1. DIABETES IN SCHOOL DR. SARAH LAWRENCE PEDIATRIC ENDOCRINOLOGIST CHILDREN’S HOSPITAL OF EASTERN ONTARIO ASSOCIATE PROFESSOR OF PEDIATRICS UNIVERSITY OF OTTAWA

2. WHY IS THIS IMPORTANT? Diabetes is common: 1 in 300 children Diabetes causes significant personal and economic burden Good diabetes control matters Better control of diabetes reduces the risk of both short and long term complications Blood sugar fluctuations affect learning Children spend 30-35 hours per week at school So it is important that efforts to improve diabetes control extend to the time children spend at school

3. How can we improve diabetes control? Attention to diet and exercise More frequent blood glucose (BG) monitoring Intensive insulin treatment (with multiple daily injections or a pump)

5. BUT Young children need help with these tasks Older children may be relatively independent but still need supervision and a place to perform these tasks Kids often come home with uneaten meals and snacks or trade food at school Treats and birthday celebrations are great fun at school but can wreak havoc on the blood sugar of a child with diabetes Varying timing and level of activities also affect blood sugar

7. Diabetes and the law Canadian Charter of Rights and Freedoms: every citizen, including people with disabilities, has the right to equal protection and benefit without discrimination United Nations Convention on the Rights of Persons with Disabilities. All provinces and territories are now bound by the convention which, among other rights, ensures that “effective individualized support measures are provided in environments that maximize academic and social development, consistent with the goal of full inclusion.” Legally, schools must reasonably accommodate the special needs of children, including students with diabetes. Consistent with the right to education, schools should minimize barriers that prevent children from the fullest possible learning experience.

8. WHAT IS THE CURRENT STATUS IN CANADIAN SCHOOLS? Only New Brunswick, Nova Scotia, Quebec and British Columbia have provincial level diabetes policies or guidelines setting minumum standards. In other parts of the country, policies have been developed at the school board level Discrepancies in resources and policy across the country, even among schools in the same jurisdiction The absence of policy could have short and long term health and learning consequences

9. Lack of consistency raises many challenges: No one to help with a blood glucose test or administer insulin or for those very young students who can’t do it on their own Only permitted to blood glucose test in a designated location (i.e. school office, empty classroom, bathroom, designated lunchroom table) Nobody to supervise meals and snacks Snacks may not be permitted in the classroom, gym or during exams

10. WHAT IS NEEDED? Systematic public policy that ensures minimum standards for all schools and for all students living with diabetes Consistent and comprehensive provincial/territorial policy provides safe and fair support for Students Teachers and other school staff Parents

11. WHAT ARE WE ASKING FOR?

12. BASIC EDUCATION FOR ALL STAFF

13. Basic education for all staff Understanding the importance of food, activity, insulin and BG checks How to recognize highs and lows

14. Preventing and treating hypoglycemia Regularly scheduled meals and snacks, and adequate time to consume them Adjusting either food intake or insulin doses for increased physical activity A clean area for blood glucose checks For all children, ready access to their emergency kit

15. ADVANCED TRAINING FOR A SMALL GROUP OF STAFF

16. At least 2 trained staff per school with a student with diabetes BG monitoring Insulin injections Bolus through a pump

17. INDIVIDUAL CARE PLAN

18. Individual care plan Should be developed by the parents, guided by their health care team using a provincial standard form Should be discussed with the principal, teacher and trained staff members The ICP should clearly outline roles and responsibilities of school personnel, parents and the child with diabetes.

19. CONCERNS Teachers worry about: increasing expectations being ill prepared for a student with diabetes in their class General knowledge of diabetes Specific knowledge for their student liability needlestick injury Diabetes health providers and policy makers: who is going to provide this education and how can we ensure it is standardized?

20. What are the next steps? It is our job as the medical team to be sure that the right educational resources are available for both general and more detailed diabetes education a provincial standard form is available to all schools for a Diabetes Individual Care Plan As policy makers, we are asking you to move forward an agenda to ensure supports for students and teachers in school that includes Education of school staff at 2 levels – general diabetes knowledge for all and specific skills for identified staff Identify who should provide standardized education to the school personnel

21. QUESTIONS?

23. SPECIFIC RECOMMENDATIONS

24. An individual care plan (ICP) must be developed for each student with diabetes and discussed among parents or guardians and the school principal (or designate) and teacher, with input from a health care provider as needed. The ICP should clearly outline roles and responsibilities of school personnel, parents and the child with diabetes. Discussions should occur before the start of the school year. Ideally, provincial authorities would make available a standardized form for this purpose. CPS/CPEG Position Statement

25. Each school ensures that at least 2 school personnel are trained to provide support to a student with diabetes Personnel are trained to help check blood sugars or administer insulin, especially for younger children Personnel are trained to recognize low blood sugar (hypoglycemia), which, if left untreated, could lead to loss of consciousness or seizure Meals and snacks are supervised to ensure that they are eaten in full and on time

26. Students are able to test their blood sugar anytime, anywhere, and to be able to eat as needed (whether in class, in the gym, or elsewhere) Students have extra time for exams or tests in the event of an episode of low blood sugar CPS/CPEG Position Statement