American Diabetes Association Complete Guide to Diabetes: The Ultimate Home Reference from the Diabetes Experts

CHAPTER 21

Work, School, and Travel

• Diabetes in the Workplace

• Diabetes at School

• Travel and Diabetes

Learning to manage your diabetes at work, at school, or during travel will take some extra effort and time. In these situations, you’re likely to run into people who don’t know about diabetes or encounter circumstances that aren’t within your control.

A common theme for managing your diabetes in all of these situations is to be organized and prepared for potential challenges. You may have to take extra time to educate and communicate with people who are unfamiliar with diabetes and its management. This chapter provides tips for talking about diabetes with bosses, colleagues, teachers, and airport security. You’ll also find out about your rights in the workplace and schools.

Diabetes in the Workplace

There’s really no end to the types of work people with diabetes can do. Today—thanks to the Americans with Disabilities Act and the Rehabilitation Act—there are more and more opportunities for people with diabetes. These two laws guarantee your rights in private employment, local government, and federal government employment.

Diabetes affects each person differently, and each person should be evaluated based on what he or she can do. As long as you are qualified, you can go after almost any job you desire.

You may have an easier time managing your diabetes if you have a regular work schedule. But if your job entails working the late shift or traveling all over the globe, diabetes doesn’t have to keep you from pursuing it. Most people can make the necessary adjustments with help from their health care team.

If your employer or prospective employer questions your ability to do your job, explain to them how you are able to manage your diabetes. Emphasize that you are in charge of your diabetes and the discipline you use in taking care of your diabetes is the discipline and determination you will bring to the workplace.

Night Shift

When you work the night shift you may feel out of sync with the rest of the world. While everyone else is eating breakfast, you’re ready for your bedtime snack. Adjusting to conventional hours on your days off can also be a challenge. Nevertheless, with careful planning and monitoring, you can learn to make adjustments so that your new routine works for you.

Insulin Adjustments for Night Shift

• If you plan to sleep through the day, you may need to adjust your insulin dose to prevent hypoglycemia while you sleep.

• It may be easier to use a more intensive approach to manage your diabetes. For example, you could take an injection of long-acting insulin at the same time every day and rapid- or short-acting insulin before your meals.

• An insulin pump may also work well. Your health care team can help you make changes.

• If you prefer to stay up until noon and sleep through the afternoon and early evening, your normal morning insulin dose may work just fine. But you may have to make adjustments in your evening dose.

• If your job calls for some nights on and some nights off, then you will need to check your blood glucose levels more often and fine-tune your insulin dose.

If you have type 2 diabetes and are not taking insulin, you may still have to accommodate your work schedule. If you are taking oral medication, eating at a particular time may make a difference. It may be as simple as making sure you eat a snack before sleeping or changing when you eat and work out.

Erratic Hours

You may not work the night shift, but you may have a job that makes you keep odd hours. Meetings with clients may have you eating later than usual. Your job may require lots of travel. Even in the most conventional job setting, there are probably going to be occasions when you’re eating or exercising at different times. Whether it happens all the time or once in a while, you’ll need to learn how to make adjustments to accommodate changes in routine.

If you tend to keep a crazy schedule, talk to your health care team about an insulin plan that allows for maximum flexibility. Afterwards, check and record your blood glucose levels and evaluate how well your plan worked.

Physical activity can also be affected by changes in schedule. If you are used to a lunchtime jog, but a noontime lunch meeting keeps you from your normal routine, your blood glucose will probably be higher that afternoon. You can compensate by eating less, or, if you’re taking insulin, by injecting a little more insulin than usual. If you take your run later in the day, you may find it necessary to eat a larger snack than usual.

Whenever changes in routine require adjustments, be extra diligent about monitoring to keep your blood glucose on target and to learn how to make future adjustments. Be sure to always keep a snack on hand in case your glucose level goes low.


Check More Frequently

Whenever you are getting used to a new routine, more frequent blood glucose monitoring will help you decide how to best adjust your daily routine to keep your blood glucose levels in balance.


Late Lunches

If you’re going to eat a late lunch, try eating your afternoon snack or part of your carbohydrates at your normal lunchtime, and you’ll be able to hold off for a while until you eat your full meal. You may also need to delay giving your insulin until your mealtime. It will take a little trial and error, but you will soon figure out how to make adjustments.


Safety on the Job

It is important to always be aware of your blood glucose levels if you operate heavy equipment, if you are involved in public safety jobs like law enforcement or firefighting, or if you drive an automobile. This is especially important for people who take insulin or oral medications that can cause a low blood glucose reaction. A low blood glucose reaction in these situations can result in injury to yourself and others and can have serious employment consequences.

Guidelines for Diabetes and Driving or Operating Heavy Equipment

• Check your blood glucose level before you leave your house or start work.

• If your blood glucose is low (70 mg/dl or less), treat it. Recheck 15 minutes after your first check to be sure your blood glucose level is rising. Otherwise, it is not safe to drive or operate equipment. If your glucose is not rising, treat again, and wait until your blood glucose level has come back up.

• Always take along a fast-acting source of carbohydrate—glucose gel or tablets, hard candy, juice boxes, or raisins. Keep them in your glove compartment, too, so you will always have something available.

• If you feel even minor symptoms of low blood glucose while driving or operating heavy equipment, stop and check your blood glucose. Driving with a low blood glucose level is dangerous. It is better to be a few minutes late or to take a little longer getting the job done than to risk an accident.

