Posted on Tue, Jun. 21, 2005


New law makes it possible for diabetics to stay healthy in school


Associate Editor

WHEN I GO to work every morning, my glucose monitor and test strips, a reusable syringe filled with a month’s worth of insulin and a modest supply of candy go with me. They’re there when I go to lunch or dinner, on a bike ride or out shopping. I even take them with me when I go to the basement of my office building for a 45-minute workout.

They’re essential tools for the lifelong job of keeping my blood-sugar levels as near that as a non-diabetic as possible. That job, in turn, is essential to protecting me from what not too long ago were the normal and expected consequences of diabetes: kidney failure, blindness, amputation, stroke.

But if I were a student in many S.C. schools, I wouldn’t be able to keep my medical kit close at hand; I would have to turn it over to the assistant principal, a nurse, a teacher or whatever adult the school designated as keeper of my health. In some schools, I wouldn’t even be able to bring any of it on campus. I could only have access to it if a parent drove to campus, picked me up and took me off campus to test my blood-sugar or inject insulin.

Or, I should say, that used to be the case. Not anymore.

Late last month, Gov. Mark Sanford signed into law a bill that requires schools to allow diabetics, asthmatics and others with chronic conditions to self-monitor and self-administer medication “in the classroom and in any area of the school or school grounds,” at school-sponsored activities and on the way to and from school.

The new law, five years in the making, moves our schools from among the most dangerous to among the safest in the nation for children with diabetes and other conditions that require routine or emergency testing or medication. And that allows children to control their diabetes in a way that no rational person would have dared tried before.

In the last two decades, we have learned that diabetics can live completely healthy lives if they maintain low blood-sugar levels. But that means testing before and after every meal and sometimes other times as well, and taking shots with each meal and whenever sugar levels go too high. It also means frequent episodes of low blood-sugar, or hypoglycemia, which leave you dizzy, disoriented, irritable and drowsy and which can, in extreme circumstances, cause permanent brain damage.

If their children can’t be guaranteed immediate access to testing equipment and fast-acting carbohydrates to treat hypoglycemia, many parents will decide not to keep their children’s diabetes as well controlled as is universally recommended. And as a former teenage diabetic and someone who has heard all the horror stories about that genus, I can tell you that even if parents insist on tight control, a lot of teens will skip that lunchtime insulin injection if it requires a trip to the principal’s office, or if they can’t be guaranteed easy access to candy when they take too much. They’ll probably back off on their morning dose for the same reason: At least when your sugar’s a little high, you don’t feel like you’re going to die until the carbs kick in.

Not only children but society in general will reap long-term rewards from allowing children to control their diabetes the way they should, because it will mean avoiding the hugely expensive complications later in life.

The new law isn’t perfect. It has a giant loophole that allows schools to bar students from taking care of themselves if there is “sufficient evidence that unsupervised self-monitoring or self-medicating would seriously jeopardize the safety of the student or others” — and it fails to define “sufficient evidence.”

And it doesn’t go as far as diabetes advocates hoped. Hunter Limbaugh is a Columbia lobbyist, father of a diabetic daughter and chairman of the American Diabetes Association’s national government affairs and advocacy committee. He had initially tried to require all schools to have at least three employees trained in the basics of diabetes, such as recognizing high and low blood-sugar levels, administering blood-sugar tests and insulin injections and administering a super-fast-acting shot that raises blood-sugar levels when a patient is unconscious or having a seizure.

Without that, he worries that no one in the schools will be willing or able to administer the emergency glucagon shot. “In terms of those schools who don’t have a nurse, I frankly don’t know what they would do if a kid has a severe case of hypoglycemia, other than calling 9-1-1,” he said. “It could just be a real tragedy if that’s the reaction.”

School officials and nurses balked at the idea of requiring anyone other than nurses to administer injections even though, as Mr. Limbaugh points out, glucagon “is pretty much idiot proof,” and it can’t harm you, even if you don’t need it.

But the reason the law finally passed was that it was a compromise, which emerged largely because Cathy Young-Jones, who works as a liaison between the state Education Department and DHEC, pulled school officials and nurses together with Mr. Limbaugh, longtime sponsor Rep. Joe Brown, doctors and other diabetes advocates last summer to work out their differences.

Despite its shortcomings, Mr. Limbaugh considers the law a major improvement for children with diabetes, because it “creates a presumption that they can manage their disease wherever that might require them to do it.”

“I think it’s going to be a change in a lot of schools, and I actually expect that there will be places that are resistant to it and don’t implement it in good faith, but I think there will be a lot that do,” he said. “There are a lot that do fine now, even without the statutory provision, and I hope this will move the situation for the better as a general rule.”

Ms. Scoppe can be reached at cscoppe@thestate.com.





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