Diabetes

DISABILITY CATEGORY: Other health impairment

TYPES: Type 1 – insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes; Type 2 – non insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes; Gestational diabetes

DEFINITION:

Our nation’s special education law, the Individuals with Disabilities Education Act (IDEA) defines diabetes under “other health impairment,” which means…

            “…having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, and sickle cell anemia; and adversely affects a child’s educational performance.”

[34 code of Federal Regulations §300.7(c)(12)]

Other definitions: Diabetes is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both. Diabetes can lead to serious complications and premature death, but people with diabetes can take steps to control the disease and lower the risk of complications (CDC Diabetes Fact Sheet 2005).

FACTS AND STATS: Diabetes is one of the most common chronic diseases in school-aged children, affecting about 151,000 young people in the United States, or about 1 in every 400 to 500 young people under 20 years of age. Each year, more than 13,000 youths are diagnosed with type 1 diabetes. In addition, health care providers are finding more and more children and teens with type 2 diabetes, even though the disease is usually diagnosed in adults over age 40.

Diabetes is a serious chronic disease that impairs the body’s ability to use food for energy. It is the sixth-leading cause of death by disease in the United States. Long-term complications include heart disease, stroke, blindness, kidney disease, and amputation of the foot or leg. Although there is no cure, the disease can be managed and complications delayed or prevented.

• Type 1 diabetes develops when the body's immune system destroys pancreatic beta cells, the only cells in the body that make the hormone insulin that regulates blood glucose. To survive, people with type 1 diabetes must have insulin delivered by injection or a pump. This form of diabetes usually strikes children and young adults, although disease onset can occur at any age. Type 1 diabetes accounts for 5% to 10% of all diagnosed cases of diabetes.

• Type 2 diabetes accounts for about 90% to 95% of all diagnosed cases of diabetes. It usually begins as insulin resistance, a disorder in which the cells do not use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce it. Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity. African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Native Hawaiians or Other Pacific Islanders are at particularly high risk for type 2 diabetes and its complications.

• Gestational diabetes is a form of glucose intolerance diagnosed in some women during pregnancy. During pregnancy, gestational diabetes requires treatment to normalize maternal blood glucose levels to avoid complications in the infant. After pregnancy, 5% to 10% of women with gestational diabetes are found to have type 2 diabetes. Women who have had gestational diabetes have a 20% to 50% chance of developing diabetes in the next 5-10 years.

• Other types of diabetes result from specific genetic conditions (such as maturity-onset diabetes of youth), surgery, drugs, malnutrition, infections, and other illnesses. Such types of diabetes account for 1% to 5% of all diagnosed cases.

• Prediabetes is a condition that raises the risk of developing type 2 diabetes, heart disease, and stroke. People with prediabetes have blood glucose levels higher than normal but not high enough to be classified as diabetes (CDC Diabetes Fact Sheet 2005).

Several studies suggest that diabetes doubles the risk of depression, although it’s still unclear why. The psychological stress of having diabetes may contribute to depression, but diabetes’ metabolic effect on brain function may also play a role. In addition, diabetes can make the immune system more vulnerable to severe cases of the flu. People with diabetes who come down with the flu may become very sick and may even have to go to a hospital.

CAUSES: Risk factors for type 1 diabetes may be autoimmune, genetic, or environmental. Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity. Other types of diabetes result from specific genetic conditions (such as maturity-onset diabetes of youth), surgery, drugs, malnutrition, infections, and other illnesses (CDC Diabetes Fact Sheet 2005).

PREVENTION: There is no known way to prevent type 1 diabetes. Several clinical trials of methods of the prevention of type 1 diabetes are currently in progress or are being planned. Studies show that people at high risk for type 2 diabetes can prevent or delay the onset of the disease by losing 5 to 7 percent of their body weight. You can do it by eating healthier and getting 30 minutes of physical activity 5 days a week.

People with diabetes can prevent the complications associated with the disease with proper glucose-management medications, exercise, and good diet, brushing and flossing teeth daily, monitoring blood glucose, quitting smoking, and checking feet daily (CDC Diabetes Fact Sheet 2005).

