HYDERABAD: Several children who have type 1 diabetes suffer in silence without proper support at school and among peers. They do not check their blood sugars and do not take insulin due to social stigma in school. They feel insecure and develop a sense of discrimination. This gets reflected in their attendance and it can have a life-long impact on their education and social activities.
City-based diabetic educators and diabetologists say that schools have their own apprehensions.
“They ask for indemnity letters before admission. They are not sure what needs to be done in case of emergencies so they usually take the pretext of being ill-equipped medically to handle the situation. From a school’s perspective, there is some support but from a child's perspective, it is still an issue. There are IGCSE and Cambridge syllabus schools, which are not in the loop of all the communication from the government. The teachers and school staff should get sessions on type 1 diabetes during their orientation sessions,” many of them opined.
In a candid interview, Dr Leenatha of Rainbow Children’s Hospital shares her multidisciplinary approach to managing juvenile diabetes. She discusses the role of parents and their support towards such children and managing diabetes at schools through awareness.
Role of parents: Parents and guardians play a pivotal role because type 1 diabetes mellitus is a condition that requires blood glucose monitoring, multiple insulin injections on a daily basis and a healthy diet to maintain good glycemic control. Parents need to show their children how to confidently manage their glucose levels. I always advise parents to prepare their kids.
Measures at school: It is very important and crucial. As children spend more than half of their waking hours at school, diabetes care has to continue in their school, as well. As far as diabetes education is concerned, schools should ensure that a student does not experience discrimination. School staff should have a basic understanding of the condition and voluntarily take up the responsibility. I must say, unlike other diseases, medication alone does not help to treat diabetes. Awareness is paramount.
Centre of Excellence at Gandhi Hospital: The Centre of Excellence for type 1 Diabetes in Children is a once-a-week clinic held at Gandhi Hospital in collaboration with Novo Nordisk Education Foundation (NNEF). It supports children by providing free insulin and counselling on how to manage their blood glucose levels. I think having such centres in the districts and encompassing all aspects of diabetes care will help more children.
The success of artificial pancreas: The response is limited. Although these are available in India, the main challenge is the cost of the device. The artificial pancreas, also known as a hybrid closed-loop or closed-loop insulin pump, is the latest innovation. It mimics endogenous insulin production. It consists of a sensor, a catheter and an insulin pump and pumps constantly synced to the continuous glucose monitoring system.
Importance of basal-bolus regimen: As a doctor, I also recommend the insulin regimen for type 1 diabetes in children as an effective preventive measure against future complications. This includes two types of insulin given as multiple daily injections. Long-acting insulin is usually given once a day, the rapid/short-acting insulin that is given before a meal is based on glucose level, meal content and portion sizes, and anticipated activity.
Glucagon and its efficacy: Glucagon is a hormone that is produced by the pancreas and prevents one’s blood glucose from dropping low. It is used when a person experiences severe hypoglycemia like when their blood glucose drops low. And also the injection in these situations can be a life-saving medication.
Infographics:
· Approximately 85,000 children under 15 years are estimated to develop T1DM annually worldwide.
· In India, there are about 97,700 children with T1DM
· 66 % of Indian children possess ‘abnormal levels of sugar
· 68% of urban children do not exercise regularly.
