Last week, the BC Medical Journal published an article called "Unsafe at School: Advocating for Children with Type 1 diabetes." It is my understanding that the document was created by parents and endorsed by many in the medical community. It was a huge feat to have this reach such a publication. It added weight to the argument that children with diabetes in schools do have special needs based on their medical condition. Parents are not asking for help for their children with diabetes in schools just because they are too lazy to take time off work to run to schools. There are many more concerns here and those concerns are justified.
The article does a great job of highlighting the real impact of hyperglycemia on learning. They note that extended exposure to hyperglycemia can have a long term impact on cognitive performance. The authors further state that because some parents are not able to get to school themselves nor are they able to get a friend or relative to go to the school to inject their child, they are put on inferior insulin regimens and the children are often forced to run high during school hours. As previously noted, this means that the student's ability to learn in the afternoon session is severely reduced.
This problem could be alleviated if aides or other school staff were allowed to assist with injections or boluses. Sadly, the article states that the BC Nursing Support Services feel that such people are not qualified to do these tasks. Personally this is political rhetoric. If this was the case, that a teacher or aide could not be trained to inject insulin or deal with glucagon, then why are we as parents, not sent home with a nurse when we leave the hospital with our child? Parents of children with diabetes come from all walks of life and all education levels and yet everyone of us is required to test, inject, and manage glucagon if the need arises. We are trained by diabetes educators and if we do not use that training we are charge with criminal negligence regarding the safety of our children. I have spoken with educator and classes of students wanting to work in the school system, most are very willing to learn and be taught to assist their students to the best of their abilities.
I do have two small issues with this article however, but let me preface first that I know how hard it is to get consensus and that some points have to be made at the sacrifice of others. It can often be necessary to use extremes to get the attention of those most important.
My first concern is the argument of children with diabetes being labelled as disabled. I was recently made aware that the Human Rights Commission of Canada has chosen to recognize diabetes as a disability. This is a very sticky area. Many people with diabetes work very hard to show that there is nothing that they cannot do. They have fought various organizations to prove that they are just as capable of flying planes and working in the protective services as anyone else. They do not see diabetes as a disability. My son would fall under this category of people.
Other people feel that someone with diabetes is disabled. They have a disabled pancreas. The need to have an external source of insulin, to test blood and carry glucagon is not normal. The fact that a person with diabetes cannot always participate in activities because of hyper- or hypoglycemia, in some people's mind makes them disabled.
In the US, this concept is widely accepted. In the US, people with diabetes are considered disabled and protected both at work and in school by the American Disabilities Act. This allows students to receive, on paper at least, protection of their rights to inject, have assistance, and be exempt from writing exams when out of range. Sadly, schools still fail to provide their students with the proper protections, often discourage parents from implementing these plans, and are looking to remove school nurses from some schools leaving young children with diabetes in a similar situation to our own children here in Canada.
There is no easy answer. We do need protection for our children. We do need standard policies in place--not just for our children but for the educators as well. Staff need to understand what diabetes is. They need to understand how each child is unique in their needs. They need to understand that while the needs of a child with diabetes change over the years, there is a need for assistance from pre-kindergarten all the way up to grade 12 and beyond.
This was my second issue with the article. I wished that there had been a way to expand their focus a little more. A child who is five may not be able to inject themselves or understand how to bolus but a child of 15 may not be able to see his/her meter when are high and properly handle their diabetes care. A child of eight may do poorly on an afternoon test because their blood sugar was high but a child of 16 may fail a provincial exam because they were also high but no one noted their blood glucose levels and waited for them to be in range to have them take that test. Finally, a child who is 7 may not yet recognize when he/she is low and will require an adult to keep an eye out for them when the stumble on the playground and feel out of sorts. A child of 17 needs the same protection when they stumble in the halls because they are low but are mistakenly sent to the Principal's office for being intoxicated in school. The rights and safety of children of all ages must be protected. They all can be in dangerous situations just because they happen to have Type 1 diabetes.
I applaud the initiative and the passion of these authors. I truly hope that the legitimacy that this article gives to some of the issues children with diabetes in schools face help students not just in BC but throughout Canada. Our concerns are real. Diabetes is deadly. Treatment methods are changing and schools must be able to accommodate the needs of our students, allowing them to use the best possible treatment methods in school so that they can be at their very best to learn while in the classroom.