DIABETES AND RETURN TO SCHOOL

A diagnosis of diabetes is always a shock for the family, a bolt from the blue that disrupts the relationships of its members and the balance in their daily lives for a long time. Denial, anger, depression - perhaps even guilt - are the stages we go through for a shorter or longer period of time until we finally reach acceptance and continue our lives with diabetes.

Parents' anxiety about their child's safety intensifies when they are away from them. They worry about how they will cope with hyperglycemia or hypoglycemia and whether they will have time to act or seek help in time. How will they manage on their own ? Who will measure them? Who will calculate the equivalents? How will they inject and administer insulin? Questions that concern them every day and thoughts that overwhelm them during the hours when their child is away from home.

The return to school is approaching and the anxiety is peaking . Before the presence of a nurse at school, the problems were almost daily and intense. Usually the mother was forced to stop her job or work fewer hours to be near the child and give him a measurement or injection during breaks or to accompany him on excursions herself, otherwise the child would not be accepted. There were cases where the mother was forbidden to enter the school to provide appropriate treatment to her child or there was a lack of cooperation between the teacher and the guardian.

The problems were resolved with the establishment of the institution of the school nurse , which is not a "luxury" but an imperative need and right of every child who needs medical care. A permanent request of parents and associations is that all nurses be in place from September and that no child be left "uncovered" during the hours they are away from home. The school nurse is an ally in the work of teachers and alleviates the justified fear of parents for the safety of their child.

An institution that was established in the 2015-16 school year and "untied the hands" of parents and teachers. Its role is decisive and valuable, as it is the connecting link between the family, the child and the teacher.

Let's take a closer look at the problems of children with diabetes at each level of education.

Daycare center

There is a possibility that a child with diabetes will not be accepted in kindergarten. If the parents choose a private kindergarten that is also staffed by a school nurse then there is no problem. Since the child is too young to handle his diabetes on his own, the teachers are hesitant to take responsibility. If they accept it, it will be for a few hours or with the presence of a nurse and always in collaboration with the parents and faithfully following their own instructions.

However, there are also teachers who embrace the child , wanting to learn what diabetes is and take over their routine, their hours of stay at the daycare center. Care is needed for parents to choose the right daycare center that will offer safety and love to their child. Care is needed for parents to choose the right daycare center that will offer safety and love to their child.

Primary education (kindergarten-elementary school)

In primary education, parents have the right to apply for a school nurse . The application is made every year and requires an opinion on the child's condition from a public hospital. In this way, the parent has the peace of mind that someone is close to their child and the teacher is relieved of the stress of monitoring the child. From the moment the nurse arrives and is informed about the child's medical file and his daily routine, he becomes his guardian angel during the hours he is at school. With the instructions of the guardian and with the help of technology, he checks the prices, intervenes when necessary, checks the child's food and is discreetly close to him without being present during class.

According to their job description, they accompany the child on school trips, but it is not uncommon for the same nurse to have two or more children under their supervision and at the same time - if necessary - take care of all the children at the school.

From the moment the child with diabetes goes to school, the parent has the obligation to:

• Inform all school support and teaching staff. There is no reason to hide it or feel ashamed. Certainly the teacher is not required to know what diabetes is or may be poorly informed. Respectful and understandable. However, in simple words, he can be informed about the medical routine that the child should follow or how to recognize simple symptoms of hypoglycemia and hyperglycemia. He can even - if he wants - be present at a measurement and participate in the child's care.

• For the teacher and parent to feel that they are together for the good of the child and not against each other. This of course does not mean that the child needs special treatment or to be pampered. Simply that he or she feels that he or she has someone to turn to if he or she does not feel well for any reason.

• Have glucagon in the school refrigerator for emergencies as well as extra supplies or extra snacks or tablets to treat hypoglycemia

A good idea would be to organize an information session in the classroom or throughout the school about what juvenile diabetes is, with the participation of the school nurse. This action will contribute positively to the child's psychology and at the same time his classmates will learn a valuable lesson in empathy , respect and acceptance of diversity.

On the other hand, the teacher:

• Allow the child to go out of the classroom when there is hypoglycemia or hyperglycemia - with an escort to prevent dizziness - to eat or make corrections
• Give him more time to finish his exercises if hypoglycemia prevents him from concentrating.
• Remind him of his snack during breaks or after physical exercise, especially until a nurse arrives.
• But -most importantly- to love and accept it so that the child can unleash all the potential that is hidden within him. The role of teachers is not to provide knowledge in a cold and professional manner, but mainly to play a decisive role in the child's positive psychology, in the safety and preservation of his health. Encouragement, acceptance and love are the cornerstones for the child to spend calmly his school years. And let's not forget that a child with diabetes should not be treated as sick or marginalized. He can do anything, as long as we believe in it!
• Inform classmates, as the child may have a mobile phone, meter and other items in his bag that are fragile and should not be lost or damaged. Also, in an emergency - if the children know what to do - they will immediately notify the nurse or teacher as soon as the child feels unwell.

Secondary education (Middle School-High School)

In secondary education, the parent-guardian has the right to request a school nurse, but adolescence is a very demanding period in a child's life and most refuse his presence, because they do not want to feel that they are different from their classmates. The teenager is already at an age where he can take on the management of his diabetes on his own, with the knowledge and technology that allows him to control his sugar levels immediately and remotely. However, in the case where the teenager has just been diagnosed, a lot of attention is needed to ensure that he returns to school safely, but also by taking responsibility for regulating his glucose levels.

The difficulties in middle school and high school are greater, and parents should inform regularly and many times during the year that their child has diabetes, as teachers move to two or three schools and do not remember the specifics of each child.

And here, the cooperation of parents and teachers is needed, so that they can be allies in the child's daily struggle.

The teacher should:

• Show flexibility and do not offend the child if it is removed, as at that time they may have hypoglycemia
• Allow him to drink juice in the classroom or be accompanied out of the classroom if he is not feeling well without having to take absences.
• The child should feel safe to take a measurement or inject during class without being stigmatized or insulted.
• To motivate the adolescent student to participate in all school activities and events without excluding him or showing, even indirectly, that he does not wish to be present.
• Show understanding when he is absent from school for reasons related to his illness
• Give him extra time if needed to finish a written test as abnormal sugar levels undoubtedly affect his concentration and performance.

With a positive attitude and constructive cooperation of all stakeholders, the school life of these sweet children will be improved, so that they can develop into balanced adults.

Information, vigilance and awareness are needed in the school community, not complacency and indifference. All children are different, but we must accept and love them all !

Happy school year to parents, students and teachers!

Written by Marianna Metaxa

Educator, Author of the books "My Sweet Kelly" and the fairy tale "Melita and Zacharoulis" and lyricist of the song "Listen to My Heart" which was set to music by Sofia Grammenou

Article sources

• Panhellenic Federation of Associations and Societies of People with Diabetes Mellitus (POSSASDIA) 

• G.E.K. 2055/26-04-2022 : Amendment of M.A. 88348/D3/ 30-05-2018 "Duties and responsibilities of the branches PE25 School Nurses and the branch DE01 Special Auxiliary Personnel in Primary and Secondary General and Vocational Education schools"
• Government Gazette 120/2018 (on the absences of students with serious illnesses in secondary education)
• Presence of a nurse in infants and toddlers attending municipal nurseries and daycare centers ( article 13, paragraph 10 of Joint Ministerial Decision 41087/2017 – Standard Regulation for the Operation of Childcare Centers and Daycare Centers).