• If you can’t check your blood glucose and you feel hypoglycemic, stop what you are doing and treat the symptoms. Don’t start driving or working again until the symptoms pass. It’s a mistake to think you can hold out until you get to your destination or until you finish up the job.

• Always wear diabetes identification.

Armed Forces and Commercial Pilots and Drivers

Federal law requires an employer to evaluate each person with diabetes as an individual, looking at the job in question and how diabetes affects that person. However, there are a few exceptions: the armed forces and commercial pilots and drivers.

Exceptions to the Law

• The federal government does not allow people who take insulin to enter the armed forces. However, some people who take insulin have been able to remain in the armed forces when diagnosed with diabetes.

• The federal government does not allow people who use insulin to pilot commercial airplanes.


ADA Wins Pilot Battle

Thanks to ADA’s efforts, the Federal Aviation Administration (FAA) overturned a 36-year-old blanket ban that prohibited people who use insulin from flying small, private aircraft.


Commercial Drivers’ Licenses

The American Diabetes Association (ADA) has worked for years to overturn the so-called “blanket bans” that sometimes prohibit anyone with diabetes from performing certain jobs or participating in other activities. The federal government used to ban people who take insulin from driving large trucks or buses on interstate routes but has now set up a program for individual evaluation of each potential driver. For example, if you were a truck or bus driver with non-insulin-treated diabetes who later began using insulin, you could lose your job.

Tips for Commercial Drivers

• Thanks to the ADA, in 2003, the U.S. Department of Transportation (DOT) instituted an exemption program to allow some people who use insulin to drive commercial vehicles in interstate commerce.

• Under this system, the DOT evaluates each case on an individual basis.

• Currently, drivers must submit an application and go through a physical examination through the DOT to receive an exemption.

In addition, the federal government allows individual states to provide waivers to intrastate drivers who use insulin. These waivers allow commercial drivers to travel within a given state, but only if the goods or people transported are not coming from or going to another state. Contact your state’s motor vehicles department to find out if your state has a waiver program for intrastate drivers who use insulin.

The ADA continues to fight for the right for each person with diabetes to be evaluated individually based on how diabetes affects him or her and to not be excluded because of misinformation and stereotypes about diabetes.

Discrimination at Work

Today there are laws to protect against discrimination in the workplace. But unfortunately, discrimination against people with diabetes still exists.

Sometimes people with diabetes are told outright they won’t be hired because of their diabetes. But other times discrimination can be subtler. Did you get passed over for a promotion because of your work performance or because your boss was afraid your diabetes might interfere with the added responsibilities? Did you fail to get that job offer because you weren’t qualified, or because you told the employer you have diabetes?

Sometimes it’s hard to know. The best thing you can do to guard against discrimination in the workplace is to do the best job you can and understand your rights. You can find more information about employment discrimination at www.diabetes.org.

Disability Laws

In 1990, the Americans with Disabilities Act was signed into law. This law protects qualified individuals with disabilities from discrimination. It covers all private-sector employees who work for companies that employ 15 or more people and people who work for state or local governments.

The Rehabilitation Act of 1973 and the Congressional Accountability Act provide similar coverage for people who work for the executive branch of the federal government, companies that receive federal funding, or the legislative branch of the federal government.

Under these federal laws, employers cannot discriminate against you if you have a disability, are qualified for the job, and can carry out the work with or without reasonable accommodation by the employer.

All of the states have their own anti-discrimination laws and agencies responsible for enforcing them. Some state anti-discrimination laws provide more comprehensive protection than federal laws.

In principle, employers are not allowed to discriminate, but in practice some discrimination still occurs. Some employers are slow to change workplace policies, such as bans on hiring anyone who takes insulin, unless they are challenged in court.


Diabetes Is a Disability Under the Law

The Rehabilitation Act, the Americans with Disabilities Act, and the Congressional Accountability Act require employers to give people with disabilities an equal opportunity. It may be difficult to think of diabetes as a “disability,” but this legal term is necessary to defend your rights.


Americans with Disabilities Amendments Act of 2008

This new law further protects people from workplace discrimination. It no longer requires that mitigating measures—such as insulin use—be considered when determining whether you have a disability. It considers your endocrine system as a major life activity that can be impaired—and diabetes is therefore a disability.


Your Rights

A person with diabetes must show that she or he meets the definition of “disability” under the law (specifically, having an actual disability, having a record of a disability, or being regarded as having a disability). One type of disability is a limitation in the functioning of a major bodily system, such as the endocrine system. So, under the law, most people with diabetes have to prove that they have limited endocrine function.


You Can Be Fired

It is important to keep in mind that if you can’t show that you have a disability, have a record of having a disability, or are regarded as having a disability then it is legal under federal law for an employer to refuse to hire you, fire you, or take other adverse action because you have diabetes.


Tips about Your Rights

• Courts are required to do an individual assessment of each person.

• The employee must also establish that he or she is qualified for the job in question. A qualified applicant possesses the skill, experience, education, and other job requirements of the position he or she would do with or without reasonable accommodation.

• Employees must also show they were treated unfairly because of their diabetes.

Before these laws were passed, you may have been asked to list any medical conditions on a job application. The employer could then refuse to hire you based on this information. But if you weren’t hired, you might not know whether it was because of your qualifications, a bad recommendation, or because of your diabetes.

