To Glucagon or not to Glucagon, that is the question.

STUDENT DIABETES MANAGEMENT: ROLES AND RESPONSIBILITIES Area	Who		Role and Responsibilities		Special Considerations
School Registration (new students) and New Diagnosis	Principal Parent Student (if appropriate)		Together determine whether or not the student is able to safely manage his/her diabetes Parents complete Life Threatening Management and Prevention Plan and obtain qualified medical practitioners direction		See: Life Threatening Management and Prevention Plan
Communication		Principal School Staff Parents		Establish clear communication methods between school and home Follow established procedures for alerting staff of student medical needs
Referral	Principal CCAC		Principal contacts CCAC for referral regarding necessary medical intervention (e.g. injections)		Nursing support is required for students requiring injections to be given at school

Well, it seems that we are in the liminal, nebulous ether of school board policy versus real life at the moment. Owen's principal kindly organized the teachers and after school teachers to attend a training "lunch and learn" session with our diabetes team nurse while parents generously volunteered to supervise students over the lunch period.

We were all geared up to return to school after the P.A. Day today, with just a few bits and bobs to go into Owen's T1D boxes at school, a little more one-on-one training with his teachers, but we were almost there! Now we are betwixt and between. It seems that the Upper Grand School Board is mandating that T1D students must have a nurse to administer injections at the school. Glucagon is a hormone manufactured by the liver that stimulates the release of glucose into the blood stream. The injection is just under the skin anywhere there is a bit of fat and it is given when the child is unconscious with low blood sugar - a life threatening situation. The child may experience seizures and the Glucagon is a necessary step while waiting for a 911 response. Did I mention that it is a life threatening situation? Similar to the use of an epipen for anaphalaxis. Insulin is given by a parent or regional nurse or the child when they are ready. Perhaps that is all that is meant by the above edict - if so, that should be clarified in the policy document. So we wait.

Our team nurse got back to me an hour ago and the news is astonishing. I am reeling.

Hi Beth,

Thanks you so much for sending me the school protocol. The Catholic School Board just this year has included glucagon in their protocol. I did meet with their Health and Safety person on their Board and also sent a letter in support of students with Type 1 diabetes receiving Glucagon in an emergency situation. The process took about 2.5 years to finalize.
I am hoping that now that the Catholic Board has it in their protocol, it will be easier for the Upper Grand Board to follow suite. Unfortunately, I am one person in our clinic and my time limits are very stretched between patient care and administrative care. I am hoping to address this with Upper Grand Board member in the near future. So I will keep you posted.

This email speaks to how stretched our healthcare system is and how the school boards act independently of each other even in matters of emergency protocol despite the obvious necessity to facilitate school attendance for all children whether they attend separate or public schools.

I continue to reel. Why is this the first that we have heard of this issue? This is HUGE. This is - someone (me) must forfeit their career to homeschool their child while the child just wants to attend school--his school with his friends, his teachers and be a normal kid. That's what we are trying to teach him--life resumes with some adjustments after a diagnosis with T1D, but you are the same as before your diagnosis. Clearly this is not the case if we explain that not only does he need to maintain blood sugar levels or risk organ damage, seizures, coma and death, but he must also uproot his entire life and either be home schooled or switch to a Catholic elementary school. What is the difference between administering an epipen for anaphalaxis and glucagon for low blood sugar? The Catholic School Board sees no difference, now the Public School Board needs to see the light.