Endocrine Abstracts

Diabetes control is poor in children in the UK with fewer than 20% of children achieving target HbAlc levels. Multiple injection therapy and insulin pumps produce the most physiological blood glucose control but both require the child to have blood glucose testing and insulin dosing at each meal and most snacks, and therefore at school. There are often huge obstacles to setting appropriate support in place in schools, particularly in children who are too young to perform their own injections and blood glucose testing, even under supervision. Many studies have now shown that glycaemic control is related to complications, even in young children, and that intensive insulin regimens result in improved control and reduced complication rates. We cannot therefore allow the fact that schools are reluctant to take on diabetes care, to be a reason for delaying the introduction of such regimens. Fortunately individual parents have started to lobby for change because of the problems they have encountered in school.

Schools now have increasing obligations under various legislation to ensure that they do not discriminate against pupils or put them at a disadvantage because of their health. It is perhaps not widely appreciated how much of an adverse impact on education badly-controlled diabetes can have, and so this is indeed an educational issue. However there is no obligation on teachers to help with administering medicines – this must be done by volunteers. Schools can employ a support worker with the role of administering insulin injections in the job description but this requires funding.

The main obstacles to schools taking this on appear to be a lack of knowledge and understanding of the importance of diabetic control, and fear of adverse incidents and litigation, all of which can be overcome by explanation and education. Indeed, once the volunteers in schools understand the reasons for the injections and blood tests, and they have been adequately taught in the practical skills, schools are generally keen to help the individual child. Indemnity cover for all school staff can be provided by the Local Authority, which will insure all staff for their activities in administering medications. Education is the key, and we should all start now.