Some state legislators say districts should be required to have a nurse for each school.

Ten-year-old Erin Sullivan is getting used to constantly being watched closely by staff members while she's at school.


The Brockton youngster was diagnosed with Type 1 diabetes in September. The condition requires regular doses of insulin, and can be life-threatening if it's not managed carefully. In Erin's case, that means lots of visits with the school nurse.


Health officials say the number of kids with diabetes is growing at a startling rate, a trend that is making the job of the school nurse more complex — and necessary — than ever.


“We see those students all day long — testing their blood sugar, administering insulin, giving them a snack if they feel low,” said Linda Clegg, nurse manager in the Taunton schools.


Nationally, about 24 out of every 100,000 kids and teens are diagnosed with Type 1 diabetes each year, according to researchers at the University of Colorado. That rate was around zero just two decades ago, the researchers said.


In Brockton, the number of students with Type 1 diabetes has made it necessary for the district to have a nurse in each school since the 1990s, said Lorraine Kuplast, nursing supervisor in the Brockton schools.


And generally, the number of overall medically fragile students has made the job of the school nurse far more complex than it once was, she said.


Kuplast and other local school nurses said the number of kids with life-threatening food allergies and asthma has skyrocketed, while nurses are also responsible for children with a range of physical disabilities.


“Now you're doing the same nursing duties that you'd be doing in any other nursing track,” Kuplast said.


Some state legislators say districts should be required to have a nurse for each school. State Rep. Christine Canavan, D-Brockton, says she supports a bill that would institute that requirement.


Advocates hope the bill would be combined with an increase in state grant money for school nurses.


“These are the support services that are needed to help kids really thrive in schools,” said state Rep. Jennifer Flanagan, D-Leominster, who filed the bill.


The bill is currently being reviewed by the Legislature's Joint Committee on Education, according to Flanagan.


Nursing officials in local school systems say Type 1 diabetes virtually didn't exist among students even just a decade ago. Now, most school districts have a few dozen students with the condition.


“It just is absolutely amazing the increase we're seeing,” said Judi McAuliffe, head nurse in the Pembroke schools.


People with Type 1 diabetes are unable to produce their own insulin, a hormone that the body needs in order to use sugar as a source of energy. The disease differs from Type 2 diabetes, which refers to people who either can't produce enough insulin or can't make use of it properly.


It's believed that Type 1 diabetes is caused by a combination of genetic predisposition and an environmental trigger, such as an infection, according to Dr. Lori Laffel, chief of pediatric and adolescent unit at the Boston-based Joslin Diabetes Center.


No one knows for sure, Laffel said. But what researchers do know is that the incidence of Type 1 diabetes is rising — about 4 to 5 percent each year in kids and teens, according to Laffel.


“In particular, more young children are developing Type 1,” she said.


Local nurses said they are witnessing this trend.


Of the 26 students in the Taunton public schools with the condition, just four of them are at the high school, according to Clegg. The district has a preschooler with Type 1 diabetes this year for the first time ever, Clegg said.


In the Stoughton school system, which has about 4,000 students overall, 17 students have Type 1 diabetes.


One of them, second-grader Heather Cardella, headed to the nurse's office at Gibbons Elementary School just before lunch on a recent morning to have her blood sugar checked and get a shot of insulin.


Cardella, who didn't even flinch while getting the shot, said she's used to the routine. She was diagnosed with the condition in kindergarten.


“Heather is very brave,” said school nurse Mary Quinn, who said one other student at the school has Type 1 diabetes.


Quinn said there are also a growing number of students at the school with other life-threatening conditions, such as food allergies. She pointed to a row of plastic boxes, each marked with a student's name and containing their unique medical supplies.


In Stoughton, each school building has a set of walkie-talkies that nurses use in the event of a diabetic or other emergency.


Nursing Director Pat Small said that in addition to the challenges of taking care of kids' conditions, nurses also have to take care of parents' fears.


“With all of these life-threatening things these kids are living with, it can be scary to send your child off to school,” Small said. “You need to have someone in the school you can trust and you know will take care of your child.”


For Leah Sullivan, the mother of 10-year-old Erin, these fears are very real. “I've been extremely nervous, though it's getting a little better every day,” she said.


But the biggest impact of all is on Erin, she said.


The girl is grappling with the fact that she can't eat as much cake at a birthday party, or as much candy on Halloween, as she used to, her mother said.


“It's tough because being 10 years old, she's just starting to exert more independence,” Leah Sullivan said. “Now she has people telling her what to eat, when to eat. There's a lot more hovering over her right now.”


Kyle Alspach of The Enterprise (Brockton, Mass.) can be reached at kalspach@enterprisenews.com.