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Nova Scotia prioritizes optimal diabetes management at school

Posted on April 26, 2024 by the Canadian Paediatric Society | Permalink

Topic(s): AdvocacyPublic educationSpotlight

Parents of children with type 1 diabetes in Nova Scotia now have more choice about their child’s insulin regimen thanks to a provincial policy that expands the care students can receive at school. The policy—fully implemented for the start of the 2023-24 school year—makes Nova Scotia only the second province (after British Columbia) to have a policy that ensures students who need support with insulin injections can receive help from trained staff.

Dr. Beth Cummings, a paediatric endocrinologist at the IWK in Halifax, was a leader in bringing this policy to life.

“For a long time, we’ve recognized there needs to be better support for diabetes care for children in school. [Since the province implemented the policy], we’re seeing that families are getting better results with their blood sugars, which is what we’re all working towards,” said Dr. Cummings, one of the physician leads on the CPS Diabetes@School project.

Like adults with type 1 diabetes, children and youth need a continuous level of basal insulin—whether delivered through a pump or injection—along with bolus doses when they eat. Until recently in Nova Scotia, students who couldn’t administer their own insulin at school by injection or pump had to rely on intermediate-acting insulin delivered at home in the morning. If a parent could not go to school each day to give lunchtime insulin, students needed to eat a pre-planned amount of food at specific times to avoid drops in blood sugar. Not only was this regimen less-than-ideal for children, it also resulted in suboptimal glucose control.  

“We can now use all the tools that are at our disposal to help families manage their diabetes well, whereas before, we weren’t able to do that for everybody. We sometimes felt like we should push people to a pump faster than maybe they felt they were ready for,” said Dr. Cummings.  

The policy has been a significant win for children and youth with diabetes, but it didn’t come quickly or easily.

“It was at least a ten-year journey and involved the support of multiple players to get this into place,” said Dr. Cummings. 

The CPS statement on diabetes management at school, which Dr. Cummings helped to author, was one resource that supported this advocacy work.

“Having the force of the guideline behind us helped move the processes forward, but it also took a lot of work and [long-term] relationship building with people from the department of education and within the school system,” she said. 

A key factor in the success of the policy, she added, is Nova Scotia’s system of School Health Partnership (SHP) nurses. SHP nurses were tasked with facilitating staff training because they already train school personnel to support students with chronic health issues during the school day. 

Initially, school staff were nervous about administering insulin injections but once training began, they became engaged. 

“They’ve taken it and owned it,” said Dr. Cummings. 

She said it was important to acknowledge school staff’s fear of administering injections and use accessible language, such as “insulin pens” instead of “needles” or “injections.” 

“Words matter, and so does being ready to empathize,” said Dr. Cummings. “This isn’t what school staff are trained for, but we were able to find a common ground: everybody wants the best for the students.” 

The success of this story comes down to three factors, said Dr. Cummings: perseverance, collaboration and understanding. 

“Part of what is different than the day-to-day of seeing patients in clinic is building partnerships outside of our silo, and listening to what everyone’s challenges are,” she said. “For example, there was a union issue at the school board when this happened. Sometimes, we’re impatient but listening and understanding why things take so long and what the other side is doing is important. Remember that everyone wants the same thing, and don’t give up. To keep going back is what helped it happen and is a satisfying part of my career as a paediatric endocrinologist.”  

CPS provides diabetes education for school staff

A learning module to help school staff across Canada support students with type 1 diabetes has become an important part of the implementation of Nova Scotia’s new policy on insulin administration in schools. 

Managing type 1 diabetes at school: An online course for educators and school staff is a one-hour self-directed module, available in English and French, that covers the basics of diabetes and specific considerations for the school day. Based on materials on the Diabetes@School website, it was developed with paediatric endocrinologists Dr. Beth Cummings and Dr. Sarah Lawrence. 

Nova Scotia requires that all staff in a school where there is a student with diabetes complete the module. To date, thousands of school staff members in Nova Scotia have completed the education.

Development of the module was supported by Abbott Diabetes Care, Dexcom Canada Co., embecta, Novo Nordisk Canada Inc., and Sanofi.

For more information, visit and click on “online education”. 


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Last updated: Apr 26, 2024