2013 diabetes care in the school and day care setting

8/14/2019 2013 Diabetes Care in the School and Day Care Setting

1/5

]Diabetes Care in the School and Day CareSettingAMERICAN DIABETES ASSOCIATION

Diabetes is one of the most commonchronic diseases of childhood (1).There are ;215,000 individu-

als ,20 years of age with diabetes intheU.S. (2). The majority of these youngpeople attend school and/or some typeof day care and need knowledgeablestaff to provide a safe school environ-ment. Both parents and the health careteam should work together to provideschool systems and day care providers

with the information necessary to allowchildren with diabetes to participatefully and safely in the school experience(3,4).

DIABETES ANDTHE LAWdFederal laws that protectchildren with diabetes include Section504 of the Rehabilitation Act of 1973(5), the Individuals with Disabilities Edu-cation Act (originally the Education for

All Handicapped Children Act of 1975)(6), and the Americans with Disabilities

Act (7). Under these laws, diabetes hasbeen considered to be a disability, and itis illegal for schools and/or day care cen-ters to discriminate against children withdisabilities. In addition, any school thatreceives federal funding or any facilityconsidered open to the public must rea-sonably accommodate the special needsof children with diabetes. Indeed, federallaw requires an individualized assessmentof any child with diabetes. The requiredaccommodations should be documentedin a written plan developed under the ap-plicable federal law such as a Section 504

Plan or Individualized Education Pro-gram (IEP). The needs of a student withdiabetes should be provided for withinthe childs usual school setting with aslittle disruption to the schools and thechilds routine as possible and allowing

the child full participation in all schoolactivities (8,9).

Despite these protections, children inthe school and day care setting still facediscrimination. For example, some daycare centers may refuse admission tochildren with diabetes, and children inthe classroom may not be provided theassistance necessary to monitor bloodglucose and administer insulin and maybe prohibited from eating needed snacks.

The American Diabetes Association worksto ensure the safe and fair treatment ofchildren with diabetes in the school andday care setting (1015) (www.diabetes.org/schooldiscrimination).

Diabetes care in schoolsAppropriate diabetes care in the school andday care setting is necessary for the childsimmediate safety, long-term well-being,and optimal academic performance. TheDiabetes Control and Complications Trialshowed a signicant link between bloodglucose control and later development ofdiabetes complications, with improvedglycemic control decreasing the risk ofthese complications (16,17). To achieveglycemic control, a child must check bloodglucose frequently, monitor food intake,take medications, and engage in regularphysical activity. Insulin is usually takenin multiple daily injections or through aninfusion pump. Crucial to achieving glyce-mic control is an understanding of the ef-fects of physical activity, nutrition therapy,and insulin on blood glucose levels.

To facilitate the appropriate care of

the student with diabetes, the schoolnurse as well as other school and day carepersonnel must have an understandingof diabetes and must be trained in itsmanagement and in the treatment of dia-betes emergencies (3,18,19,20,34,36).

Knowledgeable trained personnel are es-sential if the student is to avoid the imme-diate health risks of low blood glucose andto achieve the metabolic control requiredto decrease risks for later development ofdiabetes complications (3,20). Studieshave shown that the majority of schoolpersonnel have an inadequate under-standing of diabetes (21,22). Conse-quently, diabetes education must betargeted toward day care providers, teach-

ers, and other school personnel who in-teract with the child, including schooladministrators, school nurses, coaches,health aides, bus drivers, secretaries, etc.(3,20). Current recommendations andup-to-date resources regarding appropri-ate care for children with diabetes in theschool are universally available to allschool personnel (3,23).

The purpose of this position statementis to provide recommendations for themanagement of children with diabetes inthe school and day care setting.

GENERAL GUIDELINES FORTHE CARE OF THE CHILD INTHE SCHOOL AND DAY CARESETTING

I. Diabetes Medical ManagementPlan

An individualized Diabetes Medical Man-agement Plan (DMMP) should be devel-oped by the students personal diabeteshealth care team with input from theparent/guardian. Inherent in this processare delineated responsibilitiesassumed byall parties, including the parent/guardian,the school personnel, and the student(3,24,25). These responsibilities are out-lined in this position statement. In addi-tion, the DMMP should be used as thebasis for the development of written edu-cation plans such as the Section 504 Planor the IEP. The DMMP should address thespecic needs of the child and providespecic instructions for each of the fol-lowing:

c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c

Originally approved 1998. Revised 2008.DOI: 10.2337/dc13-S075 2013 by the American Diabetes Association. Readers may use this article as long as the work is properly

cited,theuse iseducationaland notforprot,and the workis notaltered.See http://creativecommons.org/licenses/by-nc-nd/3.0/for details.