Current federal law allows an employer to ask an applicant for medical information only after making a job offer and only if all job applicants are asked to provide this information. Then an employer may withdraw a job offer only if the applicant cannot perform the tasks required for the job, even if the employer makes reasonable accommodations.

An employer still has the option of hiring whomever he or she feels is best able to do the job. However, an employer can run into problems if he or she hires someone less qualified while refusing someone with better qualifications who happens to have diabetes or any other disability.

Reasonable Accommodation

The laws require that employers try to reasonably accommodate people with disabilities. Reasonable accommodation is defined as modification or adjustment of a job or employment practice in order to make it possible for a qualified person with a disability to be employed.

For people with diabetes, employers may have to allow workers to adjust their work schedule or take breaks to eat or check blood glucose so that they can manage their diabetes while on the job.

People with complications from diabetes might need other accommodations, such as a large-screen computer for those with retinopathy or the ability to sit on the job for those with painful neuropathy. The employer must make these accommodations available unless they create an undue burden because of cost or other factors.


Asking Medical Questions on the Job

Once you have started working, an employer can only ask medical questions if they are related to the job and consistent with the needs of the business. For example, if an employee falls asleep on the job, an employer may ask if a medical condition is the cause. However, if an employee doesn’t look well but is performing his or her job adequately, an employer may not ask whether there is a medical problem.


Protecting Your Job with FMLA

Another federal law, the Family and Medical Leave Act (FMLA), can help you—and your family—deal with diabetes in the workplace. This law allows workers to take up to 12 weeks of job-protected unpaid leave during any 12-month period to care for their own serious health condition or to care for family members (spouse, child, or parent) with a serious health condition.

Examples of when you might use FMLA for your diabetes would be for a doctor appointment or sick day because of your neuropathy pain (if your employer doesn’t allow these accommodations). Or you could use the FMLA to take your child to the emergency room in the event of severe hyperglycemia.

Tips for FMLA

• FMLA absences may be taken in a single 12-week stretch or in shorter intervals, such as a short period to deal with a diabetes-

related illness or emergency or a scheduled doctor’s appointment.

• Employers who normally pay health insurance premiums must continue to do so for an employee on FMLA leave.

• FMLA applies to most public employers and to those private companies with 50 or more local employees (within 75 miles of the workplace).

• To be eligible, employees must have been with a covered employer for at least 1 year and have worked 1,250 or more hours during the 12 months immediately preceding the date of commencement of FMLA leave.

• When leave is foreseeable, employees must give 30 days’ notice.

Some high-level company executives—those who are in the top 10% salary range—may be ineligible for FMLA leave. FMLA offers leave to care for yourself, your spouse, parents, step- and foster parents, minor children, minor step- and foster children, and adult children who are incapable of self-care. FMLA excludes leave care for unmarried partners, in-laws, siblings, grandchildren, and grandparents.

Fighting Back against Discrimination

If you believe that you have experienced discrimination, either in your job or while seeking employment, the best course of action is first to educate and then negotiate. If necessary, litigate and, last, legislate.

Sometimes, dealing with a discrimination problem is as simple as teaching people about diabetes. Many employers don’t understand the needs or capabilities of people with diabetes. Sometimes they don’t understand the laws that protect you from discrimination.

By educating employers about your needs, limitations, and strengths and by informing them of your rights and their responsibilities, you can resolve many situations in which you suspect discrimination.

Sometimes education alone may not be enough. You may have to negotiate to secure your rights. Your negotiations may be more effective if you first seek legal advice. Seeking legal advice early will maximize your attorney’s ability to help you.

Whether you have outside help or not, negotiating involves listening to the concerns of those in the workplace with an open mind and offering solutions to the perceived problems.

If this doesn’t help, you may have no choice but to litigate. The litigation process begins by filing an administrative complaint with the appropriate agency.


Suggest a Trial Period

If your employer is unwilling to take the steps to resolve a problem, you might suggest a trial period in which you can show how your solution may benefit all involved. You might also consider soliciting outside help, such as elected officials or the media.


Filing a Claim

• If you are discriminated against by a private employer or a local government, you must file a charge with the Equal Employment Opportunity Commission (EEOC) and/or the state agency that handles workplace discrimination issues. The EEOC provides free information booklets. Check the Resources section at the end of this book for more information.

• If you work for or are seeking a job with the executive branch of the federal government, you must file a complaint with your agency’s Equal Employment Opportunity Office.

• If you have been discriminated against by the legislative branch of the federal government, your claim under the Congressional Accountability Act must be filed with the Office of Compliance.

Be aware that the time limits for filing discrimination claims are very short. Claims with the executive branch of the federal government must be filed within 45 days of the act of discrimination and those with other employers can be due within 180 days of discriminatory treatment. If the agency doesn’t resolve the problem to your satisfaction, you can file a lawsuit in federal or state court claiming discrimination on the basis of disability.

If a suit is decided in your favor, the employer may be forced to pay a cash settlement, reverse the discriminatory decision, and pay penalties. To decide on the best course of action, you will want to consult an attorney.

Sources to Contact in Case of Discrimination

• The American Diabetes Association. Call 1-800-DIABETES and ask for the Association’s employment discrimination packet. If you have a specific problem, you may also want to fill out a form so that you can talk to the Association’s Legal Advocate. A great deal of information is available on the ADA website (www.diabetes.org).

• The Equal Employment Opportunity Commission or your state’s anti-discrimination agency. Most states have a commission charged with investigating discrimination.