CHARACTERISTICS: Hypoglycemia, or “low blood glucose,” usually can be treated easily and effectively. If it is not treated promptly, however, hypoglycemia can lead to unconsciousness and convulsions and can be life threatening. Symptoms can range from mild to severe, including:

shakiness
inability to concentrate
sweating
irritable or nervous
hunger
disorientation
paleness
sleepiness
headache
confusion
blurry vision
dizziness
uncoordinated
inability to swallow
changed personality
seizures or convulsions
combative
unconsciousness

As soon as symptoms of hypoglycemia are observed, give the student a quick-acting sugar product equivalent to 15 grams of carbohydrate. This may include:

• 3 or 4 glucose tablets,

• 3 teaspoons (or three-fourths of a tube) of glucose gel,

• 4 ounces of juice, or

• 6 ounces (half a can) of non-diet soda.

Hyperglycemia, also called “high blood glucose,” is a seri­ous manifestation of diabetes that may be caused by too little insulin, illness, infection, injury, stress or emotional upset, inges­tion of food that has not been covered by the appropriate amount of insulin, or decreased exercise or activity. High blood glucose symptoms include:

increased thirst
blurry vision
frequent urination
fatigue
nausea

Over a long period of time, even moder­ately high blood glucose levels can lead to serious complications, such as heart disease, blindness, kidney failure, and amputations. In the short term, hyperglycemia can impair cognitive abilities and adversely affect academic performance. Free and unrestricted access to liquids and the restroom must be provided, as high blood glucose levels increase urination and may lead to dehydration if the student cannot replace the fluids.

Some students who need insulin during the school day are able to administer it on their own; others will need supervision; and others will need someone to administer the insulin for them. The school nurse and/or trained diabetes personnel should provide this help in accordance with the Diabetes Medical Management Plan and the nursing care plan.

Children react differently to having diabetes. They may be accepting, resentful, open to discussing it, or attempt to hide it. Often, the same child will experience all of these feelings over time. School personnel should be aware of the student’s feelings about having diabetes and identify ways to ensure the student is treated the same as others. Increasingly, depression is being recognized as quite common among children and teens generally, and even more so in those with diabetes. Health care providers and school personnel must be aware of emotional and behavioral issues and refer students with diabetes and their families for counseling and support as needed (ADA).

MEDICAL TREATMENT: To survive, people with type 1 diabetes must have insulin delivered by injection or a pump. Many people with type 2 diabetes can control their blood glucose by following a healthy meal plan and exercise program, losing excess weight, and taking oral medication. Many people with diabetes also need to take medications to control their cholesterol and blood pressure. Diabetes self-management education (DMSE) is an integral component of medical care. Among adults with diagnosed diabetes, 16% take insulin only, 12% take both insulin and oral medication, 57% take oral medication only, and 15% do not take either insulin or oral medications (CDC Diabetes Fact Sheet 2005).

PROGNOSIS: There is no cure for diabetes, but it can be controlled by regular exercise, healthy eating habits, medicine, regular checkups, and weight loss, if necessary. Diabetes can affect many parts of the body and can lead to serious complications such as blindness, kidney damage, and lower-limb amputations. Working together, people with diabetes and their health care providers can reduce the occurrence of these and other diabetes complications by controlling the levels of blood glucose, blood pressure, and blood lipids, and by receiving other preventive care practices in a timely manner (CDC Diabetes Fact Sheet 2005).

EDUCATIONAL IMPLICATIONS: Diabetes must be managed 24 hours a day, 7 days a week. For students with type 1 diabetes, and for some with type 2 diabe­tes, that means careful monitoring of their blood glucose (sugar) levels throughout the school day and administering multiple doses of insulin therapy—now prescribed for most young people with diabetes. As a result, the school health team, which includes the school nurse, teachers, office personnel, and other school staff members, plays an important role in helping students manage their diabetes. As is true for children with other chronic diseases, students with diabetes are more likely to succeed in school when students, parents, school nurses, principals, teachers, other school personnel, and the student’s health care providers (or personal health care team) work together to ensure effective diabetes management. At its core, effective school-based diabetes management requires two things:

• All school staff members who have responsibility for a student with diabetes should receive training that provides a basic understanding of the disease and the student’s needs, how to identify medical emergencies, and which school staff members to contact with questions in case of an emergency.

• A small group of school staff members should receive training from a qualified health care professional such as a physician or a nurse in student-specific routine and emergency care so that a staff member is always available for younger or less-experienced students who require assistance with their diabetes management (e.g., administering insulin, checking their blood glucose, or choosing an appropriate snack) and for all students with diabetes in case of an emergency.