care.diabetesjournals.org DIABETESCARE, VOLUME36, SUPPLEMENT1, JANUARY 2013 S75

P O S I T I O N S T A T E M E N T
http://www.diabetes.org/schooldiscriminationhttp://www.diabetes.org/schooldiscriminationhttp://creativecommons.org/licenses/by-nc-nd/3.0/http://creativecommons.org/licenses/by-nc-nd/3.0/http://creativecommons.org/licenses/by-nc-nd/3.0/http://creativecommons.org/licenses/by-nc-nd/3.0/http://www.diabetes.org/schooldiscriminationhttp://www.diabetes.org/schooldiscrimination


2/5

1. Blood glucose monitoring, includingthe frequency and circumstances re-quiring blood glucose checks, and useof continuous glucose monitoring ifutilized.

2. Insulin administration (if necessary),including doses/injection times pre-scribed for specic blood glucose val-

ues and for carbohydrate intake, thestorage of insulin, and, when appro-priate, physician authorization of par-ent/guardian adjustments to insulindosage.

3. Meals and snacks, including food con-tent, amounts, and timing.

4. Symptoms and treatment of hypogly-cemia (low blood glucose), includingthe administration of glucagon if rec-ommended by the students treatingphysician.

5. Symptoms and treatment of hypergly-cemia (high blood glucose).

6. Checking for ketones and appropriateactions to take for abnormal ketonelevels, if requested by the studentshealth care provider.

7. Participation in physical activity.8. Emergency evacuation/school lock-

down instructions.

A sample DMMP (http://professional.diabetes.org/DMMP) may be accessedonline and customized for each individ-ual student. For detailed information onthe symptoms and treatment of hypogly-

cemia and hyperglycemia, refer to Medi-cal Management of Type 1 Diabetes(26). Abrief description of diabetes targeted toschool and day care personnel is includedin the APPENDIX; it may be helpful to in-clude this information as an introductionto the DMMP.

II. Responsibilities of the variouscare providers

A. The parent/guardian should providethe school or day care provider withthe following:

1. All materials, equipment, insulin,and other medication necessary fordiabetes care tasks, including bloodglucose monitoring, insulin admin-istration (if needed), and urine orblood ketone monitoring. The par-ent/guardian is responsible for themaintenance of the blood glucosemonitoring equipment (i.e., cleaningand performing controlled testingper the manufacturers instructions)and must provide materials necessary

to ensure proper disposal of materials.A separate logbook should be kept atschool with the diabetes supplies forthe staff or student to record bloodglucose and ketone results; blood glu-cose values should be transmitted tothe parent/guardian for review as oftenas requested. Some students maintain a

record of blood glucose results in me-ter memory rather than recording in alogbook, especially if the same meter isused at home and at school.

2. The DMMP completed and signed bythe students personal diabetes healthcare team.

3. Supplies to treat hypoglycemia, in-cluding a source of glucose and a glu-cagon emergency kit, if indicated inthe DMMP.

4. Information about diabetes and theperformance of diabetes-relatedtasks.

5. Emergency phone numbers for theparent/guardian and the diabeteshealth care team so that the schoolcan contact these individuals withdiabetes-related questions and/or dur-ing emergencies.

6. Information about the students meal/snack schedule. The parent shouldwork with the school during theteacher preparation period before thebeginning of the school year or beforethe student returns to school after di-agnosis to coordinate this schedule

with that of theother students as closelyas possible. For young children, in-structions should be given for whenfood is provided during school partiesand other activities.

7. In most locations, and increasingly, asigned release of condentiality fromthe legal guardian will be required sothat the health care team can com-municate with the school. Copiesshould be retained both at the schooland in the health care professionalsofces.

B. The school or day care providershould provide the following:

1. Opportunities for the appropriatelevel of ongoing training and diabeteseducation for the school nurse.

2. Training for school personnel as fol-lows: level 1 training for all schoolstaff members, which includes a basicoverview of diabetes, typical needsof a student with diabetes, recogni-tion of hypoglycemia and hyper-glycemia, and who to contact for

help; level 2 training for school staffmembers who have responsibilityfor a student or students with di-abetes, which includes all contentfrom level 1 plus recognition andtreatment of hypoglycemia and hy-perglycemia and required accom-modations for those students; and

level 3 training for a small group ofschool staff members who will per-form student-specic routine andemergency care tasks such as bloodglucose monitoring, insulin adminis-tration, and glucagon administrationwhen a school nurse is not availableto perform these tasks and whichwillinclude level 1 and 2 training as well.

