Endocrine
Pursuant to Sec. 5 CSR 20-200.300. Training of School Employees in the Care Needed for Students with Diabetes.–Training of school employees in the care needed for students with diabetes shall take place prior to the commencement of each school year, or as needed when a student with diabetes is newly enrolled at a school or a student is newly diagnosed with diabetes, but in no event more than thirty days following such enrollment or diagnosis. The school nurse or another health care professional with expertise in diabetes shall promptly provide follow-up training and supervision as needed. Coordination, delegation, and supervision of care shall be performed by a school nurse or other qualified health care professional.
Pursuant to §167.818 RSMo. A student may perform certain diabetic care for self, when.– Upon written request of the parent or guardian and authorization by the student’s diabetes medical management plan, a student with diabetes shall be permitted to perform blood glucose checks, administer insulin through the insulin delivery system the student uses, treat hypoglycemia and hyperglycemia, and otherwise attend to the care and management of his or her diabetes in the classroom, in any area of the school or school grounds, and at any school-related activity, and to possess on his or her person at all times all necessary supplies and equipment to perform these monitoring and treatment functions. If the parent or student so requests, the student shall have access to a private area for performing diabetes care tasks.
Considerations:
- Provide the student with as much privacy as possible.
- Encourage the student to assist in the procedure as much as they are able to help the student learn self-care skills.
- Ensure strips are contained in a tightly sealed container and show no signs of discoloration.
- Prolonged exposure of test strips to air may lead to inaccurate results.
- Discolored test strips should be discarded.
- Review manufacturer’s instructions regarding how long to keep an opened bottle of test strips before needing to discard.
- Be sure to inform school staff that a student with diabetes should never be sent anywhere alone if feeling hypoglycemic or hyperglycemic.
Supplies:
- Blood glucose monitor
- Testing strips
- Sterile disposable lancet
- Automatic lancet or lancet pen
- Cotton ball
- Gloves
- Sharps container
- Diabetes Medical Management Plan/Health care provider’s order and student’s Individualized Health Care Plan (IHCP)
- Parent/Guardian authorization form
NOTE: Student personal health information (PHI) shown on forms in this video is fictitious.
Procedure for blood glucose monitoring:
- Review student’s Diabetes Medical Management Plan/health care provider’s order
- Ensure proper documentation of parent/guardian authorization to perform this procedure
- Position student to provide as much privacy as possible
- Explain the procedure to the student at their level of understanding
- Encourage the student to assist in the procedure as much as they are able to help student learn self-care skills
- Gather supplies and place on a clean surface
- Check expiration date on testing strips
- Ensure strips are contained in a tightly sealed container and show no signs of discoloration
- Discolored test strips should be discarded
- Review manufacturer’s instructions regarding how long to keep opened bottle of test strips before needing to discard
- Perform quality control on equipment per manufacturer’s instructions
- Or verify that appropriate quality control has been completed today
- Wash hands
- Put on gloves
- Have student wash hands or clean the student’s fingertip with warm wet cloth, let the fingertip dry
- Insert the monitor specific test strip into meter
- Calibrate meter by matching test strip code to code on the meter (if required)
- Insert new lancet into lancing device (per lancet device manufacturer’s instructions)
- Hold the lancet device perpendicular to the student’s fingertip or other specified location and pierce the skin with the lancet (per meter specific or Diabetes Medical Management Plan/health care provider’s order), to get a drop of blood
- Do not use the pads of the fingers
- Gently squeeze or massage finger until a drop of blood forms
- Touch and hold the edge of the test strip to the drop of blood, and wait for the result
- Blood glucose level will appear on the meter’s display
- Meters do not only display numbers
- Some display “Lo” or “Hi” for results outside of the meter’s parameters
- Some display error messages
- Consult with the meter manual to determine the meaning of messages
- Hold cotton ball on student’s finger until bleeding stops
- Place used lancet in sharps container
- Once blood glucose level has displayed, remove test strip and throw away per school policy
- Remove gloves
- Wash hands
- Have the student wash their hands
- Document blood glucose reading in student’s health care record
- Follow Diabetes Medical Management Plan/health care provider’s orders for snacks, hyper or hypoglycemia, or insulin coverage
- Update parent’s and health care provider as needed
References:
American Diabetes Association. (n.d.). Training resources for school staff. Tips for school nurses. Retreived June 8, 2023, from https://diabetes.org/tools-support/know-your-rights/safe-at-school-state-laws/training-resources-school-staff/tips-for-school-nurses
Diabetic care may be provided to students, when, trained personnel to be on site. Missouri Revisor of Statutes 167.809. (2013). https://revisor.mo.gov/main/OneSection.aspx?section=167.809
Lynn, P. (2019). Obtaining a capillary blood sample for glucose testing. In Skill checklists for Taylor’s clinical nursing skills. A nursing process approach. (5th ed.). (pp. 405-406).
Mayo Clinic. (2021). Blood sugar testing: Why, when and how. Accessed on September 15, 2021 from https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/blood-sugar/art-20046628
National Association of School Nurses. (2022, June 15). School nursing evidence-based clinical practice guideline: Students with type 1 diabetes toolkit. Retrieved June 2, 2023, from https://cdn.fs.pathlms.com/HRuI7pAvQWiJPZdzH6i8
National Association of School Nurses. (2021). School nursing evidence-based clinical practice guideline: Students with type 1 diabetes. Silver Spring, MD: Author. Retrieved June 2, 2023, from https://learn.nasn.org/courses/37660
Perry, A. G., Potter, P.A., Ostendorf, W., & Laplante, N. (2021). Procedural guideline 7.9 Blood glucose monitoring. In Clinical nursing skills and techniques. (10th ed.). (pp. 216-220). St. Louis, MO: Elsevier.
Plan to be submitted by parent or guardian of student with diabetes — review by school. Revisor of Statutes 167.806. (2013). https://revisor.mo.gov/main/OneSection.aspx?section=167.806
Weinstock, R.S. (2023, April 6). Patient education: Glucose monitoring in diabetes (beyond the basics). In a D.M. Nathan (Ed.), UpToDate. Retrieved: June 5, 2023, from https://www.uptodate.com/contents/glucose-monitoring-in-diabetes-beyond-the-basics
Training of school employees, content, requirements. Revisor of Statutes 167.803. (2013). https://revisor.mo.gov/main/OneSection.aspx?section=167.803&bid=8398&hl=.
Training of school employees in the care needed for students with diabetes. Missouri Secretary of State: Code of State Regulations. Division 20–Division of learning services. Chapter 200–Office of college and career readiness. (2022).https://www.sos.mo.gov/cmsimages/adrules/csr/current/5csr/5c20-200.pdf
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Acknowledgement of Reviewers:
Angie Bulmahn, MSN, RN, NCSN
School Nurse Specialist
Missouri Department of Health and Senior Services
Marjorie Cole, MSN, RN, FASHA
State School Nurse Consultant
Missouri Department of Health and Senior Services
Renee Falkner, BSN, RN
School Nurse Supervision Specialist | Therapylog
Debra Funk, BSN, RN
Director of Practice
Missouri State Board of Nursing
Katherine Park, DNP, RN, NCSN
Nationally Certified School Nurse, Pierremont Elementary
Adjunct Professor, Maryville University School of Nursing
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Page last updated October 25, 2024
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