CUMMING, Ga. -- Georgia school nurses are on the front line in providing essential care during school hours that allows children with diabetes to stay in class and learning. With obesity, a contributing cause of type 2 diabetes, rising at epidemic rates among adolescents, the school nurses also provide wellness education to children, teachers and staff about how to avoid developing this debilitating--but, in most cases, preventable--chronic disease year-round, and especially in November, which is American Diabetes Month.
About 215,000, or 1 in every 400, U.S. children or adolescents aged 0-20 have diabetes, a chronic disease marked by high blood glucose (sugar) levels due to defects in insulin production and/or activity, according to the Centers for Disease Control (CDC). While the majority of cases (1.7 per 1,000) in this young age group have type 1 diabetes, the causes of which are independent of lifestyle factors, type 2 diabetes (formerly called adult-onset diabetes) has risen to record levels among American teens, with an obesity epidemic and low levels of physical activity being the major contributing causes of onset.
Among Georgia children aged 10-17, 37.3% are obese/overweight, according to the 2007 National Survey of Children's Health, and rates of vigorous physical activity among the state’s middle and high school students rank consistently below the Healthy People 2010 national goal (85%) across all sex, race and age groups.
Federal law mandates that children with health conditions such as diabetes be able to attend school and receive medications, such as insulin injections, at school, and as the only health professional usually on school premises, school nurses are trained both to manage routine care and recognize emergencies, says Carol Darsey, president of the Georgia Association of School Nurses (GASN) and lead nurse for the Liberty County School System.
“School nurses have the skills to recognize cognitive changes in a child which may indicate low or high blood sugar levels, which can impact their ability to learn; and calculate appropriate insulin dosage levels,” she adds. “Effective diabetes management is critical not just for the immediate safety of the child but also to prevent them from developing serious long-term complications, such as high blood pressure, vision loss, foot neuropathy and amputation.”
School nurses collaborate with the child with diabetes’ parents and primary care providers to create an individual plan to ensure they receive blood glucose monitoring, snacks, healthy meals and insulin doses at the appropriate intervals to control blood sugar levels and meet their unique health needs, Darsey says. School Nurses also provide case management for students with diabetes, and it is goal-based depending on the student’s needs. Success is based on improvements in the child’s health, quality of life or academic success—not on the number of interventions the school nurse implements.
School Nurses can help to ensure that students with diabetes are healthy, safe, ready to learn and able to participate in all school sponsored events. According to Darsey, school attendance is essential for a child’s academic success.
School nurses also can help identify self-esteem and psychological issues arising from obesity and diabetes, which can be acute during teen years, and serve as someone these kids can turn to for support,” Darsey says. “Diabetes can make children feel different,” she adds. “They may be resentful because it’s a party day, and they can’t eat all the sugar the other kids can, or they may sneak food, make up glucose levels or even forget their insulin.”
With more than 300,000 uninsured children in Georgia, a school nurse may sometimes be the only health professional a diabetic child sees on a regular basis and play a big role in educating parents about diabetes care, she adds. Unfortunately, however, many children with diabetes do not always have access to a school nurse. In the 2010-11 school year, Georgia ranked 45th in the nation in the ratio of school nurses to students, with only one full-time school nurse per every 2,317 students.
State funds cover less than one half of school nurse salaries, and a 4% budget cut in fiscal year 2012 has put extra pressure on Georgia districts, forcing them to make cuts, have nurses cover multiple schools or supplement with local taxes and/or Medicaid funds. Therefore, school nurses also provide essential education to teachers and staff who provide both routine and emergency care when a nurse is not on premises.
For example, Cynthia “Cyndi” Walston, recipient of GASN’s 2011 School Nurse of the Year Award, serves 900 K-5 students in Hollis Hand Elementary andHoganville Elementary (Troup County). She assists with monitoring and treatment of a student with type 1 diabetes, has provided family education, and trains and monitors a health aide who provides assistance when she is at her other school.
For more information on the key roles that school nurses play in caring for children with diabetes and other chronic diseases, visit www.gasn.org.
Some Facts and Figures About Diabetes and Children
What is diabetes mellitus?
Diabetes is a group of diseases marked by high levels of blood glucose (sugar), resulting from defects in insulin production, action or both.
Type 1 diabetes
l Develops when the body’s immune system destroys pancreatic beta cells, the only cells in the body that make the hormone insulin that regulates blood glucose.
l Formerly called insulin-dependent or juvenile-onset diabetes.
l Usually occurs in children and young adults, although it can strike at any age.
l Accounts for 5% of all diagnosed cases of diabetes.*
l 1.7 per 1,000 US children under age 20 have type 1 diabetes.*
l About 15,600 youth are newly diagnosed with type 1 diabetes annually (2002-2005).*
Type 2 diabetes
l Usually starts as insulin resistance, a disorder in which the cells do not regulate insulin correctly. Eventually the pancreas loses its ability to produce it.
l Formerly called non-insulin-dependent or adult-onset diabetes.
l Usually is associated with older age, obesity, family history of diabetes, history of gestational diabetes, physical inactivity and race/ethnicity.
l Is still comparatively rare but at record levels in children aged 10-19, with annual new cases, at 3,600 or 8.5 per 100,000 (2002-2005)*
l African-Americans, Hispanic/Latino American, American Indians, Native Hawaiians or other Pacific Islanders are at higher risk for type 2 diabetes and its complications.
l Experts agree obesity and lack of physical activity put children at risk to develop the disease in both childhood and adulthood.
l Can be prevented through a balanced, healthy diet and physical activity.
Other types of diabetes:
l Gestational – a form of glucose intolerance during pregnancy.
l 1% to 5% of all diagnosed cases are due to specific genetic conditions, surgery, medications, infections, pancreatic diseases and other illnesses.
l 37.3% of Georgia children, aged 10-17, are obese/overweight.**
l Georgia’s children rank a dismal 42nd in overall well-being among the 50 states.***
l Only 1 in 5 (18%) high school students eat the recommended 5 or more servings of fruit and vegetables per day.
l Percentages of vigorous physical activity among middle and high school students are consistently below the Healthy People 2010 national goal (85%) across all sex, race, and age groups.
l Chronic conditions such as type 1 diabetes and asthma area at record levels among Georgia’s children.
How to collaborate with your school nurse to help your child with diabetes:
l Review each step of your child’s diabetes management plan with your doctor and school nurse.
l Make sure you (and your child, if he is self-medicating) understand instructions for calculating and administering insulin doses, as well as any other medications.
l Ask your school nurse to help teach you and your child to use equipment, such as blood glucose monitors and insulin pumps, properly.
l Schedule routine visits with your child’s doctor and share any changes in your child’s health with your school nurse.
l Let your school nurse and doctor know when the plan is not working so it can be revised.