3. Immediate accessibility to the treat-ment of hypoglycemia by a knowl-edgeable adult. The student shouldremain supervised until appropriatetreatment has been administered,and the treatment should be availableas close to where the student is aspossible.

4. Accessibility to scheduled insulin attimes set out in the students DMMPas well as immediate accessibility totreatment for hyperglycemia includinginsulin administration as set out by thestudents DMMP.

5. A location in the school that providesprivacy during blood glucose moni-toring and insulin administration, ifdesired by the student and family, or

permission for the student to checkhis or her blood glucose level andtake appropriate action to treat hy-poglycemia in the classroom or any-where the student is in conjunctionwith a school activity, if indicated inthe students DMMP.

6. School nurse and back-up trainedschool personnel who can checkblood glucose and ketones and ad-minister insulin, glucagon, and othermedications as indicated by the stu-dents DMMP.

7. School nurse and back-up trainedschool personnel responsible for thestudent who will know the scheduleof the students meals and snacks andwork with the parent/guardian tocoordinate this schedule with that ofthe other students as closely as pos-sible. This individual will also notifythe parent/guardian in advance ofany expected changes in the schoolschedule that affect the studentsmeal times or exercise routine andwill remind young children of snacktimes.

S76 DIABETESCARE, VOLUME36, SUPPLEMENT 1, JANUARY 2013 care.diabetesjournals.org

Position Statement
http://professional.diabetes.org/DMMPhttp://professional.diabetes.org/DMMPhttp://professional.diabetes.org/DMMPhttp://professional.diabetes.org/DMMP


3/5

8. Permission for self-sufcient and ca-pable students to carry equipment,supplies, medication, and snacks; toperform diabetes management tasks;and to have cell phone access to reachparent/guardian and health careprovider.

9. Permission for the student to see theschool nurse and other trainedschool personnel upon request.

10. Permission for the student to eat asnack anywhere, including the class-room or the school bus, if necessary toprevent or treat hypoglycemia.

11. Permission to miss school withoutconsequences for illness and requiredmedical appointments to monitor thestudents diabetes management. Thisshould be an excused absence with adoctors note, if required by usualschool policy.

12. Permission for the student to use therestroom and have access to uids(i.e., water) as necessary.

13. An appropriate location for insulinand/or glucagon storage, if neces-sary.

14. A plan for the disposal of sharpsbased upon an agreement with thestudents family, local ordinances,and Universal Precaution Standards.

15. Information on serving size and ca-loric, carbohydrate, and fat contentof foods served in the school (27).

The school nurse should be the key co-ordinator and provider of care and shouldcoordinate the training of an adequatenumber of school personnel as speciedabove and ensure that if the school nurse isnot present at least one adult is presentwho is trained to perform these proce-dures in a timely manner while thestudent is at school, on eld trips, par-ticipating in school-sponsored extracur-ricular activities, and on transportationprovided by the school or day carefacility. This is needed in order to enablefull participation in school activities(3,18,20). These school personnelneed not be health care professionals(3,9,20,28,33,35).

It is the schools responsibility to pro-vide appropriate training of an adequate

number of school staff on diabetes-relatedtasks and in the treatment of diabetesemergencies. This training should be pro-vided by the school nurse or anotherqualied health care professional with ex-pertise in diabetes. Members of the stu-dents diabetes health care team shouldprovide school personnel and parents/

guardians with educational materialsfrom the American Diabetes Associationand other sources targeted to school per-sonnel and/or parents. Table 1 includes alisting of appropriate resources.

III. Expectations of the student indiabetes careChildren and youth should be allowed toprovide their own diabetes care at schoolto the extent that is appropriate based onthe students development and his or herexperience with diabetes. The extent ofthe students ability to participate in di-abetes care should be agreed upon by theschool personnel, the parent/guardian,and the health care team, as necessary.The ages at which children are able toperform self-care tasks are variable anddepend on the individual, and a child scapabilities and willingness to provideself-care should be respected (18).

1. Toddlers and preschool-aged children:unable to perform diabetes tasks in-dependently and will need an adult toprovide all aspects of diabetes care.

