Special Help Care Needs

 Definition to Diabetes

                                                         

Diabetes is a disorder of the pancreas, where not enough insulin is produced. Because insulin is needed to break down sugar in the blood, if it is not being produced then glucose starts to accumulate in the blood and in urine, and causes symptoms such as thirst, hunger, weight loss, fatigue or weakness, excessive urination, and sometimes, blurred vision

 

Two major types of diabetes exist:

·         Type I or insulin-dependent diabetes, affects people who are usually under twenty-five years of age and can be diagnosed as early as six months) and includes juvenile diabetes.  Not enough insulin is produced.

 

·         Type II, non-insulin-dependent diabetes, ordinarily occurs after age forty.  Insulin is produced but the body does not use it efficiently.

 

Prevalence

 The total population with diabetes in Canada is estimated to be 3.1 million

people (8.6%) in 2013, and will rise to 4.2 million people (10.8%) by 2020. An

additional one million have the disease but do not know it. Over one in four Canadians lives with diabetes or pre-diabetes; this will rise to one in three by 2020 if trends continue.  For children under 10, 1 in every 600 will have Type I diabetes (Winzer, 2008).

 

 

Etiology

 The exact cause of diabetes Type I is unknown, but it is thought that there is a genetic link. A trigger, such as a virus or toxin in the environment, enters the body, attacks the pancreas and it is unable to produce insulin.

 With Type ll, there is also a genetic risk but being overweight is also a considerable factor.

 

Assessment

There are a number of tests that doctors will use if they suspect that a child has Type I diabetes. The main or primary test is the random blood sugar test, which if it is shows a reading of over 200mg/dl there is a strong indicator of diabetes. Other tests include fasting blood sugar test, and glycated hemoglobin (A1C) test (checks levels over 2 to 3 months).

When a child is diagnosed with Type I diabetes, the role of a caregiver becomes more important than ever. Family life and daily routines may seem more complicated in the beginning, with the need for changes in diet, monitoring and injecting. Over time, and with the support of your diabetes team, this will change. A child with diabetes will be able to have a healthy and fulfilling life.

 

There are successful interventions for delaying and potentially preventing the development of Type 11 diabetes, managing Type II diabetes effectively, and preventing complications responsible for diminished quality of life and shortened life expectancy.

 

 

Developmental Consequences
                                                 

Children with diabetes are at risk of many long term complications, because the injection of insulin only regulates glucose. Complications that they are at risk of include heart and kidney disease, skin and vision problems.

 If a child develops diabetes Type I at an early age (before the age of four), there is a greater risk of deficit in intellectual skills, e.g. visual spatial functioning and mathematics.

 Emotionally, the onset of diabetes Type I can be a shock and cause a lot of stress to a child who will now need to monitor their urine, completely change their diet and need to inject insulin.

Testing blood glucose (sugar) and giving insulin may seem overwhelming in the beginning. As you work with your diabetes team you will learn about diabetes and become more confident. It is important that you become comfortable with caring for your child’s diabetes so that you can help your child become comfortable too.

As the caregiver of a child with Type I diabetes, you will help them with:

                Monitoring blood glucose

                Administering insulin
                Having regular meals and snacks
                Balancing food, medication and physical activity
                Recognizing the signs of low and high blood glucose

 

The most common long-term effect of Type II diabetes is damage to blood vessels. Because of this, people with diabetes are up to five times more likely to develop heart disease or have a stroke.

 

Intervention

How you talk to your child about diabetes will have a big impact on how they perceive their diabetes and them self. Be positive and supportive will help your child’s self-esteem. Talk to your child about how foods fit into a healthy lifestyle. For example, no single food should be described as “bad” or “junk”. Describe blood glucose levels as “in target”, “high”, or “low”. Try to avoid describing blood glucose levels as “good” or “bad”.  Remember that diabetes is only one part of a child’s life. Talk to your child about other important things that are happening in their life such as school, sports and social events.

 The treatment of Type I diabetes involves a diet low in carbohydrates and fats accompanied by regular injections of insulin.  Food intake, insulin, exercise, must be carefully balance and monitored throughout the diabetic’s life to prevent immediate and long-term complications associated with hyperglycemia (high blood sugar) or hypoglycemia (low blood sugar).

 Type II diabetes is a disease in which your pancreas does not properly use the insulin it makes. As a result, glucose (sugar) builds up in your blood instead of being used for energy. Your body gets glucose from foods like bread, potatoes, rice, pasta, milk and fruit. To use this glucose, your body needs insulin. Insulin is a hormone that helps your body to control the level of glucose in your blood.

 

 

 Educational Implications

 

Children spend a great deal of their daytime hours in school, this setting must meet the needs of children and youth with Type I diabetes. Levels of support and care adjusted to the age and development of a child are essential for the proper management of Type I diabetes in the school setting. In Quebec for example, guidelines on interventions in school settings for children living with Type I diabetes have recently been published. This protocol describes the role and responsibilities of the different personnel involved, including parents, school nurses, the school principal and other educators in charge of the children, as well as the children themselves. Nurses, teachers and other personnel who are trained to help monitor and support the needs of children with Type I diabetes can make a significant difference in the quality of a child's diabetes management and in ensuring that the child's health and performance in school are not compromised. It is important that teachers and education assistants understand a student's diabetes and know their role of care during the school day. Members of your child’s diabetes care team can provide education to others.

 
                                                            

The school should have the following:

                A schedule of blood glucose monitoring times and insulin requirements

                A meal and snack plan - this may differ to other students' meal breaks
                A treatment plan for low blood glucose
                A treatment plan for high blood glucose
                Contact information for emergency situations

 

Conclusion

 

Diabetes is a high incidence illness which unchecked can cause serious illness, coma and death. With a careful diet, controlled medication and regular monitoring, the illness can be controlled enough so that a child can lead a relatively normal life. Knowing about their illness and how they must take an active part in its treatment will help a child come to terms with having the illness. Sensitivity and understanding at school should mean that children with diabetes can fully participate in most activities that schools have to offer.

 

References

Winzer, M. (2008) ‘Children with Exceptionalities in Canadian Classrooms’, 8^th Edition, Person Prentice Hall, Toronto and the following web site.

Here is a great website to access any and all information on diabetes.

http://guidelines.diabetes.ca/Browse/Chapter1   (go to slide and videos).