• Your union representative. If your job is covered by a union contract, your union may be able to help.

It is up to you to prove that you have been discriminated against because of diabetes. Request a written statement saying why you weren’t hired or promoted or were let go. There may be other reasons for the employer’s decision, and you and your attorney should be aware of them.

Tips for Proving Discrimination

• If an employer is truly discriminating against you on the basis of your diabetes, he or she may not readily admit to it in writing.

• You may have to gather some information to substantiate your claim, such as the employer’s job application form, policy manuals, and any rules or regulations cited by the employer as the reason you were dismissed or not hired.

• Save copies of the job advertisement or listing, the job description, and the job performance evaluation criteria.

• You should also compile a list of potential witnesses, including their work titles and how to contact them. Include some information about their duties at work and how they would know about your situation.

• Finally, make a diary of events in chronological order.

Sometimes legislative or regulatory changes are necessary. The ADA works to change laws and policies that are unfair to people with diabetes; for example, ADA successfully fought the “blanket ban” that kept people who use insulin from driving a commercial vehicle in interstate commerce.

Fighting Discrimination: A Success Story

Jeff Kapche always knew he wanted to be a police officer. Kapche passed all the tests and the background check required to join the department as a police officer.

However, the doctor in the city of San Antonio who gave Kapche his physical examination concluded that Kapche, who has type 1 diabetes, could not do the job because of his diabetes. The doctor disqualified Kapche because driving was an “essential function” of the police job, and San Antonio considered drivers who use insulin to be a safety risk to themselves and others.

Kapche appealed the decision, but after a year he had run out of options for internal appeals. He then turned to the American Diabetes Association for help. The ADA helped secure lawyers who argued that blanket bans that disqualify all people with diabetes from a given position, such as a law enforcement position, are both unlawful and medically unnecessary.

It took more than eight years and two trips to the United States Court of Appeals for the Fifth Circuit, but ultimately Kapche’s lawsuit resulted in an important victory for workers with diabetes. The appellate court determined that blanket bans against people with diabetes—and specifically Jeff Kapche—were unjustified. Jeff Kapche’s struggle helped many people with diabetes to face discrimination on the job.

Job Hunting

Not everyone discriminates against people with diabetes, so don’t let the fear of discrimination in the workplace keep you from seeking or reaching your career goals.

Tips for Job Hunting with Diabetes

• Try not to think of diabetes as a defect. It is a part of your life.

• Be prepared by knowing your rights. Remember that employers are not allowed to ask about your health before deciding whether to hire you. Once the job has been offered, they can ask about medical conditions only as they relate to the job as part of the pre-employment physical examination.

• If you wait to disclose your diabetes until after the job has been offered, take a positive approach. Be sure to point out how diabetes helps you be a conscientious employee.

• During your physical exam, if required, accurately describe your condition and how you care for your diabetes. Don’t try to change your diabetes care plan immediately before any physical examination. Changes in routine can affect your glucose levels.

• Your company’s doctor is probably not a diabetes specialist, and you may need to educate him or her about how you manage your diabetes. Offer input from your treating diabetes physician to help the examining doctor make an accurate diagnosis.

In time, popular thinking will catch up with what many know already: diabetes doesn’t have to keep you from doing what you want to do.

Disclosing Diabetes at Work

Whether you tell your employer or fellow employees about your diabetes is completely up to you. There are reasons to tell and reasons not to. Much depends on your particular job circumstances and the people involved. Here are some of the pluses and minuses.

Advantages of Disclosing Diabetes at Work

• If you take insulin or certain oral agents, you may be prone to low blood glucose reactions. This can make you confused and unable to help yourself. If people know you have diabetes, they can help you in the event of such a reaction.

• If you need your employer to make accommodations because of your diabetes (for example, providing time for you to check your blood glucose level in a job that doesn’t allow breaks at will), your employer needs to know about your diabetes and why you need the accommodation.

• If your employer is not on official notice that you have diabetes and you suspect that some adverse action is the result of your diabetes, it may be very difficult to prove that your employer discriminated against you because of your diabetes.

• Being open helps people learn more about diabetes. You can help fight prejudice by showing that people with diabetes are just like everyone else. By not telling, you may be sending the message that you have something to be ashamed of.

• When you are open about your diabetes, you may be surprised to learn how many others have diabetes themselves or in their families. You can help each other.

• When you talk about your diabetes, other people can learn about the symptoms and treatment. As a result, people you know get the help they need if they suspect that they may also have diabetes.

Disadvantages of Disclosing Diabetes at Work

• You may want to maintain your privacy. Just as you wouldn’t necessarily talk about how much money you make, you might not want to discuss your diabetes, which is just as personal.

• If you don’t tell, you are less likely to lose a job promotion or job offer because of your diabetes. However, diabetes can be difficult to hide if you need to take breaks or leave a meeting to monitor blood glucose or take medications. Although laws protect against discrimination, it is not always easy to prove.

Diabetes at School

Adjusting to diabetes in school can be challenging. This is true whether your child has been living with diabetes and is entering school for the first time or changing schools or is already in school and has been recently diagnosed with diabetes.

You want to make sure your child is given the same opportunities as other children, but you also want to make sure your child is safe at school and that any special needs are met. And you definitely don’t want your child to feel like an outcast.

