March 18th,
2013
Dear Upper
Grand District School Board Trustees,
I am contacting
you to request altering the protocol related to administering Glucagon to Type
1 Diabetic elementary, middle and secondary school students. I am also writing
this letter to elucidate the facts surrounding Type 1 Diabetes as the parent of
an 8 year old boy, Owen, recently diagnosed with T1D (age 7 at the time of
diagnosis). Owen was attending Victory Public School and after school care with
Victory Kids’ Club until he was admitted to the Emergency Department at Guelph
General Hospital in critical condition in December. He is ready to return to
his friends and teachers, but there is a problem. The injection of Glucagon, a
life-saving measure necessary for severe blood sugar lows, is not currently
permitted to be administered by the public school teachers and other staff in
Guelph.
Superintendant
of Education and former Victory Principal, Brent McDonald, has discussed the
Public School Board emergency protocol with a few of the authors of the policy and
perhaps we will soon be closer to allowing Glucagon to be administered to
students by teachers at the public schools in Guelph. The Wellington Catholic School
Board recently adopted this protocol and Catholic School students with T1D may
now receive Glucagon at the schools in a life threatening emergency. They have
set an important precedent that was 2.5 years in the making. The rest,
theoretically, should be easy for the other school boards to follow,
particularly with full-day kindergarten being implemented with T1D kindergarten
students relying on the care of teachers for full school days and 5 day weeks.
As a family we were thrilled that Victory's principal, teachers, after school teachers and parent volunteers rallied for Owen and learned about juvenile diabetes with our diabetes nurse over a lunch hour. Owen's teachers met with my spouse and I to discuss the finer details
of his care, i.e. Owen's daily meal, snack, insulin and exercise schedule. We discussed Owen's requirements for low or high blood sugar levels, whether he would eat 15 g of carbohydrates for high blood sugar or sit out an athletic event in favour of a quieter activity when his blood sugar is a little high.
Similarly, we reviewed the emergency protocol in the event that Owen required emergency procedures for life threatening symptoms of low blood sugar when consuming carbohydrates in the form of orange juice or Dex4 tabs by mouth is impossible. The treatment for unresponsiveness in a child with T1D is an injection of Glucagon – a hormone that is produced by the liver to release glucose into the blood stream, thereby preventing seizure, coma and death.
The method for this procedure is to use a syringe of sterile water that the kit provides and inject the water into a vial of Glucagon powder, mix gently and withdraw the solution into the syringe and simply inject the child subcutaneously, not intravenously, anywhere there is a bit of padding. The importance of the response time cannot be overstated in the event of a rapid crash and ensuing risk of life that children with juvenile diabetes endure - every second counts.
Timing is crucial in the event of anaphylaxis as demonstrated by the death of Sabrina Shannon, the namesake of Sabrina's Law (Bill 3), passed in 2006. The concept behind epinephrine auto injectors (EpiPens) is very similar to the life saving Glucagon injection. I spoke and corresponded with other parents of children with T1D recently and they have met the challenge of Glucagon protocols in their children's schools through similar means. One mother volunteered around the clock at her son's school so that she would not let him out of her sight, "Velcro'd together" was her term for how close they are at school. Another mother also spent so much time at her daughter's school that the teachers privately agreed to inject her daughter should the need arise, despite protocols to the contrary. Fortunately, the parents and Type 1 Diabetics who shared their stories with me have never had an occasion to use the Glucagon.
As a family we were thrilled that Victory's principal, teachers, after school teachers and parent volunteers rallied for Owen and learned about juvenile diabetes with our diabetes nurse over a lunch hour. Owen's teachers met with my spouse and I to discuss the finer details
of his care, i.e. Owen's daily meal, snack, insulin and exercise schedule. We discussed Owen's requirements for low or high blood sugar levels, whether he would eat 15 g of carbohydrates for high blood sugar or sit out an athletic event in favour of a quieter activity when his blood sugar is a little high.
Similarly, we reviewed the emergency protocol in the event that Owen required emergency procedures for life threatening symptoms of low blood sugar when consuming carbohydrates in the form of orange juice or Dex4 tabs by mouth is impossible. The treatment for unresponsiveness in a child with T1D is an injection of Glucagon – a hormone that is produced by the liver to release glucose into the blood stream, thereby preventing seizure, coma and death.
The method for this procedure is to use a syringe of sterile water that the kit provides and inject the water into a vial of Glucagon powder, mix gently and withdraw the solution into the syringe and simply inject the child subcutaneously, not intravenously, anywhere there is a bit of padding. The importance of the response time cannot be overstated in the event of a rapid crash and ensuing risk of life that children with juvenile diabetes endure - every second counts.
Timing is crucial in the event of anaphylaxis as demonstrated by the death of Sabrina Shannon, the namesake of Sabrina's Law (Bill 3), passed in 2006. The concept behind epinephrine auto injectors (EpiPens) is very similar to the life saving Glucagon injection. I spoke and corresponded with other parents of children with T1D recently and they have met the challenge of Glucagon protocols in their children's schools through similar means. One mother volunteered around the clock at her son's school so that she would not let him out of her sight, "Velcro'd together" was her term for how close they are at school. Another mother also spent so much time at her daughter's school that the teachers privately agreed to inject her daughter should the need arise, despite protocols to the contrary. Fortunately, the parents and Type 1 Diabetics who shared their stories with me have never had an occasion to use the Glucagon.
The life and death scenarios that could
develop for students with T1D, however, shouldn't be left to the mercy of
empathetic teachers putting their jobs at risk. We are working with the
provincial and federal governments to formalize the protocol and pass a law (Bill
137) that clearly outlines the responsibility of the schools - all Guelph,
Ontario and every province and territory in Canada's schools to allow teachers
to inject Glucagon to save the lives of Canadian T1D students. Nova Scotia, New
Brunswick and Quebec have passed a Glucagon Law, and many school boards
including the Wellington Catholic School Board have expanded their protocol to
include Glucagon administration by teachers, perhaps in advance of full-day
kindergarten enrolment.
Victory
Public School’s after school care teachers are not permitted to administer
Glucagon to Owen due to the rental agreement they hold with the UGDSB. Consequently,
we have reluctantly withdrawn Owen from Victory Kids’ Club. We are not alone in
this struggle. In Cambridge, twin T1D students are in limbo as the school board
decides whether to run the after school care that currently allows Glucagon to
be given by the after school teachers and in doing so, the school board will
not allow its teachers to give Glucagon. The parents of the twins are hoping
that the status quo will prevail. We do have much support for this cause – educators,
paramedics, firefighters and other individuals from the community have
expressed their concern and offered their support for a change in the protocol.
When I discovered this gap in the emergency protocol policy after my son’s diagnosis, I was
informed that T1D parents are trying to have a law passed in favour of teachers injecting Glucagon, but nobody wants their child's name on this law. I couldn't agree more. Please consider updating the Upper Grand District School Board Glucagon Policy to include the administration of Glucagon by teachers to unresponsive Type 1 Diabetic students, kindergarten to OAC levels.
Best regards,
When I discovered this gap in the emergency protocol policy after my son’s diagnosis, I was
informed that T1D parents are trying to have a law passed in favour of teachers injecting Glucagon, but nobody wants their child's name on this law. I couldn't agree more. Please consider updating the Upper Grand District School Board Glucagon Policy to include the administration of Glucagon by teachers to unresponsive Type 1 Diabetic students, kindergarten to OAC levels.
Best regards,
Beth Mulkins