Many of these younger children willhave difculty in recognizing hypo-glycemia, so it is important that schoolpersonnel are able to recognize andprovide prompt treatment. However,children in this age range can usuallydetermine which nger to prick, canchoose an injection site, and are gen-erally cooperative.

2. Elementary schoolaged children: de-pending on the length of diagnosisand level of maturity, may be able toperform their own blood glucosechecks, but usually will require su-pervision. Older elementary schoolaged children are generally beginningto self-administer insulin with super-vision and understand the effect ofinsulin, physical activity, and nutritionon blood glucose levels. Unless thechild has hypoglycemic unawareness,he or she should usually be able to letan adult know when experiencing hy-poglycemia.

3. Middle school and high schoolagedchildren: usually able to provide self-care depending on the length of

Table 1dResources for teachers, child care providers, parents, and health professionals

Helping the Student with Diabetes Succeed: A Guide for School Personnel. National Diabetes EducationProgram, 2010. Available at http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=97#main

Diabetes Care Tasks at School: What Key Personnel Need to Know. Alexandria, VA, AmericanDiabetes Association, 2008. Available at http://shopdiabetes.org/58-diabetes-care-tasks-at-

school-what-key-personnel-need-to-know-2010-edition.aspx

Your School & Your Rights: Protecting Children with Diabetes Against Discrimination in Schools andDay Care Centers. Alexandria, VA, American Diabetes Association, 2005 (brochure). Availableat http://www.diabetes.org/assets/pdfs/schools/your-school-your-right-2010.pdf*

Children with Diabetes: Information for School and Child Care Providers. Alexandria, VA, AmericanDiabetesAssociation, 2004(brochure).Available at http://shopdiabetes.org/42-children-with-

diabetes-information-for-school-and-child-care-providers.aspx*

ADAsSafe at Schoolcampaign and information on how to keep children with diabetes safe atschool. Call 1-800-DIABETES and go to http://www.diabetes.org/living-with-diabetes/

parents-and-kids/diabetes-care-at-school/

American Diabetes Association: Complete Guide to Diabetes. Alexandria, VA, American Diabetes

Association, 2011. Available at http://www.shopdiabetes.org/551-American-Diabetes-

Association-Complete-Guide-to-Diabetes-5th-Edition.aspx

American Diabetes Association: Guide to Raising a Child With Diabetes, 3rd ed.Alexandria, VA,American Diabetes Association, 2011. Available at http://www.shopdiabetes.org/548-ADA-

Guide-to-Raising-a-Child-with-Diabetes-3rd-Edition.aspx

Clarke W: Advocating for the child with diabetes. Diabetes Spectrum12:230236, 1999School Discrimination Resources. Alexandria, VA, American Diabetes Association, 2006. Available

at http://www.diabetes.org/living-with-diabetes/know-your-rights/discrimination/school-

discrimination/*

Every Day Wisdom: A Kit for Kids with Diabetes (and their parents). Alexandria, VA, American

Diabetes Association, 2000. Available at http://www.diabetes.org/living-with-diabetes/parents-

and-kids/everyday-wisdom-kit-nov-dec-2012.html?loc=rightrail1_wisdomkit_evergreen

ADAsPlanet D, online information for children and youth with diabetes. Available at http://www.diabetes.org/living-with-diabetes/parents-and-kids/planet-d/

*Available in the American Diabetes Associations Education Discrimination Packet by calling 1-800-DIABETES.


