In recent years, advancements in diabetes technology have transformed how schools manage the health needs of students with Type 1 diabetes. Previously, children with this condition had to report to the school nurse multiple times a day for a finger prick to check their blood sugar levels. However, the introduction of continuous glucose monitors (CGMs) has largely replaced this outdated practice. These small, wearable devices, often attached to the arm, measure blood sugar continuously via a sensor that sends real-time data to a smartphone app. This technology provides immediate updates on blood sugar levels and sounds alarms when levels are dangerously high or low.
When blood sugar levels become too high, a dose of insulin—delivered either by an injection or through an insulin pump—may be necessary to prevent life-threatening complications, such as unconsciousness. Conversely, if blood sugar dips too low, a sip of juice can quickly bring levels back to normal and prevent problems like dizziness or seizures.
While many schools say they rely on teachers to listen for CGM alarms in the classroom, parents are raising concerns about the effectiveness of this system. In many cases, teachers may not hear alarms amidst the noise of a busy classroom, leaving parents to monitor their children's blood sugar levels through the app themselves. Unfortunately, they often can't easily contact their child when they are out of sight, such as during recess or lunch.
To address this, parents are advocating for school nurses or other administrative staff to remotely monitor CGM apps, ensuring that someone is always keeping track of a child's blood sugar levels—whether the student is in class, outside, or on a field trip.
However, many schools have been slow to adopt this approach, citing concerns about staffing shortages and the reliability of the internet or technical issues with the devices. A 2021 survey from the National Association of School Nurses revealed that nearly one-third of U.S. schools do not have a full-time nurse. While some schools do train other staff to monitor CGMs, the availability of such resources is inconsistent.
Before the introduction of CGMs, diabetes management in schools was more reactive, with nurses using time-consuming finger-prick tests or waiting for students to show symptoms of complications. The proliferation of insulin pumps has allowed many children to manage their own diabetes, further reducing the need for school staff involvement in administering insulin.
Parents stress that they are not asking schools to monitor their child's readings continuously but are instead requesting that school staff ensure that the child responds appropriately when a CGM alarm sounds. Julie Calidonio, a mother from Lutz, Florida, expressed frustration with the lack of support her 12-year-old son, Luke, has received at school. Calidonio said that relying on teachers to hear the alarms has led to instances where no one was available to intervene when Luke’s blood sugar levels reached critical lows.
“Why have this technology that is meant to prevent harm, and yet we are not acting on it?” she questioned.
Corey Dierdorff, a spokesperson for Pasco County School District, where Luke attends school, told KFF Health News that staff members respond when they hear a CGM alarm. However, when asked why the district has not agreed to have staff remotely monitor the alarms, Dierdorff pointed to concerns over internet reliability.
In September, Calidonio filed a complaint with the U.S. Justice Department against the district, claiming that the failure to monitor CGMs remotely violates the Americans with Disabilities Act (ADA), which mandates schools to provide accommodations for students with medical conditions. Calidonio is still waiting for a decision on her case.
This complaint comes four years after a ruling from the U.S. Attorney's office in Connecticut, which determined that having school staff monitor CGMs remotely was a "reasonable accommodation" under the ADA. The ruling came after complaints were filed by parents of students in Connecticut, and while the case set a precedent for those schools, it has not yet extended to districts outside the state.
Attorneys Jonathan Chappell and Bonnie Roswig, who were involved in the Connecticut case, say they have heard from parents in 40 states facing challenges in securing remote monitoring for their children's CGMs at school. They also noted that parents in 10 states have filed similar complaints.
CGMs are now used by the majority of the estimated 300,000 children under 20 in the U.S. with Type 1 diabetes, also known as juvenile diabetes. This autoimmune disease, typically diagnosed in early childhood, requires daily insulin to regulate blood sugar. Approximately 1 in 400 children under 20 is affected, according to the American Academy of Pediatrics.
Type 1 diabetes is different from Type 2 diabetes, which is typically linked to lifestyle factors like diet and exercise. While CGMs are also used by individuals with Type 2 diabetes, this form of diabetes is usually not diagnosed until the teenage years, and most people with Type 2 do not require insulin.
Students with Type 1 diabetes, or any other condition requiring special accommodations, typically have a healthcare plan created by their doctor that outlines the necessary accommodations at school. These plans usually include monitoring CGMs throughout the day and responding to alarms as needed.
Lynn Nelson, president-elect of the National Association of School Nurses, emphasized that when a doctor or parent determines that a student needs remote monitoring of their CGM, the school is legally required under the ADA to provide it. "It is legally required and the right thing to do," Nelson said.
Despite these legal requirements, schools often struggle to meet the demands due to staffing challenges. Henry Rodriguez, a pediatric endocrinologist at the University of South Florida, acknowledged that while the American Diabetes Association advocates for providing students with everything they need to manage their diabetes, remote monitoring can be difficult for schools to implement due to a lack of support staff.
In response to these concerns, some school districts have taken steps to improve their systems. For example, Loudoun County Public Schools in Virginia recently approved a policy change allowing school nurses to remotely monitor CGM alarms from their own wireless devices. This change, which affects about 100 students, was implemented after parents pushed for a solution to ensure their children’s blood sugar was properly monitored.
Lauren Valentine, a parent from Loudoun County, said that this new policy provides peace of mind. “It takes the responsibility off my son and the pressure off the teacher,” she explained. “Now we know the school clinic nurses are keeping track of his blood sugar, which gives us peace of mind.”
The push for better monitoring of CGMs in schools is not just about technology but about ensuring that children with Type 1 diabetes can safely manage their condition while receiving a quality education. As more parents advocate for remote monitoring, it is clear that school districts need to balance technology implementation with sufficient staffing to support students' health needs, ensuring their safety and well-being while at school.