Transcript Assisting Children with Type 1 Diabetes in Schools Laura Nabors School of Human Services College of Education, Criminal Justice, and Human Services University of Cincinnati.

Assisting Children with Type 1
Diabetes in Schools
Laura Nabors
School of Human Services
College of Education, Criminal Justice, and
Human Services
University of Cincinnati
Type 1 Diabetes
 Type I diabetes is characterized by
pancreatic failure.
 Daily exogenous insulin replacement is
necessary for the child's survival.
 The care of children with Type I diabetes
involves complex procedures including
daily blood glucose testing, dietary
monitoring, intensive insulin therapy, and
increased physical activity to maintain
metabolic control.
In this presentation…
 I will discuss ideas for supporting children at school
 1) general ideas for improving children’s coping at
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school
2) nurses perspectives on helping children with
diabetes in school
3) parent and children’s general ideas about barriers
to child management and help children need to
support their diabetes management
4) children’s reports of what they need in terms
diabetes management at school
Goal: Through this review present ideas about barriers
and supports for children and review research on
school-based management of diabetes
Improving Children’s Coping at School
 Diabetes Care Plan
 Available at American Diabetes
Association website
 Elements of a Care Plan  how to handle
high’s and low’s as well as signs to look for
when the child is high or low, what
teachers should have on hand as far as
snacks, nursing plan, emergency plan…
Improving Children’s Coping at School
 More elements of a care plan….after school
sports plan, emphasis on the importance of
allowing the child to examine his or her
blood glucose level as needed
 Care card for the teacher’s desk in the
classroom
 Communication for the child, our research
shows that the children get sick of talking
about it. Make certain information is shared
to each new teacher!
Improving Children’s Coping at School
 Help the child identify a friend to walk to the
nurse with if he or she feels high or low {I get by
with a little help from my friends…}
 Assist the child in establishing a relationship
with school staff (and school counselor if
needed)
 Encourage the child to keep working at selfmanagement, increasing efficacy for chronic
illness management can improve management
 Have a certified diabetes educator on staff at
each school district
Switch gears & Let’s talk about…
 Opinions of and information from School
Nurses
In a study of school nurses
 Ninety-seven percent reported that after
school leaders and coaches should
become more knowledgeable about
diabetes. Most (57%) were not available to
help after school and 73% did not believe
that after school activities should be
included in written health care plans.
 “Teachers and coaches are nervous about
potential problems on field trips, athletic
events … it causes a lot of stress.”
Data provided by school nurses
indicated that…
 Improving support for adolescents involved
providing instrumental support so that
adolescents could test when needed and have
snacks and medical care necessary to cope with
episodes of low blood sugar. Written care plans,
based on a communication process involving
youth, the medical team, parents, teachers, and
nurses and then dissemination to all involved
was recommended, in order to facilitate
comprehensive management.
School nurses also said…
 Nurses also stated that care plans needed
to be updated regularly with input from
the child’s medical team or physician.
 Children and adolescents needed to learn
how to communicate with others about
their diabetes management and their
NEEDS
 Food management education and support
needed.
School nurses reported teachers need:
 Education!!!!
 “Teachers and staff need more education about
Type 1 Diabetes. They do not understand the
complications of the disease and they are afraid
to help the students properly manage it.”
 “Educate teachers to recognize highs and lows.”
 “Adequate time and resources to train staff.”
 “Educational support for the
nurses…continuing ed. And updating of
procedures with introduction to new ideas.”
Other information from school nurses…
 Children don’t want to be singled out because of
their diabetes.
 “I am the only nurse for five buildings so I am
not always in the building when questions
arise.”
 “Some teachers do not understand why it is
necessary to send students to the nurse and
provide a buddy.”
 “Lack of qualified substitutes and no RN in
building at times.”
Switch gears
 Child and
parent
perceptions
{barriers and
supports}
Children's Perceptions Study
What do kids and parents say?
 Sixty children (22 boys and 36 girls) and
completed telephone interviews. Children
ranged in age from 8 years, 6 months to 15
years, 8 months (M = 12 years, 2 months;
SD = 2 years, 1 month). Forty-nine
mothers, six fathers, and 4 guardians also
completed interviews.
 Children saw having “junk” food around
the home as a barrier, because they could
sneak food
Children's Perceptions Study
 Some children had the attitude that no
matter what I do my levels won’t be good
[this notion is related to the idea that
there is not a “1-1” correspondence
between adherence and HgbA1C levels.
 Another barrier to good self-management
was not feeling motivated to count carbs
Children’s Perceptions Study
 Being on the Pump was seen as an advantage in
most cases…
 I didn’t use to like taking shots, but now it’s
better because I have the pump.
 I’m on a pump and my blood sugars have been
better since I have been on the pump. I can take