Position Statement
http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=97#mainhttp://shopdiabetes.org/58-diabetes-care-tasks-at-school-what-key-personnel-need-to-know-2010-edition.aspxhttp://shopdiabetes.org/58-diabetes-care-tasks-at-school-what-key-personnel-need-to-know-2010-edition.aspxhttp://www.diabetes.org/assets/pdfs/schools/your-school-your-right-2010.pdfhttp://shopdiabetes.org/42-children-with-diabetes-information-for-school-and-child-care-providers.aspxhttp://shopdiabetes.org/42-children-with-diabetes-information-for-school-and-child-care-providers.aspxhttp://www.diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-at-school/http://www.diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-at-school/http://www.shopdiabetes.org/551-American-Diabetes-Association-Complete-Guide-to-Diabetes-5th-Edition.aspxhttp://www.shopdiabetes.org/551-American-Diabetes-Association-Complete-Guide-to-Diabetes-5th-Edition.aspxhttp://www.shopdiabetes.org/548-ADA-Guide-to-Raising-a-Child-with-Diabetes-3rd-Edition.aspxhttp://www.shopdiabetes.org/548-ADA-Guide-to-Raising-a-Child-with-Diabetes-3rd-Edition.aspxhttp://www.diabetes.org/living-with-diabetes/know-your-rights/discrimination/school-discrimination/http://www.diabetes.org/living-with-diabetes/know-your-rights/discrimination/school-discrimination/http://www.diabetes.org/living-with-diabetes/parents-and-kids/everyday-wisdom-kit-nov-dec-2012.html?loc=rightrail1_wisdomkit_evergreenhttp://www.diabetes.org/living-with-diabetes/parents-and-kids/everyday-wisdom-kit-nov-dec-2012.html?loc=rightrail1_wisdomkit_evergreenhttp://www.diabetes.org/living-with-diabetes/parents-and-kids/planet-d/http://www.diabetes.org/living-with-diabetes/parents-and-kids/planet-d/http://www.diabetes.org/living-with-diabetes/parents-and-kids/planet-d/http://www.diabetes.org/living-with-diabetes/parents-and-kids/planet-d/http://www.diabetes.org/living-with-diabetes/parents-and-kids/everyday-wisdom-kit-nov-dec-2012.html?loc=rightrail1_wisdomkit_evergreenhttp://www.diabetes.org/living-with-diabetes/parents-and-kids/everyday-wisdom-kit-nov-dec-2012.html?loc=rightrail1_wisdomkit_evergreenhttp://www.diabetes.org/living-with-diabetes/know-your-rights/discrimination/school-discrimination/http://www.diabetes.org/living-with-diabetes/know-your-rights/discrimination/school-discrimination/http://www.shopdiabetes.org/548-ADA-Guide-to-Raising-a-Child-with-Diabetes-3rd-Edition.aspxhttp://www.shopdiabetes.org/548-ADA-Guide-to-Raising-a-Child-with-Diabetes-3rd-Edition.aspxhttp://www.shopdiabetes.org/551-American-Diabetes-Association-Complete-Guide-to-Diabetes-5th-Edition.aspxhttp://www.shopdiabetes.org/551-American-Diabetes-Association-Complete-Guide-to-Diabetes-5th-Edition.aspxhttp://www.diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-at-school/http://www.diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-at-school/http://shopdiabetes.org/42-children-with-diabetes-information-for-school-and-child-care-providers.aspxhttp://shopdiabetes.org/42-children-with-diabetes-information-for-school-and-child-care-providers.aspxhttp://www.diabetes.org/assets/pdfs/schools/your-school-your-right-2010.pdfhttp://shopdiabetes.org/58-diabetes-care-tasks-at-school-what-key-personnel-need-to-know-2010-edition.aspxhttp://shopdiabetes.org/58-diabetes-care-tasks-at-school-what-key-personnel-need-to-know-2010-edition.aspxhttp://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=97#main


4/5

diagnosis and level of maturity butwill always need help when experi-encing severe hypoglycemia. Inde-pendence in older children should beencouraged to enable the child tomake his or her decisions about his orher own care.

Students competence and capabilityfor performing diabetes-related tasks areset out in the DMMP and then adapted tothe school setting by the school healthteam and the parent/guardian. At all ages,individuals with diabetes may requirehelp to perform a blood glucose checkwhen the blood glucose is low. In addi-tion, many individuals require a reminderto eat or drink during hypoglycemia andshould not be left unsupervised until suchtreatment has taken place and the bloodglucose value has returned to the normalrange. Ultimately, each person with di-abetes becomes responsible for all aspectsof routine care, and it is important forschool personnel to facilitate a student inreaching this goal. However, regardlessof a students ability to provide self-care,help will always be needed in the eventof a diabetes emergency.

MONITORING BLOODGLUCOSE IN THECLASSROOMdIt is best for a stu-dent with diabetes to monitor blood glu-cose levels and respond to the results as

quickly and conveniently as possible.This is important to avoid medical prob-lems being worsened by a delay inmonitoring and treatment and to mini-mize educational problems caused bymissing instruction in the classroom.

Accordingly, as stated earlier, a studentshould be permitted to monitor his orher blood glucose level and take appro-priate action to treat hypoglycemia andhyperglycemia in the classroom or any-where the student is in conjunctionwith a school activity, if preferred bythe student and indicated in the stu-dent s DMMP (3,24). However, somestudents desire privacy for blood glu-cose monitoring and other diabetescare tasks, and this preference shouldalso be accommodated.

