Children

Back to School with Type 2 Diabetes

Each new school year brings new challenges, particularly with diabetic students. Back to School Preparations are different when your child has diabetes. A parent’s ultimate responsibility is to teach their children to be independent, no matter what the situation. My experience with parents of school age children with diabetes varies widely.

Many times, school officials do not know if diabetic students are type 1 or type 2. Although the difference between the two conditions is like night and day, students are treated much the same way. It is unfortunate at this time in the USA, that approved medications for Type 2 in children are limited to Metformin and insulin. Insulin is a serious medication with significant side effects if not administered properly. I understand why parents are fearful for unfamiliar staff to give insulin to their child. For this reason, parents need to teach their child about insulin dosing so that the child will be self-assured and assertive to ask questions of adults when needed.

Kids can learn amazing things. While I was medical staff at a Type 1 diabetes camp, I had some amazing experiences. I worked with the youngest group ages 6-8 years old. Danny (fictitious name), was diagnosed at age 2 years and had an older sister who was also Type 1. Although he was 7 years old, he could already feel his blood sugars dropping when he was outside playing and he knew how to appropriately treat his low. He could “guestimate” what he was eating at each meal and calculate his insulin correctly. He had to be supervised, but at a very young age he had learned how to live with his “organ failure” and still be as normal as possible. Kids can learn with parental support.

Diabetes Priorities Vary with Age

According to the American Association of Diabetes Educators (AADE) diabetes priorities vary with age. (BC-ADM, 2014)

*Preschool and early elementary school students (ages 3-7 years) need to develop self-confidence. They need to learn to trust school staff to take care of their unique needs. Parents have the responsibility to educate other caregivers about their child’s specific needs. Many times blood glucose readings are seen as “good” or “bad”. Children have a strong desire to please parents. Fear of failure can cause children to falsify their numbers. Parents need to teach their children that blood glucose readings are just used to monitor their medication needs and never meant to evaluate their child’s behavior. Developing trust with your child is very important in this phase. (BC-ADM, 2014)

*Older elementary school ages 8-11 years need to develop self-esteem with respect to friends and peer groups. Diabetes management needs to center around a flexible regiment to allow participation in many activities. Their education needs to include how to avoid and treat hypoglycemic events. Parents need to observe blood glucose testing. Parents also need to progress in teaching their children about insulin dosing and self-administration. It is also important to teach their children how to participate in special occasions (example: birthday parties particularly at school). (BC-ADM, 2014)

*Early adolescents (ages 12-15 years old) can be very challenging. Normal hormone changes during puberty will cause blood sugars to be unpredictable. Parents need to be cautious about blaming their child of eating extra foods. Although they may be very hungry due to growth hormone, other hormone shifts will cause major troubles with blood sugars. It is important for parents and children to communicate honestly to avoid emotional problems. Diabetes priorities in addition to blood glucose control include monitoring for body image distortion, eating disorders, risky behaviors and depression. Although students may learn maintaining high blood sugars can create weigh lose, they also need to be taught the dangers of complications from uncontrolled diabetes like blindness, strokes and heart disease.

Family conflicts need to be intervened possibly with a professional family counseling. Turmoil between parent and child is very common at this phase. Children want more independence while parents are very fearful of the results. There is a high divorce rate in families with diabetic kids. Counseling may be beneficial for the whole family. (BC-ADM, 2014)

*Young adults (ages 16-19) Diabetes priorities include integrating diabetes into their lifestyle after high school. Young adults need to learn good coping skills for self-management. Teen and parent conflicts are common even without diabetes. There is a normal separation of the child from the family unit. Teens begin planning for their future independence. It is the parent’s responsibility to transition their teen into independent living. This includes developmentally challenged young adults. (BC-ADM, 2014)

When appropriate, it is very important for parents to educate their child about the effects of alcohol on blood sugars. I have seen so many diabetic college students in the emergency room. If you don’t know the dangers of alcohol abuse with diabetes, I encourage you to educate yourself and your child. For more information, see my blog post on alcohol and blood sugars.

BC-ADM, C.B. (2014). Type1 diabetes throughout the life span. IN S.C. Carole Mensing RN, The Art and Science of Diabetes Self-Management Education Desk Reference (pp. 393-400)