Diabetes

DISABILITY CATEGORY

Other health impairment

TYPES

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, sickle cell anemia, and Tourette syndrome; and adversely affects a child’s educational performance.”

[34 code of Federal Regulations §300.8(c)(9)]

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 2011).

FACTS AND STATS

Diabetes is one of the most common chronic diseases in school-aged children, affecting about 215,000 young people in the United States. 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.

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 2011).

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 2011).

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:

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:

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:

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, 12% take insulin only, 14% take both insulin and oral medication, 58% take oral medication only, and 16% do not take either insulin or oral medications (CDC Diabetes Fact Sheet 2011)

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 2011).

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:

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:

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:

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
www.diabetes.org/

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)

26 Broadway
New York, New York 10004
800-533-2873
www.jdf.org/

This foundation's mission is to support and fund research to find a cure for type 1 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
617-309-2400 or 1-800-JOS-LIN1 (1-800-567-5461)
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

13001 E. 17th Place
Aurora, CO 80045
303-724-2323 (clinic) or 303-724-6836 (research)
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
212-851-5494
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
713-798-6767
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
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

Websites for Parents

Websites for Children

Other Resources