Students with diabetes must check (or test) their blood glucose levels throughout the day by using a blood glucose meter. The meter gives a reading of the level of glucose in the blood at the time it is being checked. If blood glucose levels are too low (hypoglycemia) or too high (hyperglycemia), students can then take corrective action, such as eating, modifying their activity level, or administering insulin. Low blood glucose levels, which can be life threatening, present the greatest immediate danger to people with diabe­tes.

Written plans outlining each student's diabetes management help students, their families, school staff, and the student's health care providers know what is expected of them. These expectations should be laid out in written documents, such as a:

• Diabetes Medical Management Plan, developed by the student's personal health care team and family

• Quick Reference Emergency Plan, which describes how to recognize hypoglycemia and hyperglycemia and what to do as soon as signs or symptoms of these conditions are observed

• Education plans, such as the Section 504 Plan or Individualized Education Program (IEP)

• Care Plan or Individual Health Plan generated by the school nurse that provides instructions to faculty and staff.

Many students will be able to handle all or almost all of their diabetes care by themselves. Others, because of age, developmental level, or inexperience, will need help from school staff. The school nurse is the most appropriate person to coordinate care for students with diabetes. Each student with diabetes has different needs, but the education-related plans developed for such students are likely to address the following common elements:

• Where and when blood glucose monitoring and treatment will take place

• Identity of trained diabetes personnel who are trained to conduct blood glucose checking, insulin and glucagon administration, and treatment of hypoglycemia and hyperglycemia

• Location of the student’s diabetes management supplies

• Free access to the restroom and water fountain

• Nutritional needs, including provisions for meals and snacks

• Full participation in all school-sponsored activities and field trips, with coverage provided by trained diabetes personnel

• Alternative times for academic exams if the student is experi­encing hypoglycemia or hyperglycemia

• Permission for absences, without penalty, for doctors’ appoint­ments and diabetes-related illness

• Maintenance of confidentiality and the student’s right to privacy

With some insulin regimens, it is important to maintain consistency in the timing and content of meals and snacks. The student should eat lunch at the same time each day. Snacks are often neces­sary for a child with diabetes and must be eaten to balance the peak times of insulin action. A missed or delayed snack could result in hypoglycemia. The student’s nursing care plan or education plan (504, IEP, or other education plan) should show the timing of meals and snacks and an alterna­tive plan for unusual or unforeseen circumstances. Meeting the needs of students with diabetes requires advance planning for special events, such as classroom parties, field trips, and school-sponsored extracurricular activities held before or after school. With proper planning for coverage by trained diabetes personnel and possible adjustments to their insulin regimen and meal plan, students with diabetes can participate fully in all school-related activities (ADA).

ORGANIZATIONS:

American Diabetes Association (ADA)
1701 North Beauregard Street
Alexandria, Virginia, USA 22311
1-800-342-2383
http://www.diabetes.org/home.jsp

This association's mission is to prevent and cure diabetes and to improve the lives of all people affected by the condition. It funds meritorious research, hosts a national conference, publishes the latest scientific findings, and provides education and other services to people with diabetes, their families, health care professionals, and the public. It has local chapters that plan and carry out educational, service, fundraising programs, as well as, diabetes classes and summer camps for children and teenagers. In addition, ADA collects information on physicians and researchers who treat/study the condition and disseminates this information to its membership, as well as providing referrals to state and local chapters.

Juvenile Diabetes Research Foundation International (JDF)
120 Wall Street, 19th Fl
New York, New York 10005
212-785-9500  or  800-533-2873
http://www.jdf.org/

This foundation's mission is to support and fund research to find a cure for diabetes and its complications. It awards research grants for laboratory and clinical investigations and sponsors a variety of career development and research training programs for new and established investigators. JDF also collects information on physicians and researchers who treat/study the condition and decimates this information through their research newsletter and offers referrals to other resources. Finally, JDF hosts a national conference and coordinates a parent-to-parent matching program.

Joslin Diabetes Center
1 Joslin Place
Boston, MA 02215
617-732-2562 or 1-800-JOS-LIN1 (1-800-567-5461)
http://www.joslin.harvard.edu

The Joslin Diabetes Center in Boston provides a full range of services for children and adults with diabetes, providing the medical care, training, and support they need to live with this disease. The center and its affiliates offer a number of programs to help youngsters with diabetes and their families better manage the disease. In addition to traditional medical appointments, Joslin Diabetes Center offers educational programs that include summer camps and weekend retreats as well as family-focused programs geared to three different age groups--preschoolers, school-age children, and adolescents. A new program at a center affiliate in Illinois offers counseling services for young children and adolescents with diabetes and serves as a resource for their families. Educational materials include books to help children adjust to life with diabetes as well as manuals for parents and professionals on caring for young children with diabetes.

