Life was simpler for a child with diabetes in the 1980s. I'm pinpointing the '80s because that's when I was in public elementary school. As a child with type 1 diabetes, I had access to a full-time nurse to care for me every day without fail.

Today's kids aren't as lucky. In fact, the situation has changed dramatically.

Now, entire school districts are overseen by a single school nurse who may be required to drive several miles between schools in a single territory. This creates a problem for students with emergent medical needs like type 1 diabetes.

As a registered nurse and pediatric diabetes educator, I have seen the concern this situation raises, not only for parents and other nurse educators like myself, but for school nurses. The more research I do on this topic the more aware I am a solution is not easily found or agreed upon.

No Easy Solution
What are the roadblocks to a solution? The first is money: what it would cost taxpayers to ensure a nurse is in every school. Often, districts opt for just one full-time school nurse assigned to several schools within a district and part-time nursing aides to cover the gaps. Some school districts have not hired certified school nurses or nursing aides.

The second roadblock is found in well-meaning but problematic legislation. Current legislation in Pennsylvania does not allow for delegation of "nursing tasks," such as dispensing medications by staff other than a certified school nurse or nurse practitioner.

How then can children with diabetes in a school setting receive the necessary insulin and glucagon? With the enactment of such legislation, many school districts have been forced to cut back on nursing aides and hire more expensive licensed school nurses to accommodate its diabetic population. This ends up costing school districts thousands of dollars each year.

Administering Medication
There remains a lack of agreement on whether it is safe for a nonmedical professional to take care of children with diabetes while they are in school. There is no legal requirement as to how certified school nurses or nursing aides are trained in the care of children with diabetes. It is my opinion nonmedical personnel are indeed capable of administering medications once properly trained, and should be allowed to do so.

As part of my job as a diabetes educator, I spend countless hours educating parents and caregivers - most with no previous knowledge of diabetes or diabetes treatments such as injections - about every aspect of diabetes care. I complete this comprehensive teaching in a few hours at the time of diagnosis in preparation for children to be taken home and cared for solely by their parents or other primary caregivers. This training is then continually reinforced and expanded at subsequent outpatient-clinic visits.

The same education can and should be offered to school staff - not just nurses, aides and teachers, but coaches, bus drivers and school administrators. The more staff aware of what diabetes is and how it is treated, the more secure parents will feel about sending their children to be well cared for at school.

Flexible Treatment Requires Skill
It is safe to say that years ago the daily treatment for type 1diabetes was different and required less hands-on input and analysis than the more complicated, physician-preferred treatments of today.

For example, today's treatments can include basing a child's insulin doses on counted carbohydrate intake and blood sugar value. Not all school nurses have had this training and not all are willing to take the responsibility to learn the necessary skills. Current treatments do allow for more flexibility and better blood sugar control, which both parents and medical staff find important.

Getting Down To Basics
The basics of diabetes care remain the same; the bottom line is children with diabetes need a certified school nurse in each school to care for them.

In a perfect world these certified school nurses would be specially trained in diabetes education to ensure adequate knowledge on the most current diabetes treatment options including insulin pump therapy and continuous glucose monitoring therapy.

Also, nurses should be comfortable counting carbohydrates as this is difficult for most young children to do on their own. If each school cannot afford to hire a nurse, the school should designate an individual to receive medically specific training.

As I tell clients, the best way to ensure proper care of your child with diabetes while in school is to have consistent, open communication with the entire school staff, from the teachers to school nurses to aides.

Kailin Slowick is a full-time graduate student at the University of Pennsylvania, Philadelphia, where she is pursing a master's degree as a pediatric nurse practitioner.