Changing Roles and Challenges for Teachers of Students with Diabetes

Goodrich, Susan Williams, McDermott, Robert J., Journal of School Health

Changing Roles and Challenges for Teachers of Students with Diabetes

ABSTRACT: With insulin dependent diabetes mellitus as one of the most common chronic conditions

adversely affecting the health of children, it is likely that teachers will at some point

encounter a child with diabetes in the classroom. While therapy for children with diabetes has

improved since the advent of insulin in 1922, children with diabetes continue to have special

needs at school. New research results indicate a role for teachers in helping to meet the special

needs of children with diabetes. In this paper, current research regarding the interaction of

children with diabetes and the formal educational environment is summarized, and the evolving role

of teachers in the academic development of children with diabetes is discussed. (J Sch Health

1989;59(8):341-345)

Enactment of the Education for all Handicapped Children Act of 1975 (Public Law 94-142) increased awareness that children with handicapping conditions may have special needs that must be met in school. As a result of PL 94-142, children are placed in the least restrictive environment, but may have individualized programs constructed on the basis of individual needs. While PL 94-142 is specific about the definition of "handicapped," another category of conditions, referred to as "other health impaired," is identified. Conditions in this category include asthma, cystic fibrosis, hemophilia, leukemia, seizures, sickle cell anemia, heart disease, tuberculosis, rheumatic fever, and diabetes.[1]

Traditionally, teacher preparation regarding understanding diabetes and diabetic children has been limited to "the warning signs" of hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) provided by a concerned parent or school nurse. The more common problem, hypoglycemia, usually is brought on by an insulin reaction due to too much insulin, too little food, or too much physical exercise.[2] Proper "reaction" to the diabetic child's physiological response generally has been the extent of the teacher's role in meeting the needs of the diabetic pupil.

Recent research[3] indicates teachers are underprepared to deal with chronic conditions adversely affecting health, and calls for more extensive training in managing students with chronic illness. Such training addressing diabetic pupils' needs should include exposure to new developments in therapy that offer hope for greater control and a decrease in life-threatening complications, indicating a brighter future to the diabetic pupil. Of equal importance are research findings regarding psychosocial effects of diabetes on the school-age child and family. While few clear-cut "answers" exist in this new and developing area of diabetes research, types of questions researchers have been asking and preliminary results may prove helpful to teachers of diabetic children.

CLINICAL REVIEW

Diabetes mellitus constitutes a disease of major concern. In the U.S., it affects an estimated 11 million people and is associated with severe, and often life-threatening complications, including myocardial infractions, cerebrovascular accidents, renal disease, blindness, premature atherosclerosis, neurological disorders, and lower limb amputations.[4] Uncontrolled diabetes contributes both to premature birth and stillbirth. Even with adequate control through use of diet measures or insulin administration, several important risks remain for the infant of a diabetic mother.[5]

Two major types of diabetes exists. Insulin-Dependent Diabetes-Mellitus (IDDM), or "Type I," is more frequently diagnosed in children. Traditionally, IDDM has been referred to as "juvenile diabetes," though adults have been diagnosed with this insulin-requiring form of the illness. More often, adults older than age 40 who are diagnosed with diabetes are diagnosed with Non-Insulin-Dependent Diabetes Mellitus (NIDDM). Rate of hospitalization for adults with diabetes is 2.4 times greater than for those without diabetes. Among children, the rate is 5.3 times greater.[6]

Drash[7] noted diabetes mellitus occurs in about one out of 500 children in the western world. More than 95% have the classic form of IDDM. Studies indicate that eventually more than 80% of individuals with IDDM experience serious microvascular complications including blindness, renal failure, and neuropathy. In addition, 50% or more eventually have equally serious complications of large blood vessels including accelerated atherosclerosis leading to …

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Publication information: Article title: Changing Roles and Challenges for Teachers of Students with Diabetes. Contributors: Goodrich, Susan Williams - Author, McDermott, Robert J. - Author. Journal title: Journal of School Health. Volume: 59. Issue: 8 Publication date: October 1989. Page number: 341+. © 1999 American School Health Association. COPYRIGHT 1989 Gale Group.

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