care of all the stuff that goes with having a
pump.
 Children may need supervision of their pump
use and other management activities, suggesting
that shared management with a parent-child or
adult-child teamwork approach can be helpful
Some parents reported barriers…
 She’s not doing real good with it. What she
does I think is eat and not give herself
insulin and I don’t think it’s working for her.
She won’t let me know what carbs she’s had
during the day and I can’t help with
calculations.
 He has a lot of knowledge he doesn’t apply.
He’s too casual and doesn’t take it seriously
enough.
 She doesn’t always check [test] before she
eats.
Several parents reported that their
child needed coaching, because…
 Just forgetful …gets…you know…busy
doing whatever and forgets to do what
needs to be done.
 She sometimes forgets to take her insulin.
 The adult role was to provide support,
assistance when requested and provide
reminders!
Parents also liked the pump
 She’s doing a better job with it (the pump)
because she has more flexibility and
freedom
Let’s talk about children’s ideas of
help they need at school… (Study
of over 50 children surveyed)
Children’s ideas
 How is School Going Scale
 questions address children’s perceptions of the
amount of support that they needed from
teachers, nurses, friends, and parents while they
were at school for: (1) monitoring their blood
sugar levels, (2) administering insulin, and (3)
following their meal plan. Children recorded
their answers to questions on 4-point rating
scales (1 = “never/none” to 4 = “all the
time/every day”). They also discussed types of
support they needed from each group.
How is School Going Scale
 A chi-square analysis showed no differences in
boys’ and girls’ ratings for the amounts of support
they needed from nurses, teachers, and friends.
They needed a moderate amount of support from
all three. Younger children reported needing
more support from teachers (X2 (1) = 5.22, p < .05)
and nurses (X2 (1) = 20.29, p < .001) than older
children. Results indicated no difference in
younger and older children’s ratings for the
amount of support that children needed from
their friends, both groups required a moderate
level of support from their friends.
TYPE OF SUPPORT
NURSES
TEACHERS
FRIENDS
% (45)
% (53)
% (49)
REMINDERS TO TAKE SHOTS
13.3% (6)
100% (53)
HELP ME TEST (TEST GLUCOSE LEVEL)
42.2% (19)
3.89% (2)
HAVE A SNACK AVAILABLE
68.9% (31)
62.3% (33)
HAVE JUICE AVAILABLE
73.3% (33)
66% (35)
HELP WITH LOWS
82.2% (37)
30.2% (16)
HAVE SUPPLIES FOR TESTING AVAILABLE
80% (36)
28.3% (15)
28.9% (13)
17% (9)
14.3% (7)
58.5% (31)
49% (24)
8.2% (4)
HELP WITH FOLLOWING MEAL PLAN AT
LUNCH
HELP ME RECOGNIZE WHEN I AM
BEGINNING TO EXPERIENCE A LOW
SEND ME TO THE NURSE RIGHT AWAY IF I AM
LOW
66% (35)
LET ME TEST WHENEVER I NEED TO
79.2% (42)
DON’T GIVE ME SNACKS
38.8% (19)
FIND AN ADULT IF I LOOK UNWELL
44.9% (22)
Critical Issues
Who Can Help
Improve knowledge of diabetes.
Everyone: nurses, teachers,
friends, substitute teachers,
cafeteria staff
Nurse should be there every day. Nurses
Let me keep my test kit with me
and allow me to retake tests if I
need to.
Teachers
Supplies, especially snacks
should be available.
Teachers, Nurses
Walk with me to the nurse if I
feel really low.
Friends, Teachers
Encourage me to stick to my
meal plan.
Don’t eat junk food in front of
me or have alternative snacks
and treats for me.
Friends, Teachers
Children reported… Qualitative Data
 What needs to happen at school is
 (1) improving staff knowledge, (2) availability of
supplies and snacks, (3) staff and teachers needing
flexibility, (4) help with lows, (5) reminders, and (6)
support from other people to help them manage their
diabetes at school.
 The children mentioned that participating in afterschool activities was difficult, because nurses were not
on site and their supplies were often locked in the
nurse’s office.
Thanks very much!!!
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Selected References
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American Diabetes Association (2004). Diabetes care in the school and day care setting. Diabetes Care,
27(Supplement 1), S122-128.
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Butler, D. A., & Lawlor, M. T. (2004). It takes a village: Helping families live with diabetes. Diabetes Spectrum, 17,
26-31.
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Nabors, L., Lehmkuhl, H., Christos, N., & Andreone, T. L. (2003). Children with diabetes: Perceptions of
supports for self-management at school. Journal of School Health, 73, 216-221.
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Nabors, L., Troillett, A., Nash, T., & Masiulis, B. (2005). School nurse perceptions of barriers and supports for
children with diabetes. Journal of School Health, 75, 119-124.
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Nabors, L., & Lehmkuhl, H. (2004). How is School Scale. Author.

Smith, J., Nabors, L., Henderson, E., Kichler, J., and Andreone, T. L. (2010). Parent and child perceptions of
managing childhood diabetes. A. Fortier and S. Turcotte (Eds). Health Education: Challenges, Issues, and Impact. Series:
Education in a Competitive and GlobalizingWorld (pp. 229-236). Nova Science Publishers.

Skinner, T. C., & Hampson, S. E. (1998). Social support and personal models of diabetes in relation to self-care
and well-being in adolescents with type 1 diabetes mellitus. Journal of Adolescence, 21, 703-715.
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Ruggerio, L., Kairys, S., Fritz, G., & Wood, M. (1991). Accuracy of blood glucose estimates in adolescents with
diabetes mellitus. Journal of Adolescent Health, 12, 101-106.