Children with diabetes need special care from parents, teachers

As per the World Health Organisation (WHO), diabetes will be the seventh leading cause of death by 2030 and is responsible for kidney failure, amputation and blindness worldwide.

As per the WHO, people with diabetes in India doubled from 32 million in 2000 to 63 million in 2013 and this number is projected to increase to 101.2 million in the next 15 years. New cases of diabetes among younger age groups are rising, especially among children and adolescents.

Different types of diabetes may occur in children, which need special care and attention from parents and school staff:

1) Type 1 Diabetes (auto-immune condition):

- Type 1 diabetes is an auto-immune condition, which means the body's own immune cells attack the pancreas which produces insulin. Hence the body gradually becomes deficient in insulin. Insulin is a very important hormone which helps to break down the glucose into energy. When the body is deficient in insulin then the body derives its energy from the fats, which produces a by-product called ketones. These ketones and the high blood sugar in the body cause a condition known as diabetic ketoacidosis which is very dangerous and life-threatening if left untreated.

- Parents should look out for signs to diagnose diabetes early. A diabetic child may have excessive urination, thirst, hunger, weight loss, tiredness, weakness, frequent stomach aches, bedwetting in case of younger children, crankiness, irritability and disinterest in hobbies anymore. These signs and symptoms should prompt the parents to test their child for diabetes and visit a specialist.

- Insulin is the only treatment in Type 1 Diabetes patient and this can be given through syringes, insulin pens or a novel device called insulin pump. This pump is a small pager-like device and is often called an artificial pancreas as it delivers insulin to the body like the pancreas.

- Hypoglycemia (low blood glucose) is one of the major acute complications and should be managed immediately.

2) Type 2 Diabetes (due to obesity):

- Increasing cases of obesity has been seen among school children due to rising intake of calorie-rich food (junk food) and sugar-sweetened beverages. This has mostly been seen in public schools according to our previous research, which showed almost 25-30% of school children as being overweight/obese. While most of them will remain obese as adults also, some of them will develop adult onset diabetes (Type 2 Diabetes) in their teenage.

- The management of the child is focused on weight reduction through exercise, correct dietary approach, and careful use of certain drugs which decrease blood glucose as well as weight.

- Any child with diabetes (Type 1 /Type 2) should be handled sensitively and should not be stigmatized.

- The school principal, class teacher, school medical authority and the physical education teacher may share their medical assessments; it should be kept largely confidential.

Following are a few points the school authorities should consider and action:

Firstly, the personal information page in the school diary should mention any special health condition of the child so that the schools, especially the class teachers are aware and administer necessary care.

Secondly, students with diabetes should be allowed to check their blood glucose in the class during times when there is suspected low blood glucose level.

Thirdly, students should be allowed to carry snacks to prevent low sugars during class or examinations.

Fourthly, students should be allowed to carry medical instruments such as insulin pens, glucometer, insulin pump and insulin syringes.

Fifthly, younger children less than 8 years of age may require assistance from teachers which should be provided to check their blood sugars or administer insulin.

Sixthly, children with diabetes may develop low blood sugar with blood glucose <70mg/dl during school hours. Any simple form of sugar such as glucose or a cup of fruit juice can help and should be given. If the student falls unconscious and is not able to swallow, do not attempt to give anything through the mouth. The school should inform the parents immediately and if the school medical team has a doctor, intravenous glucose should be administered.

Seventhly, students should be encouraged to eat a small snack before any physical education training.