Barbara Davis Center for Childhood Diabetes
4200 East Ninth Avenue
Box B-140
Denver, CO 80262
303-315-8796
http://www.barbaradaviscenter.org

The Barbara Davis Center for Childhood Diabetes, affiliated with the University of Colorado Health Sciences Center, is the largest diabetes and endocrine care program in Colorado with unique facilities and resources for clinicians, clinical researches, and basic biomedical scientists working to help patients with type 1 diabetes. The center provides state-of-the-art clinical diabetes care to a majority of children and many adults within the Rocky Mountain Region.

Naomi Berrie Diabetes Center
Columbia-Presbyterian Medical Center
Russ Berrie Medical Science Pavilion
1150 St. Nicholas Avenue (at 168th Street)
New York, NY 10032
212-304-5494
http://www.nbdiabetes.org

The Naomi Berrie Diabetes Center (NBDC) is the research, teaching, and clinical services unit of the Columbia-Presbyterian Medical Center at Columbia University. It offers state-of-the-art multidisciplinary and humanistic clinical care for both adults and children with diabetes, coordinated by an endocrinologist. Educational, nutritional, and psychosocial counseling focuses on helping the patient and family to cope effectively with diabetes management. Research programs at the center focus on the biologic basis of diabetes and the prevention of type 1 and type 2 diabetes. Children's programs include a pediatric insulin pump support group and a teen/children's diabetes class. There is also a Kid's Corner at the NBDC website.

USDA/ARS Children's Nutrition Research Center
Baylor College of Medicine
1100 Bates Street
Houston, TX 77030
713-798-7000
http://www.bcm.tmc.edu/cnrc

The Children's Nutrition Research Center (CNRD) is a cooperative venture between the Baylor College of Medicine, Texas Children's Hospital, and the U.S. Department of Agriculture/Agricultural Research Service. CNRC researchers study nearly every aspect of children's nutrition, and data from the center's research are used to make dietary recommendations to improve the health of children. The center investigates the nutritional needs of pregnant and nursing women and children from conception through adolescence, establishes nutritional guidelines, and studies regulatory controls of children's body weight and body composition and childhood dietary habits that contribute to long-term health and prevention of diseases such as diabetes, based on changes in diet.

Endocrine Society
8401 Connecticut Avenue
Suite 900
Chevy Chase, MD 20815-5817
301-941-0200
http://www.endo-society.org

The mission of the Endocrine Society is to promote the understanding of hormonal communication at the molecular, cellular, and systems level to prevent, diagnose, and treat disease, and improve the quality of life. The society disseminates new knowledge leading to the prevention, treatment, and cure of diseases including diabetes. The society publishes four major peer-reviewed journals about endocrinology and metabolism. In partnership with the American Association of Diabetes Educators, the society has produced an interactive satellite broadcast, available on its website, that updates medical professionals on the latest breakthroughs in diabetes management. The society's website offers several articles on children and type 2 diabetes.

RESOURCES:

http://www.ama-assn.org/  The American Medical Association (AMA) provides abstracts of articles related to children with diabetes are available on the AMA website. These articles cover topics such as adolescent type 2 diabetes, latex, hypersensitivity, and clinical management of children and teenagers with diabetes.

http://www.umassmed.edu/diabetes/ The Diabetes Division of the University of Massachusetts Medical School teaches students, nurses, and physicians to provide the best possible care for patients with diabetes and to carry out research that will aid in preventing and curing this disease. Of particular interest on the website are two forms for parents of children with diabetes that may be printed out - one for the babysitter and one for the teacher. These forms are in an easy-to-follow format. They give parents guidelines to follow to inform caretakers that their child has diabetes, what that means, warning signs preceding insulin reactions, important phone numbers to call and what to do in an emergency, what snacks children should have and when, and other important information.

http://www.nutrition.tufts.edu The Nutrition Navigator is a website that reviews and rates nutrition websites. It was developed by the Tufts University School of Nutrition Science and Policy and is designed to help users find accurate, useful, and reliable nutrition information. The website is divided into several areas of interest for educators, general nutrition, kids, health professionals, parents, and special dietary needs.

