Supporting the administration of insulin in schools

Download: Success Story Summary, January 2012 (PDF 226.4KB) / Award Entry Form (PDF 195KB)

The challenge

Changes from twice-daily insulin to basal bolus regimens in children presented Nottingham Children’s Hospital (NCH) with a problem. While the regimen was better at controlling diabetes in children, it meant they were likely to need to administer insulin during the school day, and schools were often reluctant to help with this, usually because of genuine concerns about making a mistake and harming the child. This often meant parents attending school during the day to give their child insulin. A team from NCH, local PCTs and the city and county education authorities decided to tackle the problem.

The aim

The aims were to ensure that every child who needed support in managing their diabetes in school received it, and that schools were happy about providing that support, and were aware of their rights and responsibilities in doing so. They also wanted to ensure staff providing support (including, if necessary, giving insulin injections) were fully trained and the child or young person with diabetes and their family would feel confident and happy with dealing with their diabetes at school. Finally they wanted to ensure every child or young person with diabetes would be fully able to participate in all aspects of school life and not suffer any disadvantage as a result of having diabetes.

What did they do?

Led by a paediatric diabetes nurse and the Assistant Special Educational Needs Officer for Access and Diversity at Nottinghamshire County Council, the first step was to develop clear written guidance for schools. The document was published in October 2007 and set out the responsibilities and included information on what diabetes is and how to manage any diabetes emergencies that may arise in a school setting. To support the document three half day training events were held in early 2008 for school staff. Staff from across Nottinghamshire attended the sessions and attendees included school nurses, teachers, teaching assistants, secretarial staff and lunch time supervisors. Following excellent feedback, the education sessions were run again and well over 250 staff from schools across the whole of Nottinghamshire attended. In 2010 session were extended to Nottingham City Council. They are now part of the Councils' rolling education programme and two to three sessions are run each year for both Nottingham City and Nottinghamshire County Councils. To overcome funding cutbacks sponsorship has been secured from the blood glucose monitor companies to fund the venues.

What happened?

As a result of the project all children in Nottinghamshire who require an insulin injection at school now have it administered by a member of the school staff. Additionally the work of the team has been recognised at two prestigious national meetings (Diabetes UK 2008 and Association of Children’s Diabetes Clinicians meeting 2008) and the document is available to everyone in the UK via the Diabetes UK website.

The team at the Children’s Hospital have evaluated the outcomes children starting on a basal bolus regimen from diagnosis. The findings demonstrate a significant improvement in the duration of the honeymoon period, with more than double the number of children with an HbA1C of less than 8% at year after diagnosis when started on a basal bolus regimen rather than on twice daily insulin.

Key outcomes

• All children who need it now have help to administer insulin during the school day
  
• Very positive feedback from parents and school staff
  
• 2x as many children on basal bolus regimen have HbA1C of