School Refusing to Use a Glucagon Kit

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CommPharmIndyPrescribe

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Daughter just diagnosed T1 during summer holidays so we are at the learning stage just now but she is being fantastic, 10 years old and doing all her own injections and blood tests. I know the probability of her having a hypo severe enough to require glucagon is very low but I want to know that it is available to her without an ambulance having to be called. We have had no support from the Diabetes team at hospital saying the teachers are not prescribers so cannot administer a glucagon injection. This is despite it having the same legal classification as an EpiPen and can be used by anyone trained or untrained to save life.

Is it just my Council and Healthboard who are treating diabetic children as second class citizens denying them the right of life saving medication while under their care or have other parents had similar experiences?
 
FWIW we were told a glucogen kit should always be used in conjunction with calling an ambulance it’s not an alternative. Do school have glucogel? That can be given rubbed onto the inside of the cheek for someone unable to swallow and may be more suitable anyway but if a child is in need of either then calling an ambulance would be appropriate anyway.
 
School have got glucogel, but we hadn't been told about rubbing it inside the cheek for someone unable to swallow, I will remember that. I would expect an ambulance to be called if glucagon was administered I know I might be being over protective but, due to my occupation, I have had to call ambulances to attend my workplace and while some have turned up quickly I have had over half hour waits for others.
 
Welcome to the forum @CommPharmIndyPrescribe
I am sorry to hear about your daughter’s diagnosis and understand the concerns you have around her returning to school.

Just to put the need for glucagon in perspective, I have had T1 for 14 years and never needed it. My husband has been shown how to use it but would prefer not to, and would dial 999 if it was needed.
I asked my consultant about this and he said it was important that whoever used it needed to be trained since it requires mixing the stuff (although this may have changed now), so is very different from an epi- pen.

Where you say that your diabetes team are not supporting you is this over the glucagon issue or generally. It is usual for the diabetes nurse to meet with you and the school to agree procedures for lows and highs and to agree an individual health care plan for each child. It is essential that you have a meeting with the school. I will flag some other parents such as @Sally71 and @Thebearcametoo who will have had experience of this.

I have visited a variety of school and in each they had their own arrangements agreed with the parents for managing lunch times. Some had packed lunches, with the carb count included for the support teacher to help the child with insulin doses. In another I sat down with the child for lunch and along with our meal we were also given the carb count. there are lots of different strategies used.

One of the most important things will be for your daughter to have hypo treatments with her at all times. The staff could also have a stash in each room That she uses, and also make sure that she has these with her during PE lessons. As a teacher I had them in my bag but also wherever I taught just in case.

I know that this seems a massive step at present but it will all get easier, and more manageable. Do come back with any questions that you have. Nothing is considered silly on here and there is a wealth of support to tap into.
 
There’s a glucagon nasal spray but I’m not sure if it’s available in the U.K. yet. The glucagon mixing process is liable to be messed up by people panicking around anyone unconscious so I wouldn’t trust a school to do it.

Does your daughter have a Libre or CGM yet @CommPharmIndyPrescribe ?
 
When my daughter was at primary school it never occurred to me to leave a glucagon kit there, I live close enough that they could just call me in an emergency and they would call an ambulance anyway if she was unconscious. DSN was happy with this arrangement. My daughter has just passed her 10 year anniversary and has never once needed glucagon in all that time. We always have one, but end up throwing it away when it goes out of date. Diabetic children who came to that school after my daughter had glucagon there, so I guess staff were individually trained. The only time I ever thought about it was when my daughter went on a 4-day trip to France at secondary school, I made sure I showed one of the teachers going on the trip how to use the kit just in case (as luck would have it I had just replaced one going out of date so used the old one to demonstrate). To be honest though, as long as staff treat all hypos seriously and deal with them without delay, the chances of your child ever needing glucagon are very slim.
 
Thank you all for the reassurance about Glucagon kits always going out of date and not being used. I do not expect my daughter to require a glucagon injection as she will be monitored but, it's the protective parent in me that couldn't live with myself knowing that in the rare chance she might need it I hadn't fought for it to be available for her. My mother was also type 1 diabetic and I can only recall one occasion in her life that required glucagon.

Glucagon is more complicated than an EpiPen to administer but it's not beyond the ability of someone to administer with no training though training would be best and I have offered to train the school staff myself if the diabetic team won't. Administration of some Glucagon would also be better than none, it's why Glucagon has a pile of exemptions created around it to protect anyone administering it in a life or death situation so nobody has to worry about consequences if something goes wrong during administration or it doesn't work.

