Emerging technologies and improvements to insulin pumps hold great promise for students who need to manage their diabetes, and the school nurses who help them.

Pump therapy

Linda Julia, a nurse at Candlewood Middle School and a member of the Half Hollow Hills Teachers Association, has several students who wear insulin pumps.

Instead of injections, students receive small amounts of insulin several times an hour as a "basal" and manually program the pump to deliver a "bolus" to cover meals eaten.

"Pumps allow students freedom to participate more fully in many ways," said Julia, whose school posts nutrition information, including carbohydrate content of cafeteria items on the school Web site.

"Students input the carbohydrates into their pumps and the pumps do the calculations," she added.

Catherine Marschilok, a diabetes educator and member of the Children's Work Group of the National Diabetes Education program, says this is a welcome addition to diabetes management.

"Children who need insulin often have several adults who care for them," said Marschilok.

"This increases the opportunity for a mathematical error and mis-dosing of the child."

Mathematical errors have potentially devastating results. Marschilok related an incident in which a substitute nurse miscalculated a 3.2-unit dose of insulin as 32 units.

Thankfully the shot was not administered to the young student.

Glucose monitoring

Glucose monitoring is a vital component of all insulin therapy regimens and for fine tuning of insulin dosing.

Marschilok says Continuous Glucose Monitoring Systems, although still in the early stages, are an emerging technology that already have proven beneficial in improving glycemic control without increasing occurrences of low blood glucose — a potentially dangerous side effect of insulin therapy.

Unlike blood glucose meters, the new systems give glucose level readings at intervals of between one and five minutes.

Readings of the glucose present in the interstitial fluid — the fluid between the cells — are sent wirelessly to a receiver, which in some cases is also an insulin pump.

However, there is currently a lag time in readings the sensor provides as compared to blood glucose reading and a higher reported error rate.

Because of these current limitations Marschilok believes CGMSs are currently most useful as a trending tool. 

It remains crucial for sensor users and health care professionals to remember to administer insulin only based upon the blood glucose measurement obtained from a blood glucose meter, and not from the CGMS.

— Leslie Duncan Fottrell