According
to National Institutes of Health and the Centers for Disease Control
and Prevention, diabetes is one of the most common chronic diseases
in school-aged children, affecting about 200,000 young people in the
United States. According to recent estimates, about 19,000 youths are
diagnosed with type 1 and type 2 diabetes each year (1). Diabetes is
a chronic disease in which blood sugar, called glucose, levels are
above normal.
Two
types of diabetes afflict the population, named type 1 and type 2. In
type 1 diabetes, the immune system attacks the beta cells of the
pancreas and destroys them. The pancreas of a person with type 1
diabetes can no longer produce insulin, so these people must take
insulin daily to live (National
Institutes of Health and the Centers for Disease Control and
Prevention 12).
In type 2 diabetes, the muscles, liver and fat cells do not use
insulin properly. The pancreas keep up with the added demand at
first, but over time it loses its ability to produce enough insulin
or control the glucose.
(National
Institutes of Health and the Centers for Disease Control and
Prevention 13)
Diabetes
Legislation
Legislation
protects students with diabetes and ensures they receive adequate
attention and education. Three
federal laws provide protection to children with diabetes at school:
Section 504 of the Rehabilitation Act of 1973; the Americans with
Disabilities Act; and the Individuals with Disabilities Education Act
(Kaufman 91). Section 504 is a civil rights law that prohibits
schools that receive federal funds from discriminating against people
on the basis of disability. The American with Disabilities Act is
another civil rights law that protects students with disabilities and
in order to qualify under IDEA, “the student's diabetes must impair
his or her ability to learn so that the student requires special
education.” (Kaufman 91). This protects students who experience
hypoglycemia or hyperglycemia and these dangerous episodes
significantly affects the student’s ability to concentrate.
(Kaufman 91)
Accommodations
in School
Studies
conducted by the American Diabetes Association have shown that the
majority of school personnel have an inadequate understanding of
diabetes and that parents of children with diabetes lack confidence
in their teachers’ ability to manage diabetes effectively
( S131). Despite their assurance of a safe education since the 1970s,
not all schools are equipped to service their students with diabetes.
Students with diabetes should be able to eat frequently, check their
glucose level and be closely monitored by adults to prevent
hypoglycemia. These
expectations should be committed to writing in the form of two signed
documents: a health care plan that explains what medical procedures
should take place at school; and a 504 Plan, Individualized Education
Program (IEP), or other care plan that explains in what ways the
usual school routine needs to be altered for that particular student.
(Kaufman 92) The plan should include specific information for that
child with regard to monitoring of blood glucose; insulin; meals and
snacks; treatment of hypoglycemia and hyperglycemia; and exercise and
sports (Kaufman 92).
In
school the nurse is the most appropriate person to care for a student
with diabetes, but non-medical school personnel could be trained and
supervised to perform diabetes care tasks safely in the school
setting (National
Institutes of Health and the Centers for Disease Control and
Prevention 16).
These activities may include blood
glucose monitoring, insulin and glucagon administration, and urine or
blood ketone testing. School personnel should also receive
student-specific training and be supervised by the school nurse or
another qualified health care professional
(National
Institutes of Health and the Centers for Disease Control and
Prevention 17).
Optimally,
a school health team should be created and include the student with
diabetes, the parents/guardian, the school nurse and other health
care personnel, the staff members designated as trained diabetes
personnel, administrators, the principal, the 504/IEP coordinator,
office staff, the student’s teacher or teachers, the guidance
counselor, the coach, lunchroom and other school staff members
(National
Institutes of Health and the Centers for Disease Control and
Prevention 18).
The
greatest immediate danger to students with diabetes is hypoglycemia
(National
Institutes of Health and the Centers for Disease Control and
Prevention 36).
A hypoglycemic attack can come on suddenly and while symptoms can
vary, all
school personnel should know how to recognize hypoglycemia and know
what to do if they observe its onset (National
Institutes of Health and the Centers for Disease Control and
Prevention 37).
Diabetes
Education
Educating
educators, parents and students—both diabetic and not diabetic is
imperative. One tool for diabetes education is a freeware computer
program called AIDA that permits the interactive simulation of plasma
insulin and blood glucose profiles for demonstration, teaching,
self-learning, and research purposes (Palacio 107). The downloadable
computer program has been available for free on the internet for over
10 years and it is a self-education tool, particularly for people
with diabetes and their relatives, as well as for heath care
providers and students.
(Palacio
107)
The
program allows users to manipulate of example patient parameters such
as weight, insulin sensitivity, renal function, and threshold for
glycosuria.
(Palacio
107)
In
2006, Palacio conducted a research study on the validity of the
online program. He piloted AIDA at
a Biotechnology Summer Camp in Atlanta, Georgia for middle school
students. The learning outcome was to help the students understand
some basics of insulin pharmacology, as well as the effects of
insulin in a simulated young patient with Type 1 diabetes, and the
effects of both insulin and changes in diet and lifestyle in a young
patient with Type 2 diabetes.
(Palacio
107)
Palacio found 86%
reported AIDA online to be of interest as an educational tool, 81%
found the program to have utility, and 57% expressed a desire to
continue using the software. (Palacio
110)
According
to Palacio, “The
ability to graphically display simple pharmacokinetics, and rapidly
expand the illustrations, makes AIDA online a valuable approach to
teach young teenagers with minimal knowledge of insulin about the
complex relationship between the timing of an insulin injection and
the effect of insulin within the blood.” (113).
AIDA
is just one example of established and tested diabetes education
software and supplements that exist. It can be an invaluable resource
for those afflicted with diabetes, but the most important point is to
educate not only the diabetic student, but also the parents and
school staff with the responsibilities to keep these students safe.
Bibliography
Kaufman,
Francine Ratner MD. “Diabetes at School: What a Child’s Health
Care Team Needs to Know About Federal Disability Law” CLINICAL
DIABETES
• Volume 20, Number 2, 2002 p. 91-92
National
Institutes of Health and the Centers for Disease Control and
Prevention
“Helping
the Student with Diabetes Succeed
A
Guide for School Personnel”
U.S.
Department of Health
and Human Services
Updated
Edition
2010
Palacio,
Andres M.D.; Eldon D. Lehmann, Eldon D., M.B. B.S., B.Sc. (Hons.),
Ph.D., F.R.C.R.; Darin E. Olson, Darin E. M.D., Ph.D. “Teaching
Diabetes to Middle-School Students with the www.2aida.net AIDA Online
Diabetes Software Simulator” Journal
of Diabetes Science and Technology Volume
1, Issue 1, January 2007 © Diabetes Technology Society
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