Wednesday, October 5, 2011

Diabetes in the school child

Diabetes management doesn’t stop when school starts
Sending a young diabetic child to school can be stressful for parents: They know the danger of a sudden drop in blood sugar.
Physician Rob Lindsay, a pediatric endocrinologist at Primary Children’s Medical Center, remembers a young diabetic patient who was sent alone to the school cafeteria for a snack. The child was found wandering three blocks from the school after becoming disoriented due to low blood sugar levels.
But parents can ease their fears by being proactive, Lindsay said.
“We teach the parents that they need to teach the teachers. They need to give specific signs of low blood sugar in their child. By second or third grade the children know when they are low,” he said.
Type I diabetes, also known as juvenile diabetes, is diagnosed most often in people under age 30. People with the disease produce little or no insulin and must inject themselves several times a day or wear a pump that administers the insulin for them. The cause of Type 1 diabetes is not well understood, but scientists believe the body’s immune system attacks and destroys the insulin-producing islet cells in the pancreas.
Lindsay said the number of children with Type 1 diabetes has grown along with the population, but the incidence rate is also increasing for unknown reasons.
Davis School District has 202 students with health care plans dealing with diabetes. Most are in elementary school because junior high and high school students typically have learned to deal with the disease themselves, said Shauna Lund, the district’s public information officer.
Young children with diabetes need a health care plan so school staff can help them manage their blood sugar levels.
“They have to get insulin at lunch. Initially schools were resistant to this but have become much more compliant,” said Lindsay. “Someone at the school has to supervise. Since every school does not have a nurse it is often an aide or a secretary giving the insulin.”
Nicole Ellsworth, a third-grader at Samuel Morgan Elementary School in Kaysville, was diagnosed with Type I diabetes this year. Nicole has to check her blood sugar and inject insulin before meals or snacks. Her mother, Sarah Ellsworth, makes sure Nicole has an emergency pack with snacks in her classroom.
But Ellsworth also has to be vigilant about checking school lunch menus. “To get her dosed before lunch I go on the school website, print out the menu and count the carbs, then calculate the insulin dose she will need. The aide at the school verifies that the Internet menu is the actual lunch she is being served and gives her the insulin after checking her blood sugar,” Ellsworth said.
Nicole has an aide provided by the school district to help children with medical needs, a service required by the Americans with Disabilities Act. But Ellsworth said a big part of keeping Nicole safe at school is her teacher, Julie Acord, who has taught school for 18 years. Nicole is her third diabetic student.
“I just make sure I monitor her correctly. I watch for signs and symptoms that her sugar is high or low. It’s difficult because every diabetic child is different,” Acord said. “It’s a challenge to watch her all the time with 27 students in my class.”
But Acord is comfortable helping her diabetic students, and when the need arises — on a field trip or in an emergency — she can count carbohydrates, check blood sugar and give insulin.
Ellsworth works hard to make sure that Nicole’s diabetes is managed at school.
“It was a really big learning curve. I contacted the school to make sure the [aide] got proper training. I made sure the principal was involved and the lunch staff was willing to communicate with the aide,” she said.
Still, school snacks, parties and holidays are difficult for diabetic children. Nicole wraps up her treats and brings them home so her mom can help her count the carbohydrates and calculate the insulin. “Nicole is really good about looking at the packages and calculating the serving size so all I have to do is verify,” Ellsworth said.
Nicole said she doesn’t like getting shots but doesn’t feel she is treated any differently because she is diabetic. After being diagnosed, she gave a presentation to her neighborhood friends and classmates and showed them how she checks her blood sugar and explained how she takes care of her disease.
Eight-year-old Blake Anderson was diagnosed with diabetes at 16 months.
“My perfect little family got disrupted. All of our lives changed,” said his mother, Colleen Anderson. Blake is a third-grader at St. Olaf’s, a private Catholic school in Bountiful. Because it is a private school, Blake doesn’t qualify for ADA-mandated school aides or services. His mother goes to the school every day at lunch to help Blake check his sugar, count his carbohydrates and give him a shot of insulin. Anderson also volunteers as a room mother when there are planned parties or treats.
One advantage of Blake’s school is smaller class sizes. There are only 18 students in the third grade. “His school is so little everyone knows he is diabetic,” said his mom.
Blake has been a diabetic so long he doesn’t know life any other way, his mother says. But being a diabetic child is difficult.
“Once we were having a party for speech at school and all the other kids got doughnuts. The teacher said I couldn’t have a doughnut and all I got was a really bad sugar-free cookie. It made me mad and sad,” he said.
Diabetics can eat whatever they want but need enough insulin to handle the calories and carbohydrates the food contains.
“The amount of insulin required is always changing,” Anderson said. “It depends on what he eats, how much he exercises and if he is sick. Diabetes is complicated. Taking care of it is a science project every day.”
Symptoms of diabetes
Increased thirst
Increased urination
Increased hunger
Weight loss
Blurred vision
Source • Davis School District

© 2011 The Salt Lake Tribune

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