Diabetes Medical Management Plan

The best approach to dealing with diabetes in schools is to communicate openly with the school’s administration and teachers and, if your child agrees, with the other children in class. Make sure your child’s school staff understands what it means to have diabetes, how your child manages his or her diabetes, and what needs your child has.

Your child’s school may already have a policy in effect to deal with the needs of children with chronic illnesses, including diabetes. However, you and your child’s health care team will need to develop an individual plan—called a Diabetes Medical Management Plan (DMMP)—to address your child’s specific health care needs.

The plan spells out the medical care your child should receive at school, including information about blood glucose monitoring, meals and snacks, insulin, and emergency care, which may include the administration of glucagon.

Some children are capable of self-care, whereas other children will need a great deal of help. All children with diabetes will need help in the event of an emergency.

ADA has developed a sample DMMP, which is available on the Internet for printing or downloading at www.diabetes.org or by calling 1-800-DIABETES and asking for a school discrimination packet. A sample DMMP form is located in the Resources section of this book.

Details of a DMMP

• A child should be able to receive assistance with blood glucose monitoring and insulin or glucagon administration if needed.

• A child can eat whenever and wherever necessary. This includes keeping snacks or glucose tablets close at hand.

• A child can go to the bathroom or water fountain when necessary.

• A child can participate fully in all school activities, including extracurricular activities such as sports or field trips, with diabetes care provided by trained school staff members.

• Option to refrain from exams or physical activity when blood glucose levels are too high or too low.

• A child should be able to eat lunch on schedule, with enough time allotted to finish eating.

• A child can be excused for tardiness in case of a blood glucose problem.

• A child should be allowed to check blood glucose levels in the classroom or wherever he or she happens to be (if the child is capable of this self-management task).

• A child is allowed to be absent, without penalty, for medical appointments and diabetes-related illnesses.

Section 504 Plan and Individualized Education Program

The implementation of a DMMP by the school is called a Section 504 plan if it is developed under the federal Rehabilitation Act or an Individualized Education Program (IEP) if it is developed under the Individuals with Disabilities Education Act. For example, a physician and parents develop a DMMP. The school, with input from parents, develops the 504 or IEP plan. You’ll want to ensure that your school has one of these plans in place so that your child’s needs are met. A model Section 504 plan is located in the Resources section of this book.

Communicate and Educate

Sitting down with your child’s teachers, school nurse, school administrators, and other personnel and discussing your child’s needs is important. Schools that are reluctant to accommodate a child’s diabetes needs may not actually understand diabetes.

It is your responsibility to educate your child’s school staff about your child’s diabetes so that they understand that the needs of a child with diabetes are not unreasonable. In turn, it is the school’s job to make sure your child is medically safe and has the same opportunities as other students.

Tips for Talking with Schools about Diabetes

• If your child is entering a school for the first time, meet several weeks before school starts with the school principal, school nurse, teachers, and other school personnel who will have direct contact with your child.

• If your child is already enrolled in school but has been recently diagnosed with diabetes, meet with school personnel before your child returns to school.

• Before meeting with school personnel, it is important to meet with your child’s health care team and work out a DMMP for your child.

In your initial meeting with school personnel, discuss what is in your child’s DMMP and how these needs will be met.

It is also important to understand how school policies and protocols might affect the diabetes care your child receives while at school and to educate and work with school personnel to make any needed adjustments. Discuss any concerns you might have and be sure to find out what concerns your child may have. Open communication at this stage is critical to establishing a positive working relationship.

Topics to Discuss in School Meetings

• Provide a brief explanation of diabetes, clarify any misconceptions, and explain the consequences of blood glucose levels that are too high or too low and the appropriate corrective actions.

• Find out whether there is a nurse on duty to assist with routine care and to handle emergencies and, when a nurse isn’t available, which adults will be trained to provide care to your child during the school day and at all school-sponsored extracurricular activities.

• Determine what time your child will be eating lunch and whether there is a designated snack time for all children.

• Make sure your child will have immediate access to a snack and a quick-acting form of glucose whenever necessary.

• Also, it is especially important to talk with school personnel, including your child’s physical education teacher, about the impact of food, insulin, and physical activity on blood glucose levels and how to prevent and respond to hypoglycemia.

Classroom Blood Glucose Monitoring and Self-Management

People with diabetes must manage their blood glucose levels through the careful balance of food, exercise, and medication. Blood glucose monitoring is an essential component to good health. It is the only way of making sure blood glucose levels are maintained within your child’s target range.

Your child’s immediate access to diabetes equipment and self-care is important so that symptoms don’t get worse and so that she or he doesn’t miss valuable classroom instruction or other school activities.

You may want your child to check his or her blood glucose levels and promptly treat wherever he or she is at school or during a school-related activity. However, this depends on your child’s age, level of experience and skill, and personal preference.

Good diabetes care depends on self-management. However, 

because of your child’s age, maturity level, or level of experience 

or skill, he or she may not be able to handle various aspects of diabetes care alone. Trained school personnel will be needed to check blood glucose levels, to administer insulin or medication, or to recognize and treat hypoglycemia (and administer glucagon) or hyperglycemia.

Training of School Personnel

Diabetes care training for school nurses and other school personnel should be developed and implemented by diabetes educators, school nurses or other qualified health care providers, and school administrators. There are three levels of training that school personnel should receive.

