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 learn. 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. This especially is important in November, which is American Diabetes Month.
About 215,000 — or 1 in every 400 — U.S. children or adolescents up to 20 years old 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 and Prevention. 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 ages 10-17, 37.3 percent are obese or overweight, according to the 2007 National Survey of Children’s Health. Rates of vigorous physical activity among the state’s middle and high school students rank consistently below the Healthy People 2010 national goal (85 percent) 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. As the only health professional usually on school premises, school nurses are trained to manage routine care and recognize emergencies, according to Carol Darsey, president of the Georgia Association of School Nurses 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 added. “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.”
When working with children with diabetes, school nurses collaborate with the children’s parents and primary-care providers to create individual plans 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 said.
School nurses also provide case management for students with diabetes. 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. Darsey said 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 said. “Diabetes can make children feel different. 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.”