The school meeting was fun, we contacted the school the day after she was diagnosed (during summer holidays). Did not receive any communication from the school until the first day in service back from holidays when my wife got a phone call at her work that the meeting was going to start in 20 minutes (her work is 30 minutes away). My wife was able to re arrange a meeting for the following afternoon, both the school and the diabetic team seemed surprised my wife wanted to attend the meeting. We have an individual care plan for our daughter and a week into term we are adjusting it as we discover gaps. The classic "I will eat all this for lunch" then leaves half the food so ends up in hypo because at home we would replace the carbohydrates so teacher now has a replacement bag on top of all her other bags, and discovering the school response to a hypo is "eat sweeties" and "drink some coke" rather than following the actual care plan!
 
Hello, my son was also diagnosed just this summer so we are in the same situation as you are with worries and learning.

Our diabetic nurse said the gel was never to be applied inside the mouth of an unconscious person, but could be rubbed on the outside of the cheek.

I am following along as no one mentions the glucogon kit for school. I will have to asky nurse Monday as I never thought about that.
 
SunflowerMama said:
Our diabetic nurse said the gel was never to be applied inside the mouth of an unconscious person, but could be rubbed on the outside of the cheek.
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Rubbing on cheek outside of the mouth is useless and pointless if that's what you mean. It goes on the inside of the cheek.
 
Pumper_Sue said:
Rubbing on cheek outside of the mouth is useless and pointless if that's what you mean. It goes on the inside of the cheek.
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That's what my nurse said, admittedly, sounded strange to me!
 
The inside of your cheek(s) is precisely where the body starts to digest any food or drink that you consume, and from where the body excretes some of the first of our digestive enzymes in the long chain of them as anything duly progresses through our digestive system. I learned this as part of my GCE O Level syllabus at school when I was about 14/15. Mr W also demonstrated the chemical test for 'starch' (ie the carbohydrate content) using a stale crust of thick sliced Mothers Pride he'd saved at home for this purpose, mounted via a retort stand in the Lab we had Biology, Chemistry and Physics lessons in (different teachers) so that the bread was elevated above the sink on the bench as he stood to the side with a large flask of colourless iodine, of which he poured about 50ml onto the crust - which immediately turned the most glorious deep shade of purple.

Here we are 58 years later and I can still picture this and the enzyme chain because it became VERY useful only 6 years after I passed that exam when I was diagnosed with Type 1 !

Hence it's always meant complete and utter sense to me since the first time I heard of rubbing whatever on the inner cheek of someone having a hypo who can't swallow or has an impaired swallowing reflex - and I assure you that it works! ('well' hypo, typically sees me gritting my teeth so even if it was a good idea to actually eat or drink anything, I wouldn't be able to do it, and nobody would be able to make me, without actually physically breaking my jawa - honestly) Golden Syrup works just as well as 'posh' actual glucose gel when mother's always had a tin of in the cupboard anyway cos the whole family liked it when she incorporated in puddings! Treacle tart or treacle sponge were made with it rather than Treacle itself - which only went into Xmas Puds - chez nous.
 
Hi @CommPharmIndyPrescribe

This is a battle that has been fought for years, so I’m not surprised to hear of the school’s reluctance to have glucagon on the premises. As others have said, it is very unlikely that your daughter will need it.

I suspect the school has been told it’s not needed, or even put off having it, by the hospital team. The issue has been raised at regional and national level. While some HCPs see the benefits of glucagon in schools, others are very reluctant. Their objection centres around guaranteeing competence - while they can train staff, it is likely that a long time will pass before a kit is needed, therefore training will be forgotten. In my view, it is a weak argument as (and some HCPs admit this) wrongly administered glucagon won’t do any damage.

I suspect we will only see it in schools when it becomes as simple as the epipen or the nasal spray is widely available.
 
With Glucagon being Glucagon we are stuck in the situation of a freeze dried vial for a longer expiry date an epi pen style injection that will only have a few months expiry. A dual chamber syringe may work but is likely to be as expensive as the nasal spray so unlikely to get NHS funding or doctors willing to prescribe a more expensive item.

Training shouldn't be an issue as the diabetes team are in school on an annual basis if there is a diabetic child, also the school would be phoning 999 anyway and they would be able to give instructions over the phone.
 
All school staff (much to my dismay) have the right to refuse to administer medication.
If i ever get forms from school saying that i am signing to accept that they can reserve the right not to administer medication, I cross that bit out!
i have spoken to my son's school about the glucagon injection and the staff actually said they would not be able to stand by and do nothing if my child ever did need it.
 
The issue of administering medication is a bit of a grey area. Staff do have the right to refuse to administer it, but the statutory guidance says that a child should receive the support they need. This, of course, could include needing help with insulin and glucagon. In reality, teachers will happily administer insulin, but glucagon is a different matter.
 
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