Levels of Training Appropriate for School Personnel

1. Some school personnel will need to be trained to perform actual diabetes care tasks, such as blood glucose monitoring, insulin administration, glucagon administration, and recognition and treatment of hypoglycemia or hyperglycemia. They should also receive a general overview of diabetes and explanation of type 1 and type 2 diabetes, education about nutrition and exercise, and an explanation of legal rights and responsibilities of parents and schools. School personnel should be trained to ensure that a trained person is available during the school day and at all school-sponsored events, field trips, before- and after-school activities, and extracurricular activities.

2. Other staff members who have primary responsibility for a student with diabetes need to understand how to recognize when your child needs help, what accommodations are needed, and how to locate a diabetes-trained person who can provide it.

3. All school personnel should receive a brief overview of diabetes and how to get help when needed.

Appropriately trained school personnel will help to ensure a safe school environment for your child and will enable her or him to participate in all school-sponsored events and to achieve optimal academic performance.

Your Child’s Rights

Once you have met with school personnel and discussed your child’s needs, as set out by his or her DMMP, hopefully the school will accommodate your child. Almost all schools are required by law to provide aids and related services to meet the needs of children with diabetes. Three federal laws may play an important role at school.

Federal Laws Regarding Diabetes at School

• Section 504 of the Rehabilitation Act of 1973 protects individuals with disabilities from discrimination in any federally funded program, including public school systems.

• The Americans with Disabilities Act provides similar protection 

in all public and private schools, except schools run by religious institutions.

• Both laws have been found to protect children with diabetes.

• The Individuals with Disabilities Education Act (IDEA) guarantees “free appropriate public education including special education and related service programming for all children with disabilities.” This law only applies to those children whose diabetes adversely affects their ability to learn. This can occur when your child’s blood glucose levels are often very high or low at school, if your child misses a lot of school due to diabetes-related complications, or if your child has another disability that affects learning.

• You can ask your school district to evaluate your child to determine which laws apply.

After you have discussed your child’s DMMP with school personnel, the next step is to determine how the school will treat your child. It is important to write down just what steps are going to be taken. That way, everyone—from student to parent to school staff—knows their responsibilities.

The accommodation may be documented in either a 504 plan or in an IEP. The document should specifically state your child’s disability, needs, accommodations, and how these accommodations will be delivered.

The plan sets out a blueprint for making sure your child has the same opportunities to participate in all academic and school-sponsored activities as children without disabilities. Typically, an IEP is more specific than a 504 plan with regard to your child’s academic needs.

Tips for Working with Schools

• Make sure to think through what things are important to your child’s well-being and include those in the plan.

• You are more likely to get greater cooperation from the school officials if you show a willingness to understand their concerns, but maintain a firm position on how your child’s needs must be met.

• Try to encourage the attitude that you are all members of the same team.

If you feel that your child’s school is not meeting your needs, you have no choice but to take stronger action. You may want to contact an attorney for help in deciding the best course of action. You may consider filing an administrative complaint with the U.S. Department of Education or through the school district or state appeal process. Do not delay in getting legal help. Administrative appeal and other actions need to be started quickly or you lose the ability to pursue them.

In working with school officials to meet your child’s needs, it helps to know your rights. You have the right to request that your child be evaluated for services, and if eligible, you have several other rights.

Your Public School Rights

• You can schedule a meeting with school officials. You have a right to bring an advocate, attorney, or experts to this meeting to better explain your child’s diabetes management.

• You can develop a plan to accommodate the unique needs of your child. This plan should precisely set out the types of special services your child needs to receive.

• You can withhold signing a plan if it does not meet your child’s needs. Be reasonable, but stand firm if your child’s needs are not being accommodated.

• You should be notified and review any proposed changes in your child’s plan, be included in any conference or meeting held to review the plan, and review and consider changes before they are implemented.

More School Resources from the ADA

The American Diabetes Association has long been involved in working to end discrimination against students with diabetes. To further these efforts, ADA launched the Safe at School campaign to ensure that students with diabetes are safe at school and can fully participate in all school activities. You can find more information about the campaign at ADA’s website (www.diabetes.org/safeatschool).

Written materials are also available from the ADA that explain diabetes care in a school setting. One example of an ADA pamphlet is “Children with Diabetes: Information for Schools and Child Care Providers.” The ADA’s packet on school discrimination can be obtained at www.diabetes.org or by calling 1-800-DIABETES. You can also discuss a specific school or day care problem with an ADA Legal Advocate.

More School Resources

• The National Diabetes Education Program’s “Helping the Student with Diabetes Succeed: A Guide for School Personnel” is available from www.ndep.nih.gov/publications/PublicationDetail.aspx?PubId=97#main. The National Institutes of Health, the Centers for Disease Control and Prevention, the U.S. Department of Education, the ADA, and many other diabetes and education organizations developed this comprehensive guide.

• ADA’s Diabetes Care Tasks at School Training Modules are available from www.diabetes.org/schooltraining.

Travel and Diabetes

In today’s world, almost everyone is on the go. You’re bound to have changes in your daily schedule and routine, whether jumping on a plane several times a month or riding the train every now and then. However, your diabetes should not get in the way of your travel. With a little advance planning, you can go anywhere and do almost anything. But there are a few things you should be aware of that will make your diabetes care that much easier.

Air Travel

Traveling through airports and on airplanes is a drag these days. The extra time involved in checking your bags, going through security, and boarding with carry-on luggage can leave anyone exasperated. You’ll need to be extra organized with your diabetes supplies and medications to make sure things go smoothly. Here are a few tips.

