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FOCUS ON DIABETES

Schoolgirl's case shows need for care team

It's best if parents and school officials can work together to monitor diabetes.

November 07, 2011|Marissa Cevallos
  • A school nurse can help younger pupils with regular insulin injections.
A school nurse can help younger pupils with regular insulin injections. (Coneyl Jay, Getty Images )

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. Sometimes she'll forgo checking her blood-sugar levels to avoid the stares of her classmates as she pricks her finger.

So for a while 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, even though Willow insisted otherwise.

It was two months before they discovered what they think was the cause: Willow's teacher was making her do jumping jacks each afternoon when her blood-sugar levels were high, in the belief that it would help lower them.

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

Such misguided efforts aren't unusual for children with Type 1 diabetes -- Willow's pediatric endocrinologist says he's heard all kinds of stories of classroom mishaps. After all, teachers aren't generally trained to deal with the disorder. And school nurses aren't always there to administer insulin -- their numbers have been cut and their time is spread thin, sometimes across multiple schools.

For The Record
Los Angeles Times Wednesday, November 09, 2011 Home Edition Main News Part A Page 4 News Desk 1 inches; 38 words Type of Material: Correction
Children with diabetes: An article in the Nov. 7 Health section about an elementary school student learning to manage her Type 1 diabetes said that the girl, Willow Shawl, lives in Charlotte, Va. She lives in Charleston, W.Va.
For The Record
Los Angeles Times Monday, November 14, 2011 Home Edition Health & Wellness Part E Page 2 Features Desk 1 inches; 38 words Type of Material: Correction
Children with diabetes: An article in the Nov. 7 Health section about an elementary school student learning to manage her Type 1 diabetes said that the girl, Willow Shawl, lives in Charlotte, Va. She lives in Charleston, W.Va.

And so these days 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 health. For parents grappling with a child's new diagnosis of Type 1, this can be a nerve-racking time indeed, with the most help needed in the months after the diagnosis.

Here's how one young girl, and her family and school, met the challenge.

The plan

Willow, who lives in Charlotte, Va., was diagnosed just weeks before starting second grade at a public school. Her mother, Vicki Shawl, knew something was wrong on a summer road trip when her daughter needed to stop to use the bathroom about a dozen times and always seemed to be thirsty.

The condition destroys the cells in the pancreas that produce insulin, forcing the person with diabetes to figure out when the body needs insulin by checking blood-sugar levels throughout the day. If levels are too low, he or she might start to sweat, tremble and feel hungry; letting high blood sugar go unchecked can lead to serious complications. (Children with Type 2 diabetes also need to be vigilant, though they can often control their blood sugar with diet and medication.)

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

Because Type 1 diabetes is considered a medical impairment, Willow's parents were able to draft a care plan for the school, a provision under 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, 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; later, when Willow switched to a pump, her teacher was allowed to dial in extra insulin.

The teacher was required to keep a daily log of 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 daily log to the pediatric endocrinologist, who would make adjustments to Willow's insulin dosage. Her mom would relay the adjustments to the nurse and teacher.

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

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

The support system

Willow needed four to six shots of insulin each day. 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 other children with diabetes 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. But not every child gets such careful attention.

Researchers estimate that the incidence of Type 1 diabetes is growing at a rate of 2% to 4% a year, and Type 2 diabetes rates are climbing in step with the higher rates of childhood obesity. Only 22% of children with Type 1 diabetes use an insulin pump, according to a 2009 study. The rest rely on daily injections, making supervised care important.

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