Call for greater inclusion of kids with Type 1 diabetes

Dubai: As Dubai marks World Diabetes Day on November 14, parents of children diagnosed with Type I diabetes called for greater inclusion of these young patients in schools across the UAE.

Discussing the challenges they face in helping their children manage the disease, they said lack of awareness about the condition among the general public is the main reason why children with Type 1 Diabetes feel isolated.

What is Type I diabetes?

It is an auto immune disorder affecting young children whose body makes little or no insulin. Insulin is a hormone that helps the body use sugar for energy. It is produced by the pancreas, which is an organ located behind the stomach. In Type 1 diabetes, the child’s immune system becomes faulty and destroys the cells in the pancreas that makes insulin (beta cells ). As a result, children with Type 1 diabetes need to take insulin to stay healthy. The condition can be life-threatening if it is not diagnosed early. It is different from Type II diabetes which is triggered by poor nutrition, sedentary lifestyles and obesity, resulting in insulin resistance.

Individual challenges

Pained by the lack of awareness surrounding Type 1 diabetes, Dubai-based Pamela Durant, whose son was diagnosed with diabetes at 20 months, gave up her highly successful career in health care management to start her own diabetes awareness company Diapoint to educate the community. Bringing up her son, now 11, she has been a hands on mother volunteering to accompany the school on field trips to keep an eye on her child, but she says not all kids are fortunate enough to get this inclusion.

“Children with Type I diabetes require to have their blood sugar monitored regularly to avoid high or low blood sugar episodes. Sometimes, a school understands the severity of what could happen, or the care required, it may be frightening for them, or may seem like too much of a liability. There are cases of children who have been turned away from schools or left out of school activities for this reason - which is heart-breaking. In other cases, some schools have asked parents if they could provide a private nurse for their child at school. Not only is this a financial burden for the family, but it affects the child socially. It adds to the social stigma of having diabetes.”

In another case, Nathalie, who arrived in the UAE with her husband last year, was heartbroken when her four-and-a-half-year-old daughter was given admission to a prestigious school in Abu Dhabi only to be declined when she disclosed her condition. “My daughter was diagnosed with Type 1 diabetes when she was three-and-a-half. No kid should be treated differently because of their medical condition. They are already going through a lot each and every day and do not deserve to be treated that way, especially in a place where they are supposed to learn values, respect and equality,” she remarked.

Elsewhere, Louis Kiernander, a mother of two, recently faced a terrible dilemma when her 11-year-old son had to go on a school trip in a new secondary school he had recently shifted to. Kiernander said: “In the primary school my son attended, he was well supported by the school staff and nurses and was never excluded from school trips or sports or treated differently. However, in the new school, there are 11 diabetics in the secondary section and my son is the youngest. While the school tries to be supportive, challenges remain. As per law, only a certified nurse is allowed to give a life-saving injection in case of hypoglycaemia. So my son was asked not to go on the regular school trip and instead go on another where the nurse could accompany him. He was segregated and felt ostracised. All they had to do is send the nurse on the regular trip and I do pay a handsome amount as school fees. I was asked to sign a form saying that if my son faced an emergency in those three days, no one would be giving him a life-saving injection. It was a horrible situation and felt like signing a death warrant.”

Right to a normal life

Dr Amani Osman, paediatric endocrinologist with Imperial College of London Diabetes Centre at Al Ain, who handles several cases remarked that every child had a right to be treated well in school. “This is a psychosocial element and I constantly advise parents and schools that one must not set boundaries for a child because of his diabetes. No child should be denied the right to live a normal life, play sports and go on field trips or be treated any differently because of their condition.”

Dr Osman added: “Children with Type I diabetes spend a considerable number of their active hours at school and it is important to have a proper diabetes management plan in place. This can be possible with proper awareness, education and communication between parents, school nurses and the child’s private physician.

Diabetes Management: What parents and schools can do

• Parents should be honest and not conceal a child’s condition from the school and friends so that he can get help in time. Children are afraid to be ‘different’, but in this case full disclosure can be life-saving.

• Once the condition is known, parents need to supply glucose testing kits, insulin vials, syringes to the school. Usually, children have automatic glucose pumps attached and only a test in presence of the nurse is required to determine the bolus (unit quantity of insulin ) required to delivered mechanically. In other cases, a certified nurse can administer an insulin shot at the school clinic.

• A child with diabetes requires insulin three times a day with three major meals. Children usually have breakfast at home and have their first insulin shot at home, the second one is in school during lunch hour and the child needs to go to the nurse and check his blood sugar levels before the meal to decide on the dose he needs two hours after the meal. Usually this is the only meal a child has at school. Any snack that has less than 50 gms of carbohydrates does not require the child to take insulin.

• Hypoglycaemia: Anything below 70 milligrammes per deca litre (mgdl) is low blood sugar and once detected, parents usually pack orange juice as an emergency meal. The rule is 15 gms of carbohydrates which amounts to half a glass of orange juice or a glucose gel tablet that can be given orally and 15 minutes later blood needs to be tested.

• There are cases where the blood sugar could get low enough for the child to lose consciousness. Sometimes, children take insulin and in their excitement to participate in some event, say a sport, overlook eating a proper meal. In such cases, the sugar could get very low. Nurses are trained to administer an intra muscular glucagon injection to reverse the action of insulin.

• Hyperglycaemia: This is blood sugar above 200 mgdl two hours after a meal. Diabetic children must check their blood sugar in school before meals and two hours after meal and have their insulin dose adjusted as per the reading, something which the school nurse can help them with. A child who has high blood sugar must not be allowed to do a sport activity as he can easily go into diabetes ketoacidosis which is a stage where the body has not enough insulin and begins to produce blood acids and burn fat as fuel. In both cases of high or low blood sugar, the nurse can intervene and advise the child. Nowadays most children carry continuous glucose monitoring devices and it is not difficult to know what a child’s blood sugar levels are.

• Children with Type I diabetes usually must maintain higher levels of hygiene. In case of diabetic children, it is absolutely necessary to keep them at home as their blood sugar levels can dangerously fluctuate when they are ill.

• It is also advisable that Type I diabetics get seasonal flu vaccines to keep any infections at bay as more complications would mean difficulty in managing their condition.

• Mothers must pay attention to meal qualities providing nutritionally balanced meals with dense carbohydrates and whole foods and discourage any processed and sugary foods that could spike blood sugar.

• It is important for schools to have regular physical activity and sports and encourage every child to be active. Obesity and over-weight issues are resulting in occurrence of Type II diabetes in children as young as six.

• In case of adolescent children with Type I diabetes, the school must be sensitive to not discriminate against them as these can have long term impact on their self esteem and trigger depression.

Source: Dr Amani Osman