Diabetes in primary schools: overcoming barriers to good care

With increasing numbers of children being diagnosed with type 1 diabetes at younger ages, and intensification of insulin regimens, many more children require support with their diabetes at primary school. I report here our own experience of setting up a structure for support in schools based on trained volunteers who can supervise or administer insulin with pens or pumps, and who do so based on intensive management including carbohydrate counting and correction doses. There is a clear legal framework to support families asking for help in schools but still no compulsion on schools to provide a member of staff to carry out care, which has to rely on volunteers. We have, however, negotiated a system with our primary care trust and local authority whereby diabetes specialist nurses (DSNs) train up volunteers identified by the school, and, together with the parents, draw up a comprehensive medical management plan. The volunteers are then trained by the DSN, and the parent agrees to go into the school to supervise until both the volunteer and parent are happy that they are competent, when the DSN then goes back into school to certify competence. This has taken several years to complete, but all schools in Oxfordshire but one have agreed to work according to this guidance so that over 130 children now receive appropriate care in school. Copyright (C) 2012 John Wiley & Sons.