Other health impairment
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)]
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).
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.
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).
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).
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).
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)
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).
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).
1701 North Beauregard Street
Alexandria, Virginia, USA 22311
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.
New York, New York 10004
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.
1 Joslin Place
Boston, MA 02215
617-309-2400 or 1-800-JOS-LIN1 (1-800-567-5461)
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.
13001 E. 17th Place
Aurora, CO 80045
303-724-2323 (clinic) or 303-724-6836 (research)
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.
Columbia-Presbyterian Medical Center
Russ Berrie Medical Science Pavilion
1150 St. Nicholas Avenue (at 168th Street)
New York, NY 10032
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.
Baylor College of Medicine
1100 Bates Street
Houston, TX 77030
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.
8401 Connecticut Avenue
Chevy Chase, MD 20815-5817
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.
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.
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.
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.
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.
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.
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.
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.
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.
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!
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. Download and print the PDF version or order the school guide. 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.