Just a few years ago, a child with type 1 diabetes reported to school nurses several times a day that they had stabbed their fingers to see if their blood sugar levels were dangerously high or low.
With the introduction of continuous glucose monitors (CGMs), this is no longer necessary. Small devices attached to arms usually have sensors under the skin that send measurements to apps on mobile phones and other wireless devices. This app shows your blood sugar level at a glance and sounds an alarm when it leaves the normal range.
A blood glucose level too high may require an insulin dose – delivered by injection or touching the button on an insulin pump – stopping potentially life-threatening complications, including loss of consciousness, but juice A bite can improve your blood sugar levels. Prevents problems such as too low, dizziness and seizures.
Schools across the country say teachers are listening to CGM alarms from students' cell phones in classrooms. However, many parents do not guarantee that teachers will hear alarms in busy classrooms, and monitoring the app itself to ensure that their children are safe when they are out of the teacher's ears. They say they'll fall, but they can't do it right away, but contact their kids.
Parents are noted that a nurse or administrative staff at the school remotely monitor the CGM app and that even if students are outside the classroom (rest, noisy lunchroom, or field trip), someone is paying attention. They say they need to make sure they are there.
However, many schools resisted, citing concerns about staff shortages and internet reliability and technical issues with devices. About one-third of the school There are no full-time nursesa 2021 survey by the National Association of School Nurses found that other staff could be trained to monitor CGM.
Caring for children with type 1 diabetes is nothing new to schools. There was no alarm before the CGM indicating the problem. Instead, it was caught on a time-consuming finger induction test, or when the problem progressed and the child showed symptoms of complications.
The surge in insulin pumps allows many children to respond to problems themselves, reducing the need for schools to provide injections.
Parents say they are not asking the school to continuously monitor their child's measurements, but they are asking school adults to ensure that their children respond appropriately.
“People of [school] “We've been working hard to get into the world,” said Julie Caridonio of Lutz, Florida.
Caridonio's son Luke, 12, uses CGM but receives little support from his school, she said. Relying on school staff to listen to the alarm led to cases where no one stepped in to intervene when blood sugar levels dropped to a critical level.
“Why do we have this technology to prevent harm, we have no effect on it,” she said.
Corey Deirdorff, a spokesman for the Pasco County School District where Luke attends school, said in a KFF Health News statement that staff will respond when student CGMs hear the sound of an alert. When asked why the district refused to agree to remotely monitor alarms, he noted concerns about the reliability of the internet.
In September, Karidonio filed a complaint with the US Department of Justice against the district, requiring that schools create accommodation for diabetic students as failing to monitor devices is a violation of the Disability Act. It's there. She is still waiting for a decision.
The complaint comes about four years after the Connecticut US Lawyer's Office determined that it was a “reasonable accommodation” under the ADA for school staff to monitor student CGM. The resolution comes after four students filed complaints against four Connecticut school districts.
“We fought this fight and won this fight,” said Jonathan Chapel, one of two lawyers who filed a complaint in Connecticut. However, the decision has not yet affected out-of-state students, he said.
Chappell and Bonnie Roswig are lawyers and directors of the Advocacy Disability Rights Project for the Nonprofit Center for For Children, who say they have heard from parents in 40 states that they are struggling to remotely monitor their children's CGMs at schools I did. Parents in 10 states filed similar complaints, they said.
Today's CGM is used by most of an estimated 300,000 people in the United States who suffer from type 1 diabetes under the age of 20, health experts say. Also known as juvenile diabetes, it is an autoimmune disease that is usually diagnosed in early childhood and treated with daily insulin to regulate blood glucose levels. It affects Approximately 1 in 400 people According to the American Academy of Pediatrics, under the age of 20.
(CGM is I also use it Different diseases associated with risk factors such as diet and exercise that affect tens of millions of people, including tens of millions of children, are usually diagnosed by people with type 2 diabetes, up to the early teens. Not there. Most people with type 2 diabetes don't take insulin. )
Students with diabetes or other illnesses or disabilities usually have medical plans developed by doctors and receive the support they need in school-approved plans. The accommodation details required to attend school include allowing children to eat in class, staff being trained to check their blood sugar levels and giving them shots of insulin. I'll check.
For children with type 1 diabetes, the plan usually involves monitoring CGM several times a day and responding to alarms, Roswig said.
Lynn Nelson, presidential election for the National Association of School Nurses, says that when doctors and parents decide that students need to remotely monitor CGM, the school is obligated to meet their needs under the ADA. I did. “That's legally necessary and it's right.”
Nelson, who also manages the Washington state school nurses program, said schools need to balance student needs and have adequate administrative staff.
“There are real workforce challenges, but that means schools have to go above and beyond for individual students,” she said.
Henry Rodriguez, a pediatric endocrinologist at the University of South Florida and a spokesman for the American Diabetes Association, said remote surveillance could be challenging for schools. They insist on giving all children what they need to manage diabetes in schools, but schools could be limited by a shortage of support staff, including nurses, he said .
Last year, the association updated its CGMS policy, saying:
In San Diego, pediatric respiratory surgeon Taylor Inman said that his daughter, Ruby, 8, had received little help from public schools after he was diagnosed with type 1 diabetes and began using CGM. Ta.
She says that alerts from Ruby's phone are unprecedented outside the classroom, and always asks someone at school to make sure Ruby reacts when blood sugar levels move into abnormal ranges. It wasn't guaranteed to arrive.
“We kept asking the school to chase after my daughter's CGM and were told they weren't allowed,” she said.
In a 2020 memo to substantive school nurses, Howard Taras, medical advisor to the San Diego Unified School District, says that if a student doctor recommends remote monitoring, parents or doctor's office staff should do so He said.
CGM alarms can be “confusing for staff with student education, classmates and other responsibilities,” Taras wrote.
“Alarms are closely monitored, even alarms that occur outside the classroom,” Susan Burndler, executive director of the Nursing and Wellness District, said in a statement. She said trained adults, including teachers and aides, listen to alarms during class, during breaks, gym classes or field trips.
She said the problem with remote surveillance is that staff at the school's office that monitors may not know where students will immediately lean towards them.
Inman said last year he paid $20,000 for a dog support dog trained to detect hyperglycemia or hypoglycemia and later transferred Ruby to a private school that remotely tracks her CGM. .
“Her blood sugar levels are better controlled, so she can no longer be scared and stressed, and focus on learning,” she said. “She is willing to go to school and thrives.”
Some schools have changed their policies. For over a year, several parents have lobbyed at public schools in Loudoun County, northern Virginia, and have school nurses follow CGM alerts from their wireless devices.
The district committee approved the changes that came into effect in August, affecting about 100 of the district's more than 80,000 students.
Previously, Lauren Valentine received an alert from her 8-year-old son Leo's CGM and called schools in Loudon County, without knowing whether anyone was taking action. Valentine said the school nurses are currently tracking Leo's blood sugar levels from the clinic's iPad.
“It removes responsibility from my son and pressure from the teacher,” she said. “And it gives the nurses at the school clinic a sense of security that they know what's going on.”
This article was created by KFF Health NewsThe National Newsroom is one of the core operating programs that produces detailed journalism on health issues, and is one of the national newsrooms. KFF – Independent sources of health policy research, voting and journalism.
KFF Health News is a national newsroom that produces detailed journalism on health issues, one of KFF's core operating programs and an independent source of health policy research, voting and journalism. Please see more KFF.
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