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)
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).
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.
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