The rise of continuous glucose monitors (CGMs) has revolutionized diabetes management for children, but many schools are reluctant to implement remote monitoring of these devices, leaving parents concerned about their children's safety.
Just a few years ago, children with type 1 diabetes reported to the school nurse several times a day to get a finger pricked to check whether their blood sugar was dangerously high or low. The introduction of the continuous glucose monitor (CGM) made that unnecessary. The small device, typically attached to the arm, has a sensor under the skin that sends readings to an app on a phone or other wireless device.
The app shows blood sugar levels at a glance and sounds an alarm when they move out of a normal range. Blood sugar that’s too high could call for a dose of insulin — delivered by injection or the touch of a button on an insulin pump — to stave off potentially life-threatening complications including loss of consciousness, while a sip of juice could remedy blood sugar that’s too low, preventing problems such as dizziness and seizures. Schools around the country say teachers listen for CGM alarms from students’ phones in the classroom. Yet many parents say that there’s no guarantee a teacher will hear an alarm in a busy classroom and that it falls to them to ensure their child is safe when out of a teacher’s earshot by monitoring the app themselves, though they may not be able to quickly contact their child. Parents say school nurses or administrative staff should remotely monitor CGM apps, making sure someone is paying attention even when a student is outside the classroom — such as at recess, in a noisy lunchroom, or on a field trip. But many schools have resisted, citing staff shortages and concerns about internet reliability and technical problems with the devices. About one third of schools, according to a 2021 survey by the National Association of School Nurses, though other staffers can be trained to monitor CGMs. Caring for children with type 1 diabetes is nothing new for schools. Before CGMs, there was no alarm that signaled a problem; instead, it was caught with a time-consuming finger-prick test, or when the problem had progressed and the child showed symptoms of complications. With the proliferation of insulin pumps, many kids can respond to problems themselves, reducing the need for schools to provide injections as well. Parents say they are not asking schools to continuously monitor their child’s readings, but rather to ensure that an adult at the school checks that the child responds appropriately. “People at the district don’t understand the illness, and they don’t understand the urgency,” said Julie Calidonio of Lutz, Florida. Calidonio’s son Luke, 12, uses a CGM but has received little support from his school, she said. Relying on school staff to hear the alarms led to instances in which no one was nearby to intervene if his blood sugar dropped to critical levels.Corey Dierdorff, a spokesperson for the Pasco County School District, where Luke attends school, said in a statement tothat staff members react when they hear a student’s CGM sound an alert. Asked why the district won’t agree to have staff remotely monitor the alarms, he noted concerns about internet reliability. In September, Calidonio filed a complaint with the US Justice Department against the district, saying its inability to monitor the devices violates the Americans with Disabilities Act, which requires schools to make accommodations for students with diabetes, among other conditions. She is still awaiting a decision. The complaint comes about 4 years after the Connecticut US attorney’s office determined that having school staffers monitor a student’s CGM was a “reasonable accommodation” under the ADA. That determination was made after four students filed complaints against four Connecticut school districts. “We fought this fight and won this fight,” said Jonathan Chappell, one of two attorneys who filed the complaints in Connecticut. But the decision has yet to affect students outside the state, he said. Chappell and Bonnie Roswig, an attorney and director of the nonprofit Center for Children’s Advocacy Disability Rights Project, both said they have heard from parents in 40 states having trouble getting their children’s CGMs remotely monitored in school. Parents in 10 states have filed similar complaints, they said. CGMs today are used by most of the estimated 300,000 people in the US with type 1 diabetes under age 20, health experts say. Also known as juvenile diabetes, it is an autoimmune disease typically diagnosed in early childhood and treated with daily insulin to help regulate blood sugar. It affectsby those with type 2 diabetes, a different disease tied to risk factors such as diet and exercise that affects tens of millions of people — including a growing number of children, though it is usually not diagnosed until the early teens. Most people with type 2 diabetes do not take insulin.) Students with diabetes or another disease or disability typically have a health care plan, developed by their doctor, that works with a school-approved plan to get the support they nee
CONTINUOUS GLUCOSE MONITORS TYPE 1 DIABETES SCHOOL NURSES AMERICANS WITH DISABILITIES ACT REMOTE MONITORING ADA HEALTH CARE PLANS
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