Managing type 1 diabetes in the school classroom environment

Diabetes and Special Education in School

Characteristics and Definition of Diabetes

The Centers for Disease Control 2005 survey reports that 21 million individuals or 7% of the total U.S. population have Diabetes. Furthermore, it is reported that one in every four to six-hundred students under the age of 20 years will have diabetes. (Belson, 2010) Diabetes is a "chronic metabolic disorder that results from failure of the pancreas to produce insulin (Type 1) or from insulin resistance with inadequate insulin secretion to sustain normal metabolism (Type 2)." (American Diabetes Association 2003; Centers for Disease Control, 2002 in: Getch, Bhukanwala, and Neuharth-Pritchett, 2007, p.1)

Characteristics of Diabetes

Children with diabetes have two problems that teachers must understand:

(1) Hypoglycemia; and (2) Hyperglycemia. (Children With Diabetes.com, 2010)

Hypoglycemia is low blood sugar and hyperglycemia is high blood sugar. Children with low blood sugar are known to have erratic behavior or alternatively act tired and to be hungry and shaky quite often. (Children With Diabetes.com, 2010) Children with high blood sugar also may be sleepy and thirsty and have a need to go to the restroom frequently. (Children With Diabetes.com, 2010)

II. Psychosocial Challenges Impacting Teachers

Psychosocial challenges are known to impact teachers of children with diabetes because children with diabetes tend to: (1) Experience more school-related difficulties and this is especially true if they have adjustment problems; (2) Become belligerent and moody; (3) Have poor self-confidence and achievement motivation from frequent absenteeism; and (4) Experience more anxiety and depression than their peers as a result of the poor fit between their health needs and school environments. (Getch, Bhukanwala, and Neuharth-Pritchett, 2007, p.1)

III. Findings in Survey of Elementary and Middle School Teachers

A survey of elementary school and middle school teachers, Neuharth-Pritchett and Getch (2001) states findings that "relatively few teachers have had any formal coursework or in-service training in assisting children with chronic medical conditions." (Getch, Bhukanwala, and Neuharth-Pritchett, 2007, p.1) Stated to be areas of concern that impact participation in working with a child with diabetes if likely to include: (1) Teacher anxiety; (2) Lack of appropriate preparation of teachers and other school staff; (3) Lack of clarity about school policies and the roles and responsibilities of school staff in providing services; and (4) The need for improved communication among families, schools, and healthcare providers. (Getch, Bhukanwala, and Neuharth-Pritchett, 2007, p.1)

IV. Needs of Children with Diabetes

Children with diabetes need to have the following:

(1) access to the tools for diabetes management (blood glucose testing equipment; insulin delivery systems; and oral, fast-acting carbohydrates and glucagons);

(2) sufficient time to adhere to their nutrition plan; and (3) access to personnel who are knowledgeable about diabetes and are able to assist when needed (ADA, 2002a; ADA, 2003, NIH, 2003 in: Getch, Bhukanwala, and Neuharth-Pritchett, 2007, p.1).

V. Protection for Children with Diabetes

Protection for children with diabetes falls under section 5004 of the Rehabilitation Act (1973), Individuals with Disabilities Education Act (1990) and the Americans with Disabilities Act (1990). Under these two laws, "diabetes has been determined to be a disability, making it illegal for public schools to discriminate against children with diabetes (ADA, 2003; NIH, 2003; Vennum, 1995). A diabetes healthcare plan is a necessary and vital tool for the management of diabetes. Such plans allow for communicating information about an individual child's condition, providing a supportive source of information in the case of a medical emergency, as well as promoting the involvement of medical personnel and parents in the management of the condition at schools." (Getch & Neuharth-Pritchett, 1999 in: Getch, Bhukanwala, and Neuharth-Pritchett, 2007, p.1)

VI. Individualized Healthcare Plans (IHP)

Getch, Bhukanwala and Neuharth-Pritchett (2007) report that students who are eligible for special education services should also be encouraged to have an "individualized healthcare plan (IHP)." (p. 1) The IHP makes provision of information concerning the student's healthcare procedure or physical management area." (Getch, Bhukanwala and Neuharth-Pritchett, 2007, p.1) Included in the HIP is specific information concerning:

(1) history;

(2) diagnosis; and (3) assessment data. (Getch, Bhukanwala and Neuharth-Pritchett, 2007, p.1)

VII. Information in the IHP

It is reported that students with diabetes who are not eligible under IDEA for coverage are eligible under section 504 of the Rehabilitation Act. It is emphasized in the American Diabetes Association's position statement that the child's parents, medical care team as well as school personnel should work in cohesion to develop an individualized diabetes healthcare plan. The plan should address the areas of:

(1) student history and other information;

(2) care and intervention goals;

(3) information for emergency information and contacts; and (4) specialized information. (ADA, 2003, Heller, et al., 2000, NIH, 2003, Zombek, 2002 in: Getch, Bhukanwala and Neuharth-Pritchett, 2007, p. 1)

Summary and Conclusion

It is clear that the classroom teacher and other school personnel must be actively involved in the educational plan for the child with diabetes. The child with diabetes is at risk of falling behind the class in their studies as well as having other potential difficulties due to their condition. It is possible however, for parents and teachers to mitigate the impact of diabetes on the child through proper planning and collaborative efforts in assisting the child to properly manage their condition and ultimately realize academic success.