In summary, with proper planningand the education and training of schoolpersonnel, children and youth with di-abetes can fully participate in the schoolexperience. To this end, the family, thehealth care team, and the school shouldwork together to ensure a safe learningenvironment.

APPENDIX

Background information ondiabetes for school personnelDiabetes is a serious, chronic disease thatimpairs the bodys ability to use food.Insulin, a hormone produced by thepancreas, helps the body convert food

into energy. In people with diabetes, ei-ther the pancreas does not make insulinor the body cannot use insulin properly.

Without insulin, the bodys main energysourcedglucosedcannot be used as fuel.Rather, glucose builds up in the blood.Over many years, high blood glucoselevels can cause damage to the eyes, kid-neys, nerves, heart, and blood vessels.

The majority of school-aged youthwith diabetes have type 1 diabetes. Peoplewith type 1 diabetes do not produce in-sulin and must receive insulin through

either injections or an insulin pump. In-sulin taken in this manner does not curediabetes and may cause the studentsblood glucose level to become danger-ously low. Type 2 diabetes, the mostcommon form of the disease, typicallyaficting obese adults, has been shown tobe increasing in youth. This may be dueto the increase in obesity and decrease inphysical activity in young people. Stu-dents with type 2 diabetes may be able tocontrol their disease through diet andexercise alone or may require oral medi-

cations and/or insulin injections. Allpeople with type 1 and type 2 diabetesmust carefully balance food, medica-tions, and activity level to keep bloodglucose levels as close to normal as pos-sible.

Low blood glucose (hypoglycemia) isthe most common immediate healthproblem for students with diabetes. Itoccurs when the body gets too much in-sulin, too little food, a delayed meal, ormore than the usual amount of exercise.Symptoms of mild to moderate hypogly-cemia include tremors, sweating, light-

headedness, irritability, confusion, anddrowsiness. In younger children othersymptoms may include inattention, fallingasleep at inappropriate times, unexplainedbehavior, and temper tantrums. A studentwith this degree of hypoglycemia willneed to ingest carbohydrates promptlyand may require assistance. Severe hypo-glycemia, which is rare, may lead to un-consciousness and convulsions andcan belife-threatening if not treated promptlywith glucagon as per the students DMMP(18,24,29,30,31).

High blood glucose (hyperglycemia)occurs when thebody getstoo little insulin,too much food, or too little exercise; it mayalso be caused by stress or an illness suchas a cold. The most common symptomsof hyperglycemia are thirst, frequent uri-nation, and blurry vision. If untreatedover a period of days, hyperglycemia and

insufcient insulin can lead to a seriouscondition called diabetic ketoacidosis(DKA), which is characterized by nausea,vomiting, and a high level of ketones in theblood and urine. For students using insulininfusion pumps,lackof insulinsupply maylead to DKA more rapidly. DKA can be life-threatening and thus requires immediatemedical attention (32).

AcknowledgmentsdThe American DiabetesAssociation thanks the members of the Health

CareProfessionalVolunteer Writing Group forthis updated statement: William Clarke, MD;Larry C. Deeb, MD; Paula Jameson, MSN,ARNP, CDE; Francine Kaufman, MD; Geor-geanna Klingensmith, MD; Desmond Schatz,MD; Janet H. Silverstein, MD; and Linda M.Siminerio, RN, PhD, CDE.

References1. American Diabetes Association:American

Diabetes Association Complete Guide to Di-abetes. 5th ed. Alexandria, VA, AmericanDiabetes Association, 2011

2. Centers for Disease Control and Pre-vention: National Diabetes Fact Sheet: Na-tional Estimates and General Informationon Diabetes and Prediabetes in the UnitedStates, 2011. Atlanta, GA, U.S. Departmentof Health and Human Services, Centers forDisease Control and Prevention, 2011

3. National Institutes of Health: Helping theStudent with Diabetes Succeed: A Guide forSchool Personnel. Bethesda, MD, NationalDiabetes Education Program (NIH pub-lication no. 10-5217, revised September2010)

4. Nabors L, Troillett A, Nash T, Masiulis B:School nurse perceptions of barriers and

supports for children with diabetes.J SchHealth75: 119124, 20055. 504 of the Rehabilitation Act of 1973, 29

U.S.C. 794, implementing regulations at35 CFR Part 104

6. Individuals with Disabilities EducationAct, 20 U.S.C. 1400 et seq., implementingregulations at 34 CRF Part 300

7. Title II of the Americans with DisabilitiesAct of 1990, 42 U.S.C. 12134 et seq., im-plementing regulations at 28 CFR Part 35

