Nick Jonas of The Jonas Brother shakes hands with Hannah Ryder of Maine before speaking to a U.S. Senate committee in 2009 about his experiences living with Type 1 diabetes. (Susan Walsh/Associated Press)

Some Ontario families with young children with Type 1 diabetes want school staff to be able to help students test blood sugar levels and inject insulin to better manage the condition.

Ontario's Policy 81 specifies how much help teachers can give elementary students if they have to take medication, and what role educators play in meeting the health needs of school-age children beyond teaching.

The document has not been changed since 1984, but a review is now underway by consulting firm Deloitte and Touche.

Shana Betz's 22-month-old daughter has Type 1 diabetes, like about 7,000 other children and teens in the province. It is estimated that between one-quarter and one-third need assistance managing their diabetes at school because of their age.

Betz is concerned she will have to visit her daughter's school daily to test her blood sugar levels and do insulin shots until she's old enough to do it herself. Currently, school staff in Ontario are not required to help diabetic students monitor blood-sugar levels or provide insulin injections.

The Markham, Ont., mother said many parents of diabetic children have to quit their jobs to become full-time caregivers.

Betz is a member of the group Diabetes in Ontario Schools, which has been invited to participate in the policy review. She wants to see Type 1 diabetes included in Policy 81 so the protocol is spelled out.

"We have heard horror stories from parents whose children are having a horrendous time with school personnel because they are not allowing easy things to be done to keep these children safe," said Betz, a spokesperson for the group.

"Low blood sugar can be fatal and if a little juice is all that is needed to help save a life then we expect this to happen," she added in an email.

Tapping school resources

Diabetes is a difficult disease to manage, Betz noted.

The group wants Ontario to follow New Brunswick's model, where schools can assist children with diabetes to manage their disease, including testing and providing insulin shots. The Ontario group is not specifying that teachers take on that responsibility, though in New Brunswick, teachers are allowed to assist if they choose, and doing is covered under their liability policy.

Under the New Brunswick model, responsibilities include:

• Counting carbohydrates: Parents would advise how many carbohydrates are in the foods sent for lunch and snacks. The school resource person would verify how much was eaten to confirm the calculation or in some cases make sure the child finishes their food.
• Testing: A small drop of blood is used to test blood sugar levels with a glucometer. The school resource person would need to make sure fingers are clean, and do the test for young children without the manual dexterity required to do it themselves. Older children may do the test themselves with supervision.
• Dosing: A young child needs assistance using an insulin syringe, pen, or pump. With a pump, the parent would decide how much insulin to give based on carbohydrate consumption and the blood sugar reading. The resource person would simply follow the instructions given by the parents.
• Accommodations: At the start of the school year, parents and the principal would agree to a health plan, including accommodations such as allowing the child to test their blood sugar in the classroom or eat or drink when necessary.
• Emergency treatment for low blood sugar: An injection of glucagon is used for those with diabetes who become unconscious or have a seizure because of low blood sugar. There is a device similar to an EpiPen carried by children with severe allergies. Glucagon can be injected anywhere insulin is injected and does not do any harm if misused. In New Brunswick, schools have personnel trained in the use of glucagons.

The responsibility for making management decisions would continue to rest with parents in conjunction with health-care professionals, the group stressed.

Dr. Denis Daneman, pediatrician in chief at Toronto's Hospital for Sick Children, said he endorsed "good care" for children with diabetes in school to ensure they have the support and supervision needed to do well at school without risking problems with their diabetes.

Three different provincial ministries — education, health and community and social services — are involved in the review.

"I think it's going to be quite comprehensive although it's early days to determine how anything might come out," said Andrew Morrison, a spokesperson for the Ontario Ministry of Health.

The health ministry said the review should conclude by the end of July.