Balancing act Balancing act

Managing kids' Type 1 diabetes — shots, sugars — while they are in school can be a struggle, especially with fewer nurses

November 14, 2011|By Marissa Cevallos, Special to Tribune Newspapers
  • After testing her blood sugar levels, sixth-grader Tess Anderson, 11, of South Elgin, takes an exam last week at Westminster Christian School in Elgin. Tess has Type 1 Diabetes.
After testing her blood sugar levels, sixth-grader Tess Anderson, 11, of South Elgin, takes an exam last week at Westminster Christian School in Elgin. Tess has Type 1 Diabetes. (Alex Garcia, Chicago Tribune)

CHARLESTON, W.Va. — Willow Shawl doesn't like to draw attention to her Type 1 diabetes. If a stranger asks about the insulin pump clipped to her jeans, the 10-year-old will say it's an iPod. She will sometimes forgo checking her blood sugar levels to avoid the stares of her classmates as she pricks her finger.

So for a time in third grade — when she started coming home from school with unusually high blood sugar levels — her parents suspected she was slacking in her daily routine. Willow insisted otherwise.

It was two months before the Shawls discovered what they believe was the real cause: Willow's teacher was making her do jumping jacks each afternoon when Willow's levels were high, believing it would help lower her blood sugar.

But strenuous exercise can raise blood sugar levels, the opposite of what Willow needed at that moment.

For children with Type 1 diabetes, such misguided efforts aren't unusual — Willow's pediatric endocrinologist says he has heard all kinds of stories of classroom mishaps. Teachers aren't generally trained to deal with the autoimmune disorder. And school nurses aren't always there to administer insulin — their time is spread thin, sometimes across multiple schools, as U.S. children experience increasing rates of chronic illness.

In efforts to keep up, school nurses focus on helping the 116,000 children younger than 14 in the U.S. with either Type 1 or Type 2 diabetes manage their own health, something most get a handle on by second or third grade, says Brenda Isaac, the lead school nurse in the county where Willow attends school.

For parents grappling with a child's new diagnosis of Type 1, this can be a nerve-racking time, indeed. The most help is needed in the months just after discovery.

Critical care

Willow was diagnosed just weeks before starting second grade at a public school. Her mother, Vicki, knew something was wrong on a summer road trip when her daughter needed to stop to go to the bathroom about a dozen times and was excessively thirsty.

The condition destroys the cells in the pancreas that produce insulin, forcing the diabetic to figure out when the body needs insulin by checking blood sugar levels throughout the day. If levels are too low, the diabetic might start sweating, tremble and feel hungry; letting high blood sugar go unchecked can lead to serious complications.

Willow's mom was nervous sending her back to school. She even considered home schooling. Before Willow's first day back, her mom had a two-hour meeting with the principal, Willow's teacher, nurse and other school staff.

"Almost her entire second-grade year was full of change. Every couple weeks we changed something," Vicki Shawl says.

Because Type 1 diabetes is considered a medical impairment, Willow's parents were able to draft a care plan for the school, under a provision in the Rehabilitation Act of 1973. Willow's plan involved her teacher keeping a blood glucose monitor in a drawer at her desk and reminding Willow to check her levels. Willow did the finger pricking herself, and the teacher would help discern if her sugars were high, low or within a normal range.

Only the school nurse was allowed to administer insulin shots, but when Willow switched to the pump, her teacher was allowed to dial in the insulin too.

The teacher was required to log Willow's blood sugar level and know the emergency procedures if her sugar dropped dangerously low. Every two weeks Willow's mom would send the log to the endocrinologist, who would make any needed insulin dosage adjustments, which were then relayed to the nurse and teacher.

"You have to take care of it or it will debilitate you," says Willow's dad, Mark, 41, who was diagnosed with Type 1 diabetes when he was 26.

The same goes for people with Type 2 diabetes. They can secrete insulin, but it's not used properly in the body. Children with Type 2 diabetes need to be vigilant, but they can often control their blood sugar with diet and medication. Rarely in kids does Type 2 progress to having to inject insulin, says Beth Mayer-Davis, an epidemiologist at the University of North Carolina Gillings School of Global Public Health.

The support system

Willow needed four to six shots of insulin each day, which was made difficult by her skinny arms. Her school was assigned a nurse only one day of the week, but because Willow needed care several times a day, the nurse, Rhonda Crede, drove to see Willow at snack time and lunchtime. Crede kept in close contact with Willow's mom by text, email and phone. She also juggled two more diabetics at two other elementary schools.

School nurses "play a critical role because they are the bridging gap between families and physicians. They pick up problems earlier," says Dr. Sachin Bendre, a pediatric endocrinologist at the Charleston Area Medical Center in Charleston, W.Va.