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Discussion: Share your initiative/experience with children and adolescents in school!
Reply:EXPERIENCES WITH THE SCHOOL DIABETES PROGRAMME IN TURKEY
In order to address the challenges faced by children with diabetes in schools, the Paediatric Endocrinology and Diabetes Association, in collaboration with the Ministry of National Education and the Ministry of Health, launched the School Diabetes Programme in 2010. The objectives of this programme are to strengthen the care provided to children with diabetes in schools and to assist in early diagnosis by educating teachers and students about the symptoms of diabetes in children. Within the scope of this programme, numerous activities related to all aspects of diabetes care at school have been carried out to date.
In the 10th year of the School Diabetes Programme, a significant step was taken in our country by preparing guidelines for the care of diabetic children in schools in accordance with global standards. These guidelines were published in the Ministry of National Education Bulletin on 14 October 2020 and entered into force. This guideline stipulates that "in schools with children with type 1 diabetes, the school nurse, if available, or a relevant teacher, if not, should be assigned as the person responsible for these children, and this person should be provided with training and close cooperation with the family should be ensured." However, it has not been determined who should administer insulin injections to diabetic children, especially those of primary school age, in situations where there is no school nurse, and teachers have not been assigned such a task. In this situation, in many schools in our country, families (mothers) wait at the school gates to administer insulin injections and carry out other treatment requirements. However, it is observed that a significant number of teachers support families with insulin injections, blood sugar monitoring, and hypoglycaemia treatment.
Benefits of the School Diabetes Programme
The School Diabetes Programme is a problem-focused, realistic programme that is enthusiastically embraced by all parties. It is integrated with the programmes of the Ministry of National Education and the Ministry of Health and is a unique programme within the scope of the National Diabetes Control Programme. It has been well received by many groups involved in diabetes, particularly teachers. The benefits of the programme are summarised below.
School Action Plan for Children with Type 1 Diabetes
1. Following the family informing the school administration or relevant teacher, a person responsible for the child with Type 1 diabetes's life at school should be designated. This person, ideally the school nurse, could be the class teacher/guidance counsellor or a teacher or school employee designated by the school administration if there is no nurse.
2. Ensuring that the family and diabetes team maintain communication with this person regarding all matters and issues related to diabetes.
3. Ensuring that the telephone numbers of family members are recorded in an easily accessible manner.
4. Ensuring that this designated person is trained in insulin injection, blood sugar measurement, type 1 diabetes and situations that may develop due to diabetes and require urgent intervention (especially low blood sugar), and that they are able to administer the drug Glucagon when necessary, with the written consent of the family.
5. Although not a legal requirement, ensuring that this designated person, with the family's written consent, supports children who need insulin injections and blood sugar monitoring and, when necessary, administers additional doses of insulin after consulting with the family.
6. Requesting a 'Diabetes Treatment Plan' from the family of every child with diabetes at the beginning of the school year (this plan will be prepared by the diabetes team monitoring the child and sent to the family and school) and sharing this plan with the relevant teachers and, if available, the nurse.
7. In schools without an infirmary, if the child and family wish, a room should be provided where insulin injections can be administered, and a refrigerator should be available to store a 'glucagon' kit for use in cases of severe hypoglycaemia.
8. Support should be provided at school regarding diabetes-appropriate nutrition.
9. If possible, a 'Diabetes Emergency Kit' containing fruit juice or sugar cubes, a blood glucose meter and test strips, cotton wool and plastic cups should be kept in the diabetic child's classroom.
10. In schools without a nurse, contact the nearest family doctor's surgery to ensure rapid intervention and support in emergencies.
Professor Dr. Şükrü Hatun
Paediatric Endocrinology and Diabetes Association
Diabetes at School Programme Coordinator
Koç University, Istanbul