8. Rapp J: Students with diabetes in schools.In Inquiry & Analysis. Alexandria, VA,National School Boards Association Councilof School Attorneys, June 2005

S78 DIABETESCARE, VOLUME36, SUPPLEMENT 1, JANUARY 2013 care.diabetesjournals.org

Position Statement


5/5

9. Arent S, Kaufman F: Federal laws anddiabetes management at school. SchoolNurse News, November 2004

10. Jesi Stuthard and ADA v. KindercareLearning Centers, Inc. Case no. C2-96-0185 (USCD South Ohio 8/96)

11. Calvin Davis and ADA v. LaPetite Academy,Inc. Case no. CIV97-0083-PHX-SMM(USCD Arizona 1997)

12. Agreement, Loudoun County PublicSchools (VA) and the Ofce for CivilRights, United States Department of Ed-ucation (Complaint nos. 11-99-1003, 11-99-1064, 11-99-1069, 1999)

13. Henderson County (NC) Pub. Schls.,Com-plaint no. 11-00-1008, 34 IDLER 43(OCR 2000)

14. Rapp J, Arent S, Dimmick B, Jackson C:Legal Rights of Students with Diabetes. 2nded. Alexandria, VA, American DiabetesAssociation,October2005, updated October2009. Available from http://www.diabetes.org/living-with-diabetes/know-your-rights/for-lawyers/education-materials-for-lawyers/

legal-rights-of-students-with-diabetes.html

15. Greene MA: Diabetes legal advocacycomes of age. Diabetes Spectr 19: 171179, 2006

16. Diabetes Control and Complications TrialResearch Group: Effect of intensive di-abetes treatment on the development andprogression of long-term complications ininsulin-dependent diabetes mellitus. NEngl J Med329: 977986, 1993

17. Diabetes Control and Complications TrialResearch Group: Effect of intensive di-abetes treatment on the development andprogression of long-term complications inadolescentswithinsulin-dependentdiabetesmellitus.J Pediatr125: 177188, 1994

18. American Diabetes Association: Care ofchildren and adolescents with type 1 di-abetes (Position Statement).Diabetes Care28: 186212, 2005

19. Barrett JC, Goodwin DK, Kendrick O:Nursing, food service, and the child withdiabetes.J Sch Nurs18: 150156, 2002

20. Jameson P: Developing diabetes trainingprograms for school personnel. SchoolNurse News, September 2004

21. Wysocki T, Meinhold P, Cox DJ, ClarkeWL: Survey of diabetes professionalsregarding developmental charges in di-

abetes self-care.Diabetes Care13: 6568,1990

22. Lindsey R, Jarrett L, Hillman K: Elemen-tary schoolteachersunderstanding of di-abetes.Diabetes Educ13: 312314, 1987

23. American Diabetes Association: DiabetesCare Tasks at School: What Key PersonnelNeed to Know. Alexandria, VA, AmericanDiabetes Association, 2008. Available fromhttp://www.diabetes.org/assets/pdfs/schools/forward2008.pdf

24. Jameson P: Helping students with di-abetes thrive in school. In On the Cut-ting Edge, American Dietetic AssociationsDiabetes Care and Education Practice

Group Newsletter. Summer 2006, p. 2629

25. Owen S: Pediatric pumpsdbarriers andbreakthroughs. Pediatric Pumps32 (Suppl.1), January/February 2006

26. American Diabetes Association: MedicalManagement of Type 1 Diabetes. 6th ed.Kaufman F, Ed. Alexandria, VA, AmericanDiabetes Association, 2012

27. Accommodating Children with Special DietaryNeeds in the School Nutrition Program:Guidance for School Food Service Staff.Washington, DC, U.S. Department of Ag-riculture Food and Nutrition Service, 2001

28. American Diabetes Association: Safe atSchool Campaign Statement of Principlesendorsed by American Academy of Pedi-atrics, American Association of ClinicalEndocrinologists, American Associationof Diabetes Educators, American Dia-betes Association, American Dietetic

Association, Children with Diabetes, Dis-ability Rights Education Defense Fund,Juvenile Diabetes Research Foundation,Lawson Wilkins Pediatric Endocrine Soci-ety, Pediatric Endocrine Nursing Society,Endocrine Society [article online].Availablefrom http://www.diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-at-school/safe-at-school-statement-of.html