Tips for Packing

• You will want to take enough supplies and medication for your trip plus extras in case you get delayed, you misplace something along the way, or you decide to stay longer.

• Make sure that all your diabetes supplies are in your carry-on bag. You can’t count on your luggage getting to your destination at the same time you do.

• You should also be sure to pack snacks to carry with you and have accessible whenever you may feel your blood glucose going low.

• If you take insulin or other injectable medications, make sure they are in your carry-on bag. The luggage compartments on airplanes are often very cold, and your insulin could freeze. Also, your bag could be left in the hot sun and the insulin could get too warm.

• If you use an insulin pump, take an alternate source of insulin in case your pump stops working while you are away from home. Most pump companies will send another one to your destination by express mail, but you need a way to take insulin in the meantime.

Carry-On Luggage Checklist

Medications

• Insulin or other injectable medications or pens

• Syringes, pen needles, or pump supplies

• Oral diabetes medications

• Glucose tablets or other source of quick-acting carbohydrate

• Snacks, such as dried fruit or crackers

• Antibiotic ointment

• Other prescribed medications

• Glucagon kit

• Anti-nausea and anti-diarrhea medications

Blood Monitoring Equipment

• Test strips

• Lancets

• Blood sampling device and a spare

• Glucose meter

• Hand-washing gel or alcohol wipes

• Spare batteries for glucose meter

• Cotton or tissues

Airport Security

Much has changed in airports and airport security in the past few years. The important thing to keep in mind is that your diabetes equipment and medications are necessary and permitted through security checkpoints.

However, new restrictions on everyone traveling may mean that it takes a little longer to get through security than it did in the past. Being patient and organized when you arrive at security will make things go more smoothly.

New rules implemented by the U.S. Transportation Security Administration (TSA) may affect people who use insulin pumps. If you use an insulin pump, you may be required to undergo more comprehensive screening, including hand and explosives checks of all of your carry-on luggage. Be aware of these new rules, and allow extra time to pass through security.

Security regulations allow anyone to pass through security with 3.4 ounces or less of liquids, aerosols, or gels. These items must be put in one quart-size, sealable bag. However, larger volumes of prescription liquids and other liquids needed by people with disabilities and medical conditions are allowed through airport security. They must be declared to the TSA officer on duty.

Some Allowed Prescription and Other Liquids

• All prescription and over-the-counter medications (liquids, gels, and aerosols), including petroleum jelly, eye drops, and saline solution for medical purposes.

• Liquids, including water, juice, or liquid nutrition, or gels for passengers with a disability or medical condition.

• Life-support and life-sustaining liquids, such as bone marrow, blood products, and transplant organs.

• Items used to augment the body for medical or cosmetic reasons such as mastectomy products, prosthetic breasts, bras or shells containing gels, saline solution, or other liquids.

• Gels or frozen liquids that are needed to cool disability-related or medically related items used to treat disabilities or medical conditions.

The TSA has developed specific advice for travelers with diabetes. You should notify the security agent that you have diabetes and that you are carrying diabetes medication and supplies with you.

TSA-Allowed Diabetes Supplies and Equipment

• Insulin and insulin-loaded dispensing products (vials or box of individual vials, jet injectors, biojectors, epipens, infusers, and preloaded syringes).

• Unlimited number of unused syringes when accompanied by insulin or other injectable medication.

• Lancets, blood glucose meters, blood glucose meter test strips, alcohol swabs, and meter-testing solutions.

• Insulin pump and insulin pump supplies (cleaning agents, batteries, plastic tubing, infusion kit, catheter, and needle), but must be accompanied by insulin.

• Glucagon emergency kit.

• Urine ketone test strips.

• Unlimited number of used syringes when transported in a disposal container or other similar hard-surface container.

• Sharps disposal containers or similar hard-surface disposal container for storing used syringes and test strips.

• Insulin in any form or dispenser must be clearly identified.

Although not required, it is a good idea to take a letter from your diabetes care provider saying that you have diabetes. This is particularly helpful if you are traveling overseas.

For more information or to report unfair treatment by security personnel, contact the Transportation Security Administration at 1-866-289-9673 or www.tsa.gov.


Request a Visual Inspection

You can always ask to have a visual inspection of your diabetes medication and supplies.


Meals during Air Travel

Many flights no longer offer food service. Ask at the desk before you board the plane if there will be a meal or snack. You can purchase something at the airport to carry on the plane and eat around your usual mealtime or before you board.

If a meal will be served, you can order a special meal in advance. Most airlines have low-sugar, low-fat, low-salt, and low-cholesterol meals available on request. Most airlines require that you request special meals at least 24–48 hours in advance. However, many people prefer to get the regular meals and choose which food to eat.

Tips for Meals on Airlines

• Mealtimes on the plane can be somewhat unpredictable. So don’t inject your premeal insulin until your meal has been served. Bad weather, a bumpy flight, or air traffic can delay service.

• Take along extra snacks in case your meal is delayed, there is no meal service, or there is no time to buy food at the airport.

• You may want to tell your flight attendant that you have diabetes, especially if you are traveling alone. That way, your airline crew will be prepared should any emergency arise. If there is a meal delay, he or she may be more willing to see that you get your meal as soon as possible.

• If you order a diet soda from beverage service, ask for the can or watch the flight attendant pour your drink. This can prevent you from accidentally getting a regular soda that could raise your blood glucose too high.

