developmentally, children are at a stage in life where they want to fit in and be like their peers. Having a disease like diabetes can make them stand out and feel different, especially if their peers do not understand what diabetes is and the steps that children with diabetes must take to live a healthy life. The school nurse, along with helping students with diabetes manage their illness, can also provide general education for all students to learn about this condition and what must be done on a daily basis for a student with diabetes to keep his or her blood glucose levels under control.

If caring for diabetes becomes emotionally overwhelming, parent/guardian notification and involvement may be needed to refer the student for counseling and support. School nurses may struggle with knowing when it is appropriate to notify parents/guardians about a student who is having an emotionally difficult time with their diabetes. This can be particularly challenging because school nurses may feel obligated to keep the student’s communications with them confidential. To address this issue, schools may consider developing policies and protocols to determine when confidentiality may be broken, so that the student can receive the appropriate medical care needed.

The National Diabetes Education Program (NDEP), jointly sponsored by the Centers for Disease Control and Prevention and the National Institutes of Health, has developed resources for schools and youth that address diabetes management, including a tip sheet for teens that focuses on emotional health and diabetes titled Tips for Teens with Diabetes: Dealing With the Ups and Downs of Diabetes. NDEP has also developed a guide entitled, helping the Student with Diabetes Succeed: A Guide for School Personnel, which includes sections on effective diabetes management, developing and implementing school health plans, and dealing with emotional and social issues. To learn more about these and other resources on diabetes prevention andmanagement , visit the NDEP website at www.YourDiabetesInfo.org or call 1-888-693-NDEP.

Having diabetes can be a daunting experience for students. Children and young adults have to manage their disease and urgent situations that may arise in all settings—where they live, learn, and play. School nurses, other trained school personnel, parents/guardians, and the healthcare team are all essential contributors to help schools provide students with a supportive environment to take care of themselves and their diabetes. With advance planning and established healthcare plans, students with diabetes, like Trish, can feel safe in the school setting.