Metropolitan Boston is home to institutions housing world-class diabetes care clinics and research facilities, yet Massachusetts is one holdout where school glucose testing, administration of insulin, and even emergency glucagon injections must be performed by or directly supervised by a school nurse. State public health regulation prohibits school nurses from delegating administration of any “parenteral” medication to a child – a parenteral medication is any medication that can’t be taken via the digestive system. That means that technically an insulin shot, an infusion site change, resetting a pump, or pricking a finger shouldn’t take place if a nurse isn’t available.
I spoke with several parents about this at a JDRF 2016 Summit in Boston this past February. Two parents were Boston-area physicians who have kids with Type 1 at private school; they asked not to be identified for the story. They said they were very happy with the level of care provided by the school’s full-time nursing staff, and they observed that teachers at the school were enlightened and compassionate where their kids’ welfare was concerned. They are frustrated, however, that their kids aren’t able to take full advantage of athletics and other school-sponsored extracurricular activities when school nurses aren’t available, unless the the parents have arranged for professional care or are in attendance themselves.
One of the parents did testify a year ago at the Massachusetts statehouse on a proposal to allow other non-medical professionals to oversee diabetes care – this would move the state closer to the protocol advocated by the American Diabetes Association with their Safe at School movement. A pair of bills came out of this effort, and both seem to be nudging toward a more decentralized approach to diabetes care in schools. It didn’t go as far as the parents hoped, however.
The Massachusetts House passed a bill that would allow students to carry their own diabetes self-care supplies, and do their own self-care, if parents have given permission. The bill also allows trained non-medical professionals to administer glucagon in emergency situations, again with parental permission. Meanwhile, the Massachusetts Senate is considering a bill that doesn’t go as far – it would only allow the emergency administration of glucagon by non-medical personnel; that bill is still only in committee.
The legislature has until the end of July to act on the bills.
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