Tonya Clutts was grateful for a school nurse intervening when her diabetic child was left alone in a room to complete a spelling assignment while the rest of her class went to lunch.
"The nurse said, 'You can't do that. She's got to have a glucose check and she's got to eat at a normal time,' " Clutts said.
Although she ultimately decided to home-school, the Giles County mom said a school nurse is an important guardian for diabetic children.
She and other parents of diabetic children in Tennessee are divided about a proposed state law that would allow teachers and coaches, instead of school nurses, to administer insulin. Similar laws are being passed throughout the nation, and the American Diabetes Association is lobbying for Tennessee to make the change.
Current state law allows non-medical personnel to give glucagon shots — hormone injections that boost blood sugar levels in emergency situations — but it specifies that nurses provide diabetes treatment to students. The debate hinges on whether access to daily care or the potential for dosage mistakes is the greater issue facing diabetic children.
Not every school has a school nurse. That's the reason the ADA is pushing for the legislation, said Brittany Freeman, state advocacy director for the organization in the southeast.
"Even if there is a school nurse, oftentimes she or he is not available full time," Freeman said. "Sometimes, you are sharing schools. Sometimes, you can't be in two places at once. You might have two children with two different needs at any given time."
Parents complain about having to go to schools to administer insulin themselves, their children not being allowed to go on field trips and other problems involving access to care on campuses.
Tennessee requires every school district in the state to have a nurse, said Lisa Nistler of Nashville, the president of the Tennessee Association of School Nurses. That does not mean every school has a nurse, she admitted. However, administering insulin requires daily blood checks and complex computations, she said.
"Insulin is a high-alert medication," Nistler said. "That's because it has the potential to result in serious harm to the patient, including death. That's because if you err on the side of too much insulin, the child's blood sugar would go too low. The child could slip into a diabetic coma."
Most diabetic children in Tennessee have the Type 1 form of the disease, which can make them more prone to severe swings in blood sugar levels. With Type 1 diabetes, the body produces no insulin, so daily treatment is critical for staying healthy.
"Living with Type 1 diabetes is an hour-to-hour, minute-to-minute struggle to balance," said Rebecca Garrett of Pulaski, the mother of a child blinded by the disease.
She prefers a school nurse doing the daily maintenance.
However, another mother of a diabetic child understands why the ADA is seeking law changes. Deb Holmes of Brentwood said that although the nurse at Edmondson Elementary School is "absolutely wonderful," she knows other children don't have access to the same level of care.
"I'm part of a support group," Holmes said. "Pretty much all the other parents have had a good deal more difficulty in having a nurse available. There are nurses being shared by a couple of schools. It really adds a lot of burden to the kids' academics to get insulin given to them when needed. It is probably a good law, but it is one that would not benefit me."
Freeman said her organization has no problem with school nurses. The organization is counting on school nurses to help train educators who volunteer to administer daily insulin injections.
"We love school nurses," Freeman said. "We wish we could have a school nurse or five or 10 in any school. The problem, right now, is I don't know of any state that has the budget to be able to do so."
The legislation to change the Tennessee law is Senate Bill 1445 and House Bill 1383.
"We feel this legislation is important because it will allow students to remain in the classroom setting, to receive the care and support that they need to manage their diabetes on a regular basis," Freeman said.
"Right now, what we're seeing in school settings where there is not a school nurse, or where there is not a full-time school nurse, parents are being asked to leave their jobs and come once, twice or three times to a school during the day to help their child administer an insulin dose."
Nistler worries about the children whose parents may not be knowledgeable about treatment of the disease. Nurses have the professional training to recognize when a diabetic child is "trending" and should go to a doctor to have dosage recommendations changed.
"Sometimes, the parents don't know to take care of their children," Nistler said. "They just don't have the capacity to have the knowledge. The school nurse is there to fill the gap."