In Diabetes Today

Astiasaran-Perez said she asked Wagner to give up what she thought was a beeper, said Principal Ira Margulies. But Wagner and a friend say the assistant principal tried to yank the pump from where it was attached to the teenager's lower back.

Margulies said Thursday that school officials are still trying to understand exactly what happened. Astiasaran-Perez declined to comment.

Margulies gave this account: In a crowded cafeteria, Astiasaran-Perez called Wagner over because she should have been sitting down. She noticed that Wagner, an eighth-grader, was wearing what appeared to be a beeper. Students are prohibited from bringing pagers to school.

Wagner said it was not a beeper, but Astiasaran-Perez "kept asking" what it was. Wagner got upset, took it off, put it on a table and ran out of the cafeteria, according to Margulies.

Another student told the assistant principal that the beeper was actually a blood-sugar monitor, Margulies said. Wagner enters information about the foods she eats into the pump's computer, and the device dispenses the needed amount of insulin.

Astiasaran-Perez soon realized it was a medical device and called the school's police officer, who immediately found Wagner and returned it, Margulies said.

But Wagner and a friend who saw the incident say Astiasaran-Perez tugged on the pump as Wagner was taking it off. They have given their account of the event to school officials.

"She was pulling on it," said Wagner, 14. "I felt it. It was bleeding. I said, `Ow.'"

The monitor is connected to Wagner's lower back with tubing and a needle. A friend who was with Wagner at the time, Sara Krecker, supported Wagner's story.

"Astiasaran-Perez said, `Give me your beeper,' and Nikki said it wasn't a beeper, and [the assistant principal] said `Don't give me attitude,'" Krecker said. The assistant principal tugged on it while Nikki was pulling it out, Krecker said.

Wagner's parents are angry about the incident and have contacted several school district and state officials. Her parents say they have worked hard to let school officials know about the needs of diabetic children.

In juvenile diabetes, the pancreas produces little or no insulin, which is needed to regulate blood sugar. Symptoms of low blood sugar include excessive thirst, extreme hunger, sudden weight loss, excessive urination, and drowsiness or exhaustion.

Children with diabetes need daily doses of insulin. Many need to eat regularly to help keep their blood sugar levels stable.

Nikki has had several encounters with teachers who did not know how to handle blood-sugar problems. In elementary school, her teacher did not allow her to have a midmorning snack during a state exam. Her blood-sugar level dropped so low that the school called her mother, who said the staff must allow her to eat.

Her parents have visited congressional offices, joined a School District health committee, created a diabetes Web site and lobbied schools on behalf of parents who have had similar problems.

"We need to educate the educators," said her mother, Debbi Wagner. "They don't follow their own procedures."

Wagner said Nikki's health care requirements are on file with the school. She said any staff member expected to have contact with her should be familiar with them.

A spokesman for the Juvenile Diabetes Research Foundation said she had never before heard of a school official confusing an insulin pump with a beeper. She said some teenagers could be reluctant to stick up for themselves in such a situation because they may feel embarrassed about the illness.

"Perhaps there was not the communication that was so critical," spokeswoman Michele Ariano said. "A teenager sometimes doesn't communicate. I'm not sure my principal knew who I was when I was growing up."

Margulies said he plans to speak with his staff when they come back from spring break next week to talk about how to handle similar situations.

"The real key issue is making sure the confusion doesn't happen again," he said.

From "Letters To The Editor" of the Palm Beach Post March 30, 2002

Education needed on insulin pumps

The recent incident involving the alleged insulin pump disconnection of a student by a school official ("Metro report," March 21) actually provides a promising opportunity. I am always afraid my pump will beep in the middle of a business seminar wherein colleagues may misinterpret my pump beep for that of a rude beeper/cell phone interruption.
People need more education about insulin pumps and the importance of not disconnecting one without a doctor's orders. As a former teacher, I know school personnel face difficult disciplinary tasks. Maybe a renewed effort to listen and hear what children are saying could prevent such circumstances. If the school official is found to be negligent, perhaps part of her penance could include participation in diabetes/insulin pump seminars.
BARBARA A. UR
West Palm Beach

From "Letters To The Editor" of the Palm Beach Post April 1, 2002

In-school care of diabetic students debated
By Shannon Colavecchio, Palm Beach Post Staff Writer
Monday, April 1, 2002

A frustrated parent can't get teachers to understand that sometimes her diabetic daughter has to eat in class, even though school rules say otherwise.
A couple's diabetic 11-year-old daughter spends 20 to 90 minutes of
class time each day in the nurse's office because teachers will not let her test her blood-sugar level in class.
These stories are among the dozens posted from across the country at www.type1info.com, the Web site created by suburban Boca Raton parents Jeff and Debbi Wagner, who have spent the past six years trying to improve the in-school care of diabetic students like their daughter Nikki.
Earlier this month, the Wagners posted their own incident on the Web site's "Your Stories" section, after Nikki's $5,000 insulin pump was confiscated by an Eagles Landing Middle School assistant principal who thought it was a beeper.
District officials are investigating the allegations against Nereyda
Astiasaran-Perez, a new administrator at the school. But they insist the March 11 incident was an isolated and unfortunate situation that does not point to a larger problem within Palm Beach County schools.
"Everyone in that school knows that child has this pump, but unfortunately this one assistant principal was new and didn't have that information," district spokesman Nat Harrington said. "There are 40 other students at the school with medical issues, and there's never been a problem before now."
The Wagners disagree and say the insulin pump ordeal should serve as a wake-up call to Palm Beach County -- and school districts across the state -- that firmer, more detailed laws are needed to ensure the proper care of diabetic students, whose numbers are growing nationwide.