Also be aware that air travel can be dehydrating, so you’ll feel better at the end if you drink lots of fluids. Avoid alcohol because it can only add to dehydration.

Time Zones

Crossing time zones can sometimes be confusing. Should you be eating according to east coast or west coast time? If you are in the air, when should you inject your next dose of insulin?

Tips for Time Zones

• In general, when you lose hours from your day (traveling from west to east), you may need less insulin.

• When adding hours to your day (traveling from east to west), you may need an extra dose of insulin.

• If you are uncertain of how to work your insulin and meals into your travel and business plans, take a copy of your itinerary and work schedule to your diabetes care provider. He or she can suggest some sample routines to try.

• Your health care team can help you adjust your intermediate-

acting insulins for travel days. Long-acting and rapid-acting insulins and insulin pumps are usually easier to manage.

• If you are crossing several time zones or traveling overseas, it will probably take a day or two to get adjusted to the new schedule.

Car, Train, and Bus Travel

If you are traveling by automobile or other types of ground transportation, you often have more flexibility in your schedule, but there are still things to think about. You need to be sure that your insulin is properly stored. Extreme temperatures—either hot or cold—may reduce the potency of your insulin. Even backpacks or cycle bags can get too hot in warm weather.

You don’t have to routinely store open insulin bottles in the refrigerator. But putting insulin in glove compartments and trunks and even in a locked car in a parking lot can cause the insulin to overheat. If there is a danger of overheating, keep insulin in an insulated container. The other caution is very cold weather. Insulin left overnight in a car trunk can freeze. Once insulin freezes, it loses all potency and needs to be discarded.

General Tips for Travel

The key to successful traveling, especially when you have diabetes, is careful planning. Think of contingencies that might arise or any particular needs that you might encounter and develop a plan in advance. You may want to ask your health care provider for advice on how to pack and what to bring on your trip.

Tips for Travel

• Wear a medical ID bracelet or necklace that says you have diabetes.

• Keep a prescription for insulin and other medications on hand. This is especially important if your travel plans are subject to frequent changes.

• To be safe, pack twice as much injectable medication and blood glucose monitoring equipment as you think you will need. Pack your supplies in your carry-on luggage, so you’ll always have them within reach.

• Don’t get separated from your supplies. Get used to carrying a tote bag, fanny pack, or backpack with your injection supplies such as insulin, syringes, meter, lancets, glucose gel or tablets, glucagon kit, and some food.

Tips for Traveling Abroad

• If you are traveling abroad, learn how to say, “I have diabetes” and “Sugar or orange juice, please,” in the language of the country you are visiting. If you find the words difficult to say, write the phrase on a piece of paper and show it to the person with whom you’re trying to communicate.

• If you are overseas and need medical attention—and you have a choice—think about contacting the nearest American consulate, American Express, or a local medical school for a list of English-speaking doctors.

• If you find yourself running low on insulin while abroad, remember that insulin sold outside the United States is sometimes a different strength. If you buy insulin that is a different strength (U-40 or U-80), you must also buy new syringes to match the new insulin to avoid errors in dosing.

• If you are going overseas, call the ADA for a list of International Diabetes Federation groups.

Physical Activity during Travel

You’ve got everything under control. You are exercising regularly and eating well. Then your boss decides to send you out of town at the last minute to meet with some prospective clients. In situations like this and others, how will you manage? Fear not. You may not be able to schedule a 2-hour workout session, but here are a few suggestions to keep your program on track.

Tips for Exercising during Travel

• Pack a pair of comfortable walking shoes and some athletic socks. It is easier to squeeze a brisk walk into a busy schedule than most other activities and can be done in almost any locale.

• If your schedule is jammed with long meetings, try getting up a little earlier and squeeze in a walk after breakfast. On long car trips, stop every 2 hours and take a brisk 10-minute walk.

• If you are attending a conference, wear comfortable shoes. You’ll be more likely to walk around the exhibit hall, walk outside to a restaurant, or take a stroll in a nearby park if your feet aren’t killing you. You will also be less likely to injure your feet.

• Take along your exercise equipment when packing your bags. If space is tight, take a swimsuit or walking shoes. If you are driving, you might be able to take a racquet and balls, golf clubs, skis, a soccer ball, or even a bicycle.

• Suggest that the whole family participate. Play with your children or grandchildren, organize a game of tag or touch football, or go for a walk. Everyone will benefit from the activity, and it’s nice to spend time together.

• Before booking your hotel, ask if it has a health club, swimming pool, or exercise room. Some hotels provide access to a nearby fitness center.

• Check with health clubs in the area you are visiting to see if you can buy a few days of use. If you belong to a national health club chain, see if they have clubs in the city you are visiting.

Eating during Travel

Eating on the road can be more unpredictable than eating at home or as part of your daily routine. To keep things on target, check your blood glucose levels more often than usual, even if you have type 2 diabetes.

Eating different foods and different eating and exercise schedules can affect your blood glucose. Keep snacks on hand in case your blood glucose levels start to drop or you have an insulin reaction. Also, talk to your health care team about adjusting your insulin and meal schedules when crossing time zones.

Book Your Ticket

We’re traveling more than ever and farther from home these days. Your job may demand that you travel or you may live on the other side of the country from your family and friends. Managing your diabetes on the road or in the air will probably take adjustment. However, you’ll learn tricks and personal strategies the more often you travel. So, if your diabetes has been keeping you from traveling, book a ticket or hop in the car. The world awaits you.



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