http://www.diabetes-exercise.org The Diabetes Exercise and Sports Association (DESA) is a nonprofit service organization dedicated to enhancing the quality of life for people with diabetes through exercise. The organization's education programs include workshops and conferences. Educational materials include a quarterly newsletter that provides role models of athletes who have diabetes, and brochures that give information on how people with diabetes can safely incorporate a physical activity regimen into their diabetes control efforts. A pamphlet is designed to inform physical education teachers, trainers, and coaches about diabetes and physical activity.

http://www.hcf-nutrition.org The HCF Nutrition Foundation is a nonprofit, public foundation that promotes nutrition as a choice for better health and advocates for a healthful lifestyle that includes regular exercise, abstinence from smoking, and stress management. An HCF Nutrition Plan helps in the prevention and treatment of conditions such as diabetes, high cholesterol, heart disease, high blood pressure, obesity, and cancer by increasing fiber in the diet. The Foundation disseminates information through seminars, public forums, and personal contacts.

Websites for Parents:

http://www.mychildhasdiabetes.com/Here at MyChildHasDiabetes you'll learn what to expect and how to  be prepared for the challenges you'll face, both for your child with  diabetes and your family. This information comes from the parent of a diabetic child who has already faced and overcome these same challenges. We've got: information for parents of diabetic kids, our free E-book, information for kids with diabetes, diabetes health concerns, diabetes, news, articles, and more.

Websites for Children:

http://www.childrenwithdiabetes.org Children with Diabetes is an online resource with comprehensive information for children with  diabetes and their families. The mission of Children with Diabetes is to promote understanding of the care and treatment of diabetes, especially in children; to increase awareness of the need for unrestricted diabetes care for children at school and daycare; to support families living with diabetes; and to promote understanding of research into a cure.

http://www.kids.jdrf.org/index.cfm Welcome to JDRF Kids Online, the Web site for kids with diabetes and their friends and family. The Juvenile Diabetes Research Foundation is here to find a cure for diabetes—and to help you deal with diabetes day-to-day. Browse through the five "zones" for stories about kids with diabetes and lots of fun stuff.

http://www.grandmasandy.com/Grandma Sandy (Sandra J. Hollenberg) has free downloadable games and books about kids with type 1 diabetes. This material, created for her grandson, is now used by diabetes professionals throughout the world as teaching tools for their young patients.

http://www.angelarose.com/FamousDiabetics/index.html Famous Diabetics list page started in 1997 and has grown by leaps and bounds. The hope is to inspire others with diabetes and to make everyone realize how important it is to take care of yourself and your diabetes, because complications do arise.

Other Resources:

Diabetes Support Group  http://health.groups.yahoo.com/group/Diabetes_Support_Group/ Was created to serve as a support forum, a locale for diabetic recipes, to provide reports on diabetes breakthroughs, and to provide a place where people from all walks of life can vent, ask questions, and find links to helpful sites. No matter where we're from, we're all in this together!

“Helping the Student  with Diabetes Succeed” Use this comprehensive guide designed to empower school personnel, parents, and students to create a safe learning environment and equal access to educational opportunities for all children with diabetes. To learn more, read these in-depth articles from School Nurse News on topics related to helping students manage their diabetes. See Other Resources section for companion training modules. Download and print the PDF version or order the school guide at http://www.ndep.nih.gov/diabetes/youth/youth.htm

Tip Sheets for Kids with Type 2 Diabetes Updated in 2005, these colorful tip sheets provide basic information about type 2 diabetes and encourage young people to take steps to manage the disease for a long and healthy life. Written in simple language, the tip sheets are helpful for anyone who has type 2 diabetes and their loved ones. Also available in Spanish. Topics include: “What is Diabetes?,” “Be Active,” “Stay at a Healthy Weight,” and “Eat Healthy Foods.”

Download and print PDF files at http://www.ndep.nih.gov/diabetes/youth/youth.htm

The Starbright Foundation is a nonprofit organization dedicated to creating projects that help children and teens to address the psychosocial challenges that accompany chronic illnesses. A diabetes CD-ROM targeted to children and teens ages 5 to 18 is available (in English and Spanish) free of charge to children with diabetes and their parents at http://www.starbright.org

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