An estimated 800,000 Americans have Type 1, or juvenile, diabetes. Earlier this month, Yale University researchers reported that a quarter of obese children may be at high risk for developing Type 2 diabetes, normally seen in inactive, overweight adults. Health officials estimate that nearly 50 percent of all new childhood diabetes cases may be Type 2. At least 16 million Americans have diabetes; the number is expected to rise to 22 million within 25 years.
Last school year, the Palm Beach County Health Care District reported 272 public school students with diabetes, a 15 percent drop from the 1999-2000 year, when schools recorded 323 diabetic students. But last year, school nurses recorded 13,688 student visits (an average of 387 each week) for diabetes and low blood sugar, a 2.5 percent increase from 1999-2000, when nurses recorded 13,281 visits.
Considering those statistics, the Wagners want a state law that establishes mandatory guidelines for the care and rights of diabetic children in public schools. Right now, there are no laws specific to diabetes or insulin pumps -- even though the devices have been around for almost 25 years and is often prescribed for Type 1 diabetics.
State law requires school districts to provide training, by a nurse or other licensed health official, to school staff who help administer medication or perform health services, including glucose monitoring and tube feeding.
The law does not require all school staff to receive training. Debbi Wagner says that is unacceptable, because any school official might at some point have to deal with a student whose blood sugar is rising fast or falling dangerously low.
"My daughter has a medical ID bracelet, she has a health plan with the school and that didn't help Nikki," said Debbi Wagner, who serves alongside her husband on the district's school health advisory committee and the standing 504 committee, which deals with schools' compliance with the Americans With Disabilities Act.
"We're not happy this happened," she said, "but if this is what it takes for people to start doing things common sense should tell them to do, OK." 
Jeff Wagner, who has sent Gov. Jeb Bush dozens of letters and e-mails, wants the state to require that all teachers get training to deal with diabetes and other chronic diseases, such as asthma.
Harrington said a uniform policy, on the district or state level, is
impractical.
"No single training program could accommodate the needs of every child," he said. "It would be ludicrous to assume a broad awareness program could solve this. What works is the principal working with the nurse and the family and their doctors to customize the treatment and training, which is what we do."
The school district's policy mirrors state law, allowing trained school
personnel to administer medication as outlined in students' health plans.
The policy also states that asthmatic students can carry their inhalers while in school. It does not mention insulin pumps.

Parents, schools should share care

By Claire and Peter Petrosky
Posted April 29 2002 Sun Sentinel

   
The recent dispute involving a student who has Type 1, or juvenile, diabetes
and a school official -- along with many other similar and regrettable
incidents that inevitably crop up around the country -- underscores how
important it is for us, the parents, to better educate our educators about
our children who have chronic illnesses. It also calls for parents and
school officials to work closely together to eliminate the possibility of
future conflicts.

As parents of a 16-year-old daughter, Lauren, who was diagnosed at age 8
with Type 1 diabetes, the most serious and deadly form of diabetes, it is
critical that we take primary responsibility for meeting with and informing
administrators, teachers, and even medical or health personnel at our
daughter's school about the daily attention she requires and about any
special equipment necessary for tending to her condition.

At the same time, it is just as vital that those who are in positions of
responsibility at our schools go the extra mile to know which students have
special medical needs and to take steps to help ensure those students'
well-being.

In short, we all should view and approach the care of our young people as a
partnership.

There are schools that deserve a "D" or an "F" when it comes to seeking out
students with chronic illnesses and adequately addressing their needs.
Stories young people with diabetes have shared with us or that we have heard
from other parents are hard to fathom. One high school student, for
instance, passed out in a math class; his peers thought he was on drugs and
the teacher did nothing except send him to the office after he woke up on
the floor. The teacher's actions could have caused the student's death.
According to the young man, apparently no one in the school remembered he
had diabetes.

Many people who do not have diabetes simply do not understand the disease.

In Type 1 diabetes, the pancreas produces little or no insulin, a hormone
that, in most people, turns food into energy the body can use, and, thus,
sustains life. Insulin does not cure diabetes, it only provides life
support. To stay alive, people with Type 1 diabetes must take multiple
insulin injections daily (or they may opt to use a pump to give themselves
insulin), plus test their blood sugar by pricking their fingers for blood
six or more times a day.

But even with careful balancing of diet, exercise and insulin,
life-threatening episodes of high or low blood-sugar reactions can still
occur.

If dealing with Type 1 diabetes is this challenging for our daughter and our
family, it, understandably, is no easier for school officials responsible
for hundreds or thousands of students.

Guidelines for schools are available through local chapters of the Juvenile
Diabetes Research Foundation (www.jdrf.org). Making sure all necessary
personnel are informed about a student's condition, watching a student's
behavior before meals and snacks, making sure meals are eaten on schedule,
not assigning exercise just before a meal when a student may be in need of
food, and keeping a source of sugar readily available are just a few tips
JDRF offers to schools.

Until there is a cure for our daughter and others who suffer daily, we all
owe it to our children to give them the best quality of life at home and at
school.

The authors are volunteers with the Greater Palm Beach County Chapter of the
Juvenile Diabetes Research Foundation.

To Nikki and the Wagner Family:

Dear All,

As a user of insulin since the late 1940s and as a retired educator, I can
only offer sympathy, empathy and apology for the recent experiences
involving diabetes mechanism confusion. I have followed your story via the
internet and newspaper and I remain aghast at the circumstances surrounding
recent events. I'm certain that much has been suggested to the school
district about diabetes awareness and I won't add to the discussion. I've
found in life with diabetes that I bear responsibility for my maintenance
even though others have come to my rescue many times. I think young adults,
however, should share life's vicissitudes particularly when diabetes is
involved. May I extend to Nikki in particular and to your supportive
parents and sibling my congratulations for handling a very difficult
situation with dignity and aplomb.

Sincerely,

Ted Telford