Managing diabetes in children involves the near-constant scrutiny of blood glucose levels, carbohydrates, insulin doses and exercise, often with the aid of complex and ever-evolving medical device technology.

That’s why pediatric diabetes educators at Johns Hopkins Children’s Center reached out to help school nurses across Maryland, “who have been drowning in cases of type 1 and type 2 diabetes, especially since returning to school after COVID,” says Kylee Gerohristodoulos, the nurse manager for Johns Hopkins Pediatric and Specialty Care Clinics.

Both types of diabetes are on the rise among children worldwide, with medical researchers linking a recent spike to the coronavirus pandemic.

“Many school nurses never learned how to manage type II diabetes because it wasn’t a problem in children and teenagers, but that has changed,” says Kelly Busin, a pediatric diabetes educator in the pediatric endocrinology division at the Children’s Center, who initiated the effort to help school nurses after fielding, on average, four to six phone calls a day from nurses in need of guidance.

“When schools shifted to online learning during the pandemic, some students with type 1 started using [newly released] hybrid closed-loop insulin pumps,” says Busin. When in-person learning resumed, school nurses found themselves in unfamiliar territory with the closed-loop systems, which aren’t easy to use, says Busin. “We were hearing reports of kids with diabetes being turned away from school because the nurse didn’t have the training or capacity,” she says. “Parents also reached out with concerns about school nurses who didn’t understand the basics of diabetes.”

All of this prompted Busin to work with her colleagues to take action. They started by reaching out to the Maryland State Department of Education (MSDE) to explain, through a persuasive, data-rich PowerPoint presentation, why school nurses need more diabetes-related training and support. MSDE agreed to allow them to do a pilot presentation at a virtual meeting for school nurses across Maryland.

After receiving positive feedback on the pilot, MSDE established a way for Busin and her colleagues to work with individual counties to provide workshops and create resources for nurses to keep on hand.  

“Our goal is to deliver a bedside resource book for school nurses,” with easy-to-access information about everything from how to use various glucagon kits to treat severe hypoglycemia, to how to troubleshoot popular insulin pumps like the Omnipod and Tandem t:slim, Busin explains.

“At this point, none of the diabetes training for school nurses is mandatory in Maryland,” Busin says. “Our shooting-for-the-stars aspiration is to ultimately help the state standardize diabetes education, while making it ongoing, for school nurses. But there’s a lot of work to do.”