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Unlike the United States of
America, Canada does not have a single law regarding the rights and
policies for children with diabetes in the public school system. Each
province has its own guidelines and each board has its own policies.
The links provided give general and specific information regarding the
various policies throughout the country.
If your school's policy is not mentioned
please let us know so
that it may be added.
If you school's policy needs to be revamped
please contact school board trustees and bring this issue to their
attention. In our research we found boards looking to change but not
sure how to go about it.
Please
contact us, if they
would be interested in looking at a copy of our policy or working with
us to create something that works for your area.
 Diabetes
Advocacy's Policy for Children with Diabetes in our Schools
With the input of professionals and parents, the creator of this website
has written a policy for Children with Diabetes in Our Schools.
It takes elements from existing policies as well as sections from 504
Policies drafted in the US and brings them together into what we hope to
one day see as a "Canadian Policy for Children with Diabetes in our
Schools". To request a copy, please email
barbram@diabetesadvocacy.com and indicate "school policy request"
in the title. The current document is a work in progress and is in Word
format. If you would like to be involved in helping to bring this policy
to your province, again, please
contact us.
Why we need a policy?
Diabetes care has changed dramatically over the past 20 years. We now
see children testing and injecting more frequently. Insulin pumps are
fast becoming the norm in diabetes therapy. The more we know about this
disease, the better we are able to protect our children. This extents to
protecting their rights in school--the right to be healthy, to test, to
inject, and to be in the best physical condition before exams and
physical activities.
But do they really need to test before exams? Do highs and lows
really effect test scores?
Unequivocally yes!! Below are just some articles which prove this point.
Please feel free to share them with your educators to help them
understand the real effects of this disease on our children.
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The effects of acute hypoglycaemia on memory acquisition and recall
and prospective memory in type 1 diabetes.
-
Memory Remains Intact in Type 1 Diabetics Review of 33 studies
find that those with type 1 diabetes had significantly lowered
performance on the intelligence, speed of information processing,
and psychomotor efficiency tests. Lowered performance was also
observed on visual and sustained attention, cognitive flexibility,
and visual perception.
-
Hyperglycemia Slows Mental Functions in People with Diabetes
- Int J Clin Pract Suppl. 2002 Jul(129):20-6.
Related Articles, Links.
The effects of glucose fluctuation on cognitive function and the
functional costs of hypoglycaemia and hyperglycaemia among adults
with type 1 or type 2 diabetes.Cox D, Gonder-Frederick L,
McCall A, Kovatchev B, Clarke W.University of Virginia,
Charlottesville, USA. Publication Types: * Review * Review, Tutorial
PMID: 12166601 [PubMed - indexed for MEDLINE]
It is traditionally believed that while acute hypoglycaemia has
detectable negative consequences , such as unpleasant symptoms and
cognitive-motor disruptions, acute hyperglycaemia is not associated
with such consequences. However, recent research with adults
affected by either type 1 or 2 diabetes mellitus demonstrates that
relatively mild hyperglycaemia is associated with unpleasant
symptoms and cognitive disruptions. Both hyperglycaemia and
hypoglycaemia can be associated with patient experiences of
physical, affective, and cognitive symptoms, as well as
cognitive-motor disruptions. These effects can lead to impaired
functioning and quality of life. Because these effects are different
across patients, their significance can be difficult to appreciate.
There is ample evidence that acute hypoglycaemia is a problem for
both adults with type 1 and those with type 2 diabetes, and that
mild and moderate hypoglycaemia reduce one's mental efficiency
relative to euglycaemic performance. There is growing evidence that
transient hyperglycaemia has similar negative effects. At relatively
mild levels of extreme blood glucose--either hypoglycaemia or
hyperglycaemia--cognitive efficiency may decay by a third. The
impact of this effect will depend on the task the patient is dealing
with at the time. If the person is engaging in a relatively
dangerous task, such as driving a vehicle, significant consequences
could follow. Both hypoglycaemia and hyperglycaemia have been
demonstrated to have not only acute, but also chronic effects in
patients with type 1 as well as those with type 2 diabetes. Although
hypoglycaemia occurs at a lower rate among patients with type 2
diabetes than among those with type 1, the number of patients with
type 2 diabetes is so large that even this low rate results in many
persons being affected.
- J Pediatr Endocrinol Metab. 1996
Jul-Aug;9(4):455-61.
