Diabetes Prevention and Control Program - Diabetes and School Care in Rhode Island

Diabetes Prevention and Control Program

Rhode Island Department of Health

Diabetes & Children

[Artwork by Brianna Hoyle, Age 11, Warwick, RI]

What is diabetes?
Type 1 diabetes
Type 2 diabetes
Treating Diabetes
Diabetes and School (Care plans & policies)
Diabetes Camps for Children
Resources for Teachers & Schools
Diabetes Resources for Kids/Teens & Families

What is diabetes?

Diabetes is a disease that affects the body's insulin, impairing the body's ability to use food. Insulin is the hormone made in the pancreas which helps change food into energy. People with a diabetic pancreas either do not make insulin or the body does not use the insulin properly. There are several types of diabetes including Type1, Type 2, gestational diabetes (during pregnancy), and impaired glucose tolerance or other diabetes related symptoms.

Type 1 Diabetes

Type 1 diabetes, where the body produces no insulin, is one of the most common chronic diseases in children. Nearly one child out of every 600 develops it. Children with type 1 need daily insulin shots to help their bodies use food. This type of diabetes usually peaks around puberty (10 to 12-year-old girls, and 12 to 14-year-old boys). Type 1 diabetes tends to run in families, and whites have a higher incidence of Type 1 diabetes than other racial groups.

Warning signs of Type 1 Diabetes
(Symptoms may occur suddenly)

Excessive thirst
Constant hunger
Excessive urination
Sudden weight loss for no reason
Rapid, hard breathing
Sudden vision changes
Weakness
Drowsiness or exhaustion
Fruity odor of breath
(Source: Juvenile Diabetes Foundation International)

Type 2 Diabetes

Type 2 diabetes occurs when the body cannot make enough -- or can't properly use -- insulin. In the United States, Type 2 diabetes occurs in at least 90% of the population with diabetes. Detecting type 2 diabetes in children is hard because it can go undiagnosed for a long time since children can have mild or no symptoms, and blood tests are needed for diagnosis.

An increasing number of Americans are putting themselves at-risk for type 2 of diabetes because of the growing problem of obesity. Although this was once referred to as "adult onset", type 2 diabetes now affects both children/teens and adults. Reasons for this include a number of lifestyle changes such as drinking more sodas, skipping meals, eating larger portions, eating out more, and less physical activity (i.e. being driven to school than walking, exercising less).

According to the Centers for Disease Control and Prevention's diabetes statistics on children and adolescents in North America, those diagnosed with type 2 diabetes are generally between 10 and 19 years old, obese, insulin-resistant, have a strong family history for type 2 diabetes and Acanthosis Nigricans (a dark brown-looking, thick skin lesion that appears on the neck, underarm or groin area). All ethnic groups suffer from type 2, but American Indian youth have the highest prevalence in the U.S.

For more information on prevention click here: preventing Type 2 diabetes

Treating Diabetes

There is no current cure for diabetes but it can be treated. Family/social support, daily care and treatment, can allow you and your child to take control of diabetes to lead a healthy, active, and fun-filled life. The American Diabetes Association (ADA) outlines the goals of diabetes treatment for children as follows:

to maintain healthy growth and developmentto keep blood sugar levels within a target range (not too high, not too low) as much as possible -- ask a qualified medical provider such as a doctor or nurse of what range is right for your child's age.
to promote emotional well-being
Keeping blood sugar levels in a target range means balancing insulin, food, and exercise. Food raises blood sugar levels while insulin and exercise lowers them. Children and families should work with their doctor and diabetes team in finding a treatment plan that is best for them.

Diabetes and School

Teachers and other support staff should be aware if a child has diabetes, especially if an emergency were to occur. Parents, caretakers should work together with school personnel on a diabetes care plan for their children.

The Diabetes & Children Subcommittee of the Rhode Island Department of Health, in collaboration with diabetes specialists, school nurse teachers, parents, and Department of Health and Department of Education staff, developed the Physician Orders for Students with Diabetes form. This form entered into circulation at the beginning of the 2006/2007 school year and has been revised each year based on feedback received. An updated version for the 2008/2009 school year has been distributed and may be downloaded here. Please note that the 2007/2008 version of the form is still valid for use.

Physician Orders for Students with Diabetes (pdf)
The primary goal of the Physician Orders for Students with Diabetes form is to provide a simple, comprehensive form for use by a students school nurse teacher in the development of a diabetes medical management plan.

Questions to ask to learn more about diabetes management at school:
Alerting teacher/staff -- How will the child let them know if he/she feels low blood sugar coming on? Will the child raise his or her hand? Do the teachers know the signs of low blood sugar?
Testing -- Will the child be allowed to test his/her blood sugar in class, or will the child be required to have the test in the nurse's office?
Snacking -- If the child gets a low reading, will he/she be allowed to have a snack in class or leave the classroom?
Glucagon -- If the child has really low blood sugar and needs a shot of glucagon, who at the school will be responsible for administering the shot?
Insulin -- If the child needs insulin injections, who will give them?
(Source: Juvenile Diabetes Foundation International)

There are laws ensuring students with disabilities in all public schools and publicly funded day care centers are able to fully participate in their educational experience (Americans with Disabilities Act and Special Education laws). These laws ensure that your child is treated fairly at school and that his/her medical needs during the school day are met. Public School Districts and non-public schools have their own policies on providing diabetes care.

There is also no federal law prohibiting blood glucose testing in the classroom and several U.S. states have created specific policies related to diabetes care in schools. Currently, there are no specific provisions in the Rhode Island Rules and Regulations for School Health Programs related to blood glucose testing or training of school staff for diabetes care. The National Diabetes Education Program in collaboration with several national agencies has recently released a Guide for School Personnel: "Helping the Student with Diabetes Succeed" . The DCP continues working with several task groups to address the issue of diabetes care in the schools. Please contact the DCP for more information on this issue.

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