Diabetes Forecast

"Superstar" Schools Set the Bar for Diabetes Care

By Katie Bunker , ,

Jordon Lebsock (right), 9, with his brother, Trey, 7, and their dogs, Daisy and Buster.
Buster (foreground) is a diabetes service dog.

When Cheryl Lebsock's son Jordon began first grade at Stargate Elementary in Denver, she met with school staff to set up a diabetes care plan. At the time, no one at Stargate kept glucagon on hand to treat severely low blood glucose, teachers and other personnel weren't trained in diabetes care, and just correcting a low could mean leaving class for a visit to the school health clinic. Jordon struggled with frequent blood glucose fluctuations and regularly missed substantial chunks of class time.

Today, Stargate Elementary is recognized as an American Diabetes Association Safe at School Superstar, a school that provides exemplary care for students with diabetes. It is one of seven schools to receive the award for 2009–2010, the program's pilot academic year. Stargate now has several teachers and other staff members trained to help kids with diabetes. That means that no matter where the school nurse is on a given day, someone else with training is available, even on field trips. And Stargate permits Jordon, now 9, to stay in class when he checks his blood glucose.

Action Plan

When Allison Episkopos, RN, became the school nurse at Stargate five years ago, Jordon was the first student with diabetes in her care. Under her leadership, the school adopted new policies for handling kids with diabetes. Staffers were trained in how to inject glucagon in accordance with federal law (which requires schools to provide health services to students with disabilities that are necessary for them to attend school safely) and as expressly provided for in Colorado Board of Nursing regulations. Episkopos crafted a plan that spells out where the nurse will keep a blood glucose meter for use, if needed, during a fire drill or a lockdown. Plus, she's made sure that Jordon's teachers know that if he needs to come to the nurse's clinic, someone should escort him. "You don't want a child walking to the nurse by himself, because he could pass out" from hypoglycemia (low blood glucose), Episkopos says. "Sometimes people don't realize how serious this is."

The nurse has worked with Jordon's mom and his doctors to anticipate his needs before an emergency arises. Cheryl Lebsock says that the more she explained Jordon's diabetes (at first, with the help of an ADA legal advocate, who wrote the local superintendent a letter about the rights of children with diabetes), the easier it was to have his needs addressed at the school. "What I always say about my kid with diabetes is that he looks like a normal kid, but you [don't] know what it took behind the scenes to make him look like a normal kid," Lebsock says. "When something goes wrong, it's really easy to upset the balance."

Episkopos has gone above and beyond what was asked of her, Lebsock says. The nurse has done things like rescheduling Jordon's visits to her clinic so he won't have to miss eating lunch with friends. "When you're 9, that's a big deal," says Lebsock. "It's hard drawing the line between managing Jordon's diabetes care and giving him a good quality of life.

Rebecca Marcincavage (right) helps two students with their insulin pumps.

A Carolina Superstar

Forbush Elementary School in East Bend, N.C., another Safe at School Superstar award winner, has used strategies similar to Stargate's for students with diabetes. "Kids are never kept from doing anything because of their diabetes," says Amy Johnson, RN-C, school nurse for the Yadkin County schools, including Forbush. "If one of our diabetic students is going on a field trip, a parent can go if they want to, but if the parent doesn't want to, I'm there. The entire staff is trained [in the basics]. And we have two intensively trained personnel" who can administer insulin.

In addition to the federal protections that apply to students across the country, North Carolina has a specific state law covering diabetes care at school, the Care for School Children With Diabetes Act. It mandates that written care plans be established for all North Carolina students with the disease, and that there be trained diabetes care assistants to administer insulin and glucagon if a nurse is unavailable.

At Forbush, Rebecca Marcincavage, a second-grade teacher, learned about type 1 diabetes five years ago when a girl in her class kept complaining of thirst and asking to go to the bathroom. The teacher alerted the student's mother. That night, the mother called Marcincavage with the news that the girl had been diagnosed with type 1 diabetes. Marcincavage soon was trained in how to calculate carbohydrate-to-insulin ratios and give insulin shots. (Just a year and a half later, Marcincavage's daughter Lauren, now 12, developed similar symptoms and was also diagnosed with type 1.)

As Marcincavage told Forbush colleagues what she had learned, more staff members got on board to help Johnson and her make the school a safe place for kids with diabetes. Teachers were trained, emergency kits were stored in various classrooms, and the cafeteria staff distributed nutrition information for each month's meals.

If you need help explaining your child's right to diabetes care to school administrators, start by calling the ADA Center for Information and Community Support at 1-800-DIABETES (1-800-342-2383) and by reviewing the resources at diabetes.org/safeatschool.

At both Stargate and Forbush, the first step to becoming diabetes care Superstars was education: Sometimes all it takes is a conversation for schools to know what a child needs, and why. If that doesn't work, ADA recommends that parents negotiate or even litigate to secure these protections in school. Ultimately, the solution may be reform of state law, with ADA help. "The key is you can't come in as an angry parent. You need to go in with the mind-set of forming a team," Lebsock says. "You need to go to bat for your child. But I don't believe your child is going to get the best care unless people are educated and understand your child's needs."

Is Your Child's School a Superstar?

A checklist of ADA Safe at School practices.

  • The school's nurse and administrators coordinate with a student's parents or guardian and doctor to create a diabetes care plan.
  • Written care plans include the Diabetes Medical Management Plan and the Section 504 Plan, which detail everything about a child's care at school and during school-related activities. This includes what to do in case of an emergency, which school staff members have been trained to provide care, and how much diabetes management the child may do on his or her own.
  •  The school allows a capable child to check blood glucose in class, unless the care plan calls for giving the student assistance or granting privacy.
  • If a child with diabetes goes on a field trip, a school staff member trained in diabetes care is also present.
  • A child with diabetes is welcomed into any after-school program or sports team, and a staff member or coach trained in diabetes care is present at that school-sponsored activity.
  • The school nurse or other qualified health care professional has trained staff members on how to recognize and treat low blood glucose. Select staff members are also trained to check blood glucose and administer insulin and glucagon.
  • The school's cafeteria staff provides nutrition information, including carbohydrate counts, with menus.

ADA Superstar Schools for 2009–2010:

Central High, Grand Junction, Colo.; The Classical Academy North Campus, Colorado Springs, Colo.; Devinny Elementary, Lakewood, Colo.; Forbush Elementary, East Bend, N.C.; Kyffin Elementary, Golden, Colo.; Oberon Middle, Arvada, Colo.; and
Stargate Elementary
, Denver.



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