29. Evert A: Managing hypoglycemia in theschool setting. School Nurse News, No-vember 2005

30. Bulsara MD,Holman CD, David EA, JonesTW: The impact of a decade of changingtreatment on rates of severe hypoglycemiain a population-based cohort of childrenwith type 1 diabetes. Diabetes Care 27:22932298, 2004

31. Nabors L, Lehmkuhl H, Christos N,Andreone TF: Children with diabetes: per-ceptions of supports for self-managementat school. J Sch Health 73: 216221,2003

32. Kaufman FR: Diabetes mellitus. Pediatr

Rev18: 383392, 199733. Pediatric Endocrine Nursing Society:

Children With Diabetes at School. Septem-ber 2005. Available from the PediatricEndocrinology Nursing Society, 7794Grow Dr., Pensacola, FL 32514

34. Committee on School Health, AmericanAcademy of Pediatrics Policy Statement:Guidance for the administration of medi-cation in school. Pediatrics 124: 12441251, 2009

35. Hellems MA, Clarke WL: Safe at school:a Virginia experience. Diabetes Care 30:13961398, 2007

36. American Medical Association: Report 4of the Council on Science and PublicHealth (A-08):Ensuring the Best In-SchoolCare for Children with Diabetes [articleonline], June 2008. Available fromhttp://www.ama-assn.org/resources/doc/csaph/csaph4a08.pdf


Position Statement
http://www.diabetes.org/living-with-diabetes/know-your-rights/for-lawyers/education-materials-for-lawyers/legal-rights-of-students-with-diabetes.htmlhttp://www.diabetes.org/living-with-diabetes/know-your-rights/for-lawyers/education-materials-for-lawyers/legal-rights-of-students-with-diabetes.htmlhttp://www.diabetes.org/living-with-diabetes/know-your-rights/for-lawyers/education-materials-for-lawyers/legal-rights-of-students-with-diabetes.htmlhttp://www.diabetes.org/living-with-diabetes/know-your-rights/for-lawyers/education-materials-for-lawyers/legal-rights-of-students-with-diabetes.htmlhttp://www.diabetes.org/living-with-diabetes/know-your-rights/for-lawyers/education-materials-for-lawyers/legal-rights-of-students-with-diabetes.htmlhttp://www.diabetes.org/assets/pdfs/schools/forward2008.pdfhttp://www.diabetes.org/assets/pdfs/schools/forward2008.pdfhttp://www.diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-at-school/safe-at-school-statement-of.htmlhttp://www.diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-at-school/safe-at-school-statement-of.htmlhttp://www.diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-at-school/safe-at-school-statement-of.htmlhttp://www.ama-assn.org/resources/doc/csaph/csaph4a08.pdfhttp://www.ama-assn.org/resources/doc/csaph/csaph4a08.pdfhttp://www.ama-assn.org/resources/doc/csaph/csaph4a08.pdfhttp://www.ama-assn.org/resources/doc/csaph/csaph4a08.pdfhttp://www.ama-assn.org/resources/doc/csaph/csaph4a08.pdfhttp://www.ama-assn.org/resources/doc/csaph/csaph4a08.pdfhttp://www.diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-at-school/safe-at-school-statement-of.htmlhttp://www.diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-at-school/safe-at-school-statement-of.htmlhttp://www.diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-at-school/safe-at-school-statement-of.htmlhttp://www.diabetes.org/assets/pdfs/schools/forward2008.pdfhttp://www.diabetes.org/assets/pdfs/schools/forward2008.pdfhttp://www.diabetes.org/living-with-diabetes/know-your-rights/for-lawyers/education-materials-for-lawyers/legal-rights-of-students-with-diabetes.htmlhttp://www.diabetes.org/living-with-diabetes/know-your-rights/for-lawyers/education-materials-for-lawyers/legal-rights-of-students-with-diabetes.htmlhttp://www.diabetes.org/living-with-diabetes/know-your-rights/for-lawyers/education-materials-for-lawyers/legal-rights-of-students-with-diabetes.htmlhttp://www.diabetes.org/living-with-diabetes/know-your-rights/for-lawyers/education-materials-for-lawyers/legal-rights-of-students-with-diabetes.htmlhttp://www.diabetes.org/living-with-diabetes/know-your-rights/for-lawyers/education-materials-for-lawyers/legal-rights-of-students-with-diabetes.html

2013 diabetes care in the school and day care setting

Documents