Acute hyperglycaemia impairs cognitive function in children with
IDDM. Davis EA, Soong SA, Byrne GC, Jones TW.Department of
Diabetes/Endocrinology, Princess Margaret Hospital for Children,
Perth, Western Australia.Publication Types: * Clinical Trial *
Randomized Controlled Trial PMID: 8910814 [PubMed - indexed for
MEDLINE] OBJECTIVE: The effects of acute hyperglycaemia on cognitive
function in children remain controversial. This study was designed
to investigate the suggestion that acute hyperglycaemia impairs
cognition in IDDM children. DESIGN: To examine this question we
studied 12 randomly selected children with IDDM (6 boys, 6 girls,
mean age 12.4 years). Cognitive performance was assessed on two
occasions at least six months apart (7.4 +/- 1.4 mths, range:
6.3-11.1 mths) under randomized conditions of hyperglycaemia (20-30
mmol/l) on one occasion and euglycaemia (5-10 mmol/l) on the other.
Target glucose levels were achieved using a modified clamp technique
with subjects and psychologist blinded to the glycaemic level.
Cognitive tests chosen to assess performance skills were subtests
from the Wechsler Intelligence Scale for Children-3rd Edition
(WISC-111). RESULTS: No significant learning effect was present.
However, there was a reduction in performance IQ at hyperglycaemia
compared with euglycaemia (106 +/- 4.3 vs 112 +/- 4.5 IQ points
respectively, p < 0.05). Under hyperglycaemic conditions the mean
decrease in percentile score for performance IQ was 9.5%. Of the 12
children tested, 8 had a decrease in IQ when hyperglycaemic, which
was independent of duration of diabetes and long term metabolic
control assessed by HbA1c. CONCLUSION: Acute hyperglycaemia results
in impairment of complex cognitive function in children with IDDM.
This may have important implications for school performance.
- Diabetes Care. 1999 Aug;22(8):1318-24.
Comment in: * Diabetes Care. 1999 Aug;22(8):1239-41.Conventional
versus intensive diabetes therapy in children with type 1 diabetes:
effects on memory and motor speed. Hershey T, Bhargava N,
Sadler M, White NH, Craft S. Department of Psychiatry, Washington
University School of Medicine, Washington University, St. Louis,
Missouri, USA.
tammy@npg.wustl.edu Publication Types: * Clinical Trial *
Randomized Controlled Trial PMID: 10480777 [PubMed - indexed for
MEDLINE] OBJECTIVE: Severe hypoglycemia may impair medial
temporal-mediated cognitive skills, such as the ability to recall
past events explicitly (delayed declarative memory). The objective
of this study was to determine whether delayed declarative memory
deficits are present in a group of diabetic children with an
increased risk of severe hypoglycemia. RESEARCH DESIGN AND METHODS:
Nondiabetic children (n = 16) and children with type 1 diabetes who
had been randomly assigned to either intensive (IT) (n = 13) or
conventional (CT) (n = 12) diabetes therapy at the time of diagnosis
participated in the study. All episodes of severe hypoglycemia were
prospectively ascertained. All children were tested on memory tasks
that have been closely linked to medial temporal functioning and on
reaction time measures. RESULTS: Our results demonstrated that the
IT group had a threefold higher rate of severe hypoglycemia,
performed less accurately on a spatial declarative memory task, and
performed more slowly, but not less accurately, on a pattern
recognition task than did the CT group or control subjects. In
addition, both groups of type 1 diabetic children were significantly
impaired on a motor speed task compared with their nondiabetic
peers. CONCLUSIONS: These results indicate a selective relative
memory impairment associated with IT that is consistent with the
effects of severe hypoglycemia and medial temporal damage or
dysfunction. If larger prospective studies determine that severe
hypoglycemia is the mediating factor for this memory impairment,
extreme caution in imposing overly strict standards for glucose
control in young patients with type 1 diabetes would be indicated
because of the increased risk of hypoglycemia associated with IT
regimens.
- Physiol Behav. 1998 Jul;64(5):653-60.
Related Articles, Links
Effect of acute hypoglycemia on visual information processing in
adults with type 1 diabetes mellitus. Ewing FM, Deary IJ,
McCrimmon RJ, Strachan MW, Frier BM.
Department of Diabetes, Royal Infirmary of Edinburgh, University of
Edinburgh, Scotland, UK. Publication Types: * Clinical Trial PMID:
9817577 [PubMed - indexed for MEDLINE] Acute hypoglycemia in people
with type 1 (insulin-dependent) diabetes mellitus causes general
impairment in cognitive performance. The effects on more specific
cognitive processