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The number of American schoolchildren managing diabetes continues to grow, and experts predict that by 2060, more than 500,000 will suffer from the chronic health condition.
This means that educators and school health staff will increasingly need to support students with monitoring and medical assistance throughout the school day. Over the past five years, school districts from Connecticut to California and Tennessee to Texas have been hit with civil rights complaints for failing to adequately manage student diabetes during the school day and after-school programs, and in some cases, the U.S. He is facing a Justice Department investigation.
Dr. Henry Rodriguez, a pediatric endocrinologist and co-chair of the American Diabetes Association’s Safe Schools Task Force, said it’s important for educators, physicians and families to plan together for managing a student’s diabetes. Ta.
“as [doctors]If things go according to plan, I’ll see patients three times a year for maybe 30 to 40 minutes,” he said. “That school nurse and that teacher see the child every day throughout the school year. We often rely on them to indicate if there is a problem.”
The U.S. Department of Education has released a new resource guide for schools on how to support these students. Here’s what educators need to know about this chronic health condition.
What is diabetes?
The endocrine system controls how the body processes glucose for energy. Even in healthy people, blood sugar levels can rise after meals, due to illness, or stress, but blood sugar levels remain within a narrow, stable range. Normally caused by a malfunction of insulin, the hormone that controls blood sugar levels in the body, high blood sugar levels for long periods of time can lead to a variety of health problems, including heart and kidney disease and vision problems. There is a risk that this may occur.
- Type 1 diabetes occurs when the body is not normal. Produce Enough insulin. This type is often diagnosed very young and is sometimes called “juvenile diabetes” because it is the most common type among children.
- Type 2 diabetes occurs when the body loses its ability to: use Administer insulin effectively. It progresses over time and can sometimes be managed with diet and exercise, with or without insulin medication. This type is sometimes called “adult-onset” diabetes, and its prevalence is increasing among children and adolescents. Increased rates of type 2 diabetes are associated with increases in childhood obesity.
How common is diabetes among young people?
Diabetes is one of the most common chronic diseases in school-age children. As of 2017, over 213,000 children under the age of 18 have been diagnosed with some form of diabetes. According to the Centers for Disease Control and Prevention, 1 in 4 adults with diabetes As of 2019, those under 40 were identified as school-age.
If diabetes rates continue to rise as fast as they did from 2002 to 2017; Country estimates This means a 65 percent increase in type 1 diabetes and an almost eight-fold increase in type 2 diabetes. The prevalence of diabetes, particularly type 2 diabetes, is increasing most rapidly among students of color.
As of 2019, nearly 14% of U.S. adults with less than a high school diploma had diabetes, nearly twice the rate of adults with post-secondary education, according to the latest research. CDC data.
How does diabetes affect a student’s academic performance?
Although there is little research on the health effects of diabetes, Student test scoresresearch shows that students with diabetes very unlikely Graduating from high school, enrolling in university, or going on to higher education.
Students whose blood sugar levels fluctuate wildly on a daily basis can feel exhausted and irritable. Difficulty concentrating, reading, and communicating. And you need to eat, drink, and go to the bathroom more often. Spikes or drops in blood sugar levels can also cause behavioral problems.
Is diabetes considered a disability?
yes. Diabetes can “substantially limit major life activities” and put students at increased risk of bullying and harassment. Title II Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 Prohibits discrimination against students on the basis of disability. Individuals with Disabilities Education Act (IDEA) Funds special education and support services for students with disabilities, including chronic health conditions.
Under federal law, schools must provide facilities to allow students with diabetes to access and participate in school.
A Department for Education spokesperson said: “Students with diabetes have different needs and different options to meet their needs to ensure students have equal access to school educational programs and activities.” . “If a student needs help managing diabetes, elementary and secondary schools may be required to train teachers and staff who can provide that support. In other situations, schools may be required to provide assistance to students with diabetes. You may choose to have the school nurse available, appoint a paraprofessional to assist the student, or determine that the student is independent in managing his or her diabetes and does not require any assistance other than medical treatment. We may do so in the event of a medical emergency.”
Among more than a dozen civil rights settlement agreements surrounding diabetes management, school districts most often address how diabetes can affect students and ensure schools have multiple adults available to help in an emergency. We found that we needed to train more staff to understand how to secure them on campus.
What role does technology play?
For decades, the main method of tracking blood sugar levels was to directly measure blood sugar levels by “finger pricking,” or pricking the skin to draw blood.
Doctors are now increasingly prescribing “continuous glucose monitoring” (CGM) systems to their students. The sensor remains on the skin and often uses a sample of glucose in subcutaneous fluid, rather than blood, to estimate blood sugar levels. These measures are often relayed to a monitoring app on your smartphone or tablet, which may also be connected to an automated insulin pump.
“You’ll probably measure from 4 to 6 [glucose] Daily levels are now well above 280,” Rodriguez said. Additionally, CGMs typically display trend lines as well as individual blood sugar levels. It turns out that Sally’s blood pressure actually tends to drop, and by setting an alarm for it, the individual can intervene before a major problem develops into a crisis. ”
However, CGM is not without controversy. Low-income students with diabetes are more likely to be uninsured or underinsured than their more affluent peers, so these insurance policies can be difficult to obtain.
In some schools, problems arose because staff were not trained in how to use the system or because the system was considered inconsistent with other policies. In Connecticut public schools, East Lyme, glastonburyand stanford The device is the subject of a civil rights complaint for failing to properly respond to diabetes alerts from the device, according to an investigation by the state attorney general’s office.
“There has been a lot of controversy among the school community recently, with people suggesting that we should have a school nurse with a tablet to supervise. [diabetic students’] “Blood sugar levels change every minute, 24 hours a day, 365 days a year,” Rodriguez said. “If a school has the ability to do that, that’s great. But it’s also important to note…just because you can monitor it in real time all the time doesn’t mean you need it.”
He said it’s more important for school staff to be aware of monitoring alarms and symptoms of students having difficulty.
For example, parents of diabetic primary school students in Glastonbury reported receiving remote alarms that their blood sugar levels were sometimes 60 points below safe levels and sometimes 200 points above safe levels, but “no one at school “They were unaware of the child’s health condition.” He was in serious danger,” the civil rights complaint states.
While many schools prohibit students from using smartphones and tablets in the classroom, especially during tests, Rodriguez said they need to work with parents and students to continue monitoring students’ blood sugar levels. He said there is.
For example, a proctor might keep a student’s smartphone and keep it close enough to alert the student if there are significant fluctuations during a long exam period. Some students may also reschedule their tests if their blood sugar levels are noticeably high or low at the beginning of the testing period.
How should schools approach support?
new 504 guidance resourcesthe Ministry of Education pointed out some common school facilities for students with diabetes, including:
- Access to refreshments during school hours.
- Increased number of bathroom breaks.
- Make up assignments and exams without penalty if a student experiences symptoms of diabetes.
- Plan and excuse absences due to medical appointments or diabetic episodes.
- Train teachers and staff to recognize the signs of blood sugar spikes or dips and administer emergency glucagon (for hypoglycemia) or insulin (for hyperglycemia).and
- Protect students from disability-related harassment, such as being bullied for what they eat or having to go to the bathroom too often.
Collaboration with the school nurse is important.More than one study 100 school districts in North Carolina They found that in districts with lower student-to-school nurse ratios, students with diabetes had significantly fewer absences, improved academic performance, and better control of their diabetes over time.
However, school nurses report Schools often lack the policies, staff training, and communication with students and families needed to manage the health of students with diabetes. She also noted that students with diabetes need more opportunities for physical activity, which also helps manage blood sugar levels.
Rodriguez noted that there is no one-size-fits-all approach to supporting students with diabetes, and schools need to consider how policies impact students with different needs.
For example, Professor Rodriguez pointed out that vigorous physical activity is essential to reduce health risks for all students and assist in blood sugar management for students with type 2 diabetes. However, students with type 1 diabetes may need additional support during exercise to keep their blood sugar levels from dropping too low.
