Last year, a school nurse in East Moline faced a moral dilemma when a diabetic student lost consciousness in her office. Now she’s trying to make sure no other school nurse has to face the same tough choice.
Low blood sugar can usually be cured with orange juice and a granola bar. But those snacks and glucose tabs weren’t helping the 7th grader sitting in Jennifer Jacobs’ office.
“Her blood sugar kept falling, and we kept pushing the snacks,” Jacobs says.
Jacobs is a nationally certified school nurse with 30 years of experience — 17 of those at Glenview Middle School. She was on her lunch break when the student came in, so Jacobs’ assistant, a licensed practical nurse, started treatment.
“Within probably five or 10 minutes of my returning from lunch,” Jacobs says, “the student fell on the floor. [She] wasn’t seizing but was tremoring, and her eyes were rolling back in her head…”
Jacobs applied glucose gel inside the student’s cheek, but the meds just slid out of her mouth in a stream of drool. The student was crashing.
“It was beyond anything that we could do,” Jacobs says.
Well, it was beyond anything they could do legally. But Jacobs and her assistant both knew there was one more medication, made specifically for such emergencies, right there within reach. It’s a hormone called glucagon. Once injected, it can help a diabetic recover from a crash, by stimulating the release of stored glucose.
The problem was: The only glucagon kit in the office belonged to another diabetic student — not to the 7th grader drooling on the floor. Could they use that glucagon to treat this student? To Jacobs, that wasn’t the right question.
“In my mind, I’m thinking, well I could lose my RN license for this. I could lose everything. I’m putting the school district at a huge liability risk. I mean, it could’ve been hugely detrimental,” she says. “But how do you not do this to save the girl’s life? How do you not? It just comes down to that. How do you not?”
The only other option was simply unthinkable.
“The progression for untreated severe hypoglycemia would be seizures and to stop breathing and to die,” she says.
Jacobs made a split-second decision. She grabbed the glucagon and injected the student. Paramedics arrived and had to administer a second dose of glucagon en route to the hospital.
“This girl was crashing so severely that the one I administered wasn’t even affecting her,” Jacobs says. “Think what would’ve happened if I hadn’t used that one. That gives me goosebumps. That makes me nauseous.”
She had urged the girl’s family to provide a glucagon kit. The student was “a very brittle diabetic,” Jacobs says, meaning her blood sugar levels tended take sudden swings. But such severe hypoglycemic episodes are relatively rare. In fact, this incident was the first time Jacobs had to give anyone glucagon in her 30-year career. So she understands why the family hadn’t gotten around to providing glucagon.
“There are so many reasons, so many obstacles,” Jacobs says. “When you’re talking about buying all the supplies needed by a diabetic to manage their diabetes, the cost is astronomical. And this family not only had their 7th grade daughter but they have an 8th grade son and the father and the mother all have diabetes. Three of the four are insulin-dependent.”
Jacobs called the other student’s family immediately, and the school district replaced their child’s glucagon the next day. The girl who experienced the hypoglycemic crash made a full recovery.
But for Jacobs, that’s not a happy enough ending. She persuaded her state representative — Democrat Michael Halpin, of Rock Island — to file legislation allowing schools to buy glucagon and keep it on hand.
“It just makes sense,” she says. “We have a school-provided inhaler for students that have severe asthmatic reactions. And schools have EpiPens for severe allergic reactions. And we have Narcan to be used for opioid overdoses.”
Halpin’s bill has cleared the House and is set to be heard in the Senate. It’s gotten unanimous approval at each step of the legislative process, so lawmakers apparently agree with the decision Nurse Jacobs made that day. As she would say: How could you not?