Mothers slam diabetes emergency injection policy

By Don Fraser, St. Catharines Standard

Christi Webster and her 3 year-old daughter Maya are photographed in their St. Catharines home on Friday, November 7, 2014. Christi is concerned about sending her diabetic daughter to school because the school board doesn't allow staff to administer her glucagon injections.

Christi Webster and her 3 year-old daughter Maya are photographed in their St. Catharines home on Friday, November 7, 2014. Christi is concerned about sending her diabetic daughter to school because the school board doesn't allow staff to administer her glucagon injections.

A Niagara school board policy is putting the lives of diabetic students at risk, say two concerned parents.

The mothers are troubled that District School Board of Niagara personnel are not allowed to administer a potentially life-saving injection for their diabetic children.

The board says each student with a pre-existing condition has a medical plan of action. Injections must be given by a trained student, parent or health-care professional.

Christi Webster said her trouble began when it was noticed her toddler, Maya, was excessively thirsty. Webster’s family has a history of diabetes.

“And so then my radar went right off,” said the mom.

In February, Maya was diagnosed with Type 1 diabetes. She will be three years old when she attends junior kindergarten at Connaught School next year in St. Catharines.

In Type 1 diabetes, the body’s immune system destroys the cells that release insulin, eventually stopping insulin production. Without insulin, cells cannot absorb sugar to make energy.

“It came to my attention that District School Board of Niagara staff will not administer glucagon, which is used for diabetics that become unconscious due to a sugar low,” Webster said.

That medicine, usually from a pre-measured syringe, rapidly raises the blood sugar of someone experiencing a crash. Insulin itself can come from a syringe, “pen” or pump. Maya uses a pen.

“It terrifies me to know she will not be safe to attend school (in my opinion) … it’s a pretty scary situation,” said Webster. “They are not about to give her the glucagon, and we can’t be guaranteed a nurse will be there.

“I would like training for staff to be able to administer glucagon in case of an emergency and have it available with her,” she said. “This isn’t about criticizing the staff at Connaught, I want to stress that. It’s about the DSBN and for other parents that have to deal with this.”

Joy Callicott is also concerned about her own daughter Jaelynn, 4, who attends Carlton School in St. Catharines.

She said Jaelynn keeps an injection kit at school, and acknowledged she met with the principal who advised her he and no other staff member could administer the injection. The school would instead call 911.

Callicott said her daughter recently came home with an uneaten snack that had been packed for her lunch. Earlier that day, she had noticed Jaelynn in what she said seemed a very low mood, possibly brought on by low blood sugar.

“When I got home, I realized the 10 a.m. snack was not eaten at all. That’s why it was low at lunch,” she said. “It was just pure dumb luck that she was (blood sugar) high enough that it didn’t drop low enough to result in seizures or unconsciousness.

“If the glucagon was needed, no one would be able to give it right away.”

Bottom line: “I’d like to see a policy in place where at least one person in the school is responsible for giving a shot if it’s needed.”

School board spokeswoman Kim Yielding said board policy states any medication to be injected at school be provided by the pupil, parent or health care professional. That includes glucagon and insulin.

Staff are not required to administer medical injections as part of their jobs.

“A third-party health professional (such as Community Care Access Centre) has an important connection to schools, because they are trained to administer medication by injection and calculate dosage requirements,” Yielding said.

A plan of care is set up for each student with a pre-existing condition, including diabetes. This includes blood glucose tests and the administration of insulin as needed.

Any time any medical emergency happens, 911 is called immediately.

“Every situation is unique,” Yielding said.

“And that includes an emergency-action protocol for each student.”

She said responsibility for student care is shared by the provincial Ministries of Education, Health, and Community and Social Services. School policies and procedures are also based on Ministry of Education legislation.

Niagara Catholic District School Board education director John Crocco said his board also has a diabetes-management policy applying to affected students.

Similar to the DSBN, responsibility for diabetes management rests with the parent or guardian, student and medical practitioner.

School staff will seek support from the parent or guardian, the CCAC or other agencies involved with the student but will not administer medication.

“All this is discussed as part of a diabetes management plan, with arrangements to be made where students are not able to self-care,” Crocco said.

While injections will not be done by staff, EpiPens used for anaphylactic allergy attacks are an exception as they are done by “auto-inject” and there’s no exposure to needles, he said.

Assistance will also sometimes be offered if a student needs help monitoring their sugar levels or for oral medication for diabetes management for students under age 18, Crocco said.

The policies of both Niagara boards are generally consistent with other school boards across the province.

Gabriella Simo, Ontario manager of advocacy for the Canadian Diabetes Association, said it recently released guidelines for the care of students at school with diabetes to help boards improve their policies and increase students’ safety.

An estimated 14,000 elementary and high school-age children in Ontario have Type 1 diabetes. It is not known precisely how many of them are in Niagara.

“In the case of emergencies, our guidelines call for school personnel to be trained to recognize emergency situations and to administer glucagon in the case of severe hypoglycemic reactions.”

Simo added: “I believe most boards in Ontario are not doing that.”

She said her association is working with parents, schools and the Ministry of Education “to ensure that kids with diabetes are adequately protected and supported in schools.”

She said as part of her group’s recommended emergency-injection policy, school personnel should receive proper training. There should also be a student emergency treatment plan on file and prior consent from the parent or guardian must be received.

Gary Wheeler, a spokesman for the provincial Education Ministry, said Ontario’s school boards, as independent corporations, are responsible for developing their own policies and procedures, “including those pertaining to the administration of medical services.”

Wheeler added boards work collaboratively with families and community service providers to “meet the specific medical needs of their students.”



Glucagon belongs to the group of medications called hypoglycemic agents. It is used to treat severe hypoglycemia (low blood sugar) when someone with insulin-treated diabetes is unable to give glucose to themselves or is unconscious. Symptoms of severely low blood sugar include disorientation, unconsciousness and seizures.

The medication works in the liver to produce glucose (sugar) and increase blood sugar. It usually works within 10 to 15 minutes. If a person does not respond to the med within 10 to 15 minutes, they require immediate medical attention.

Source: MediResource Inc.



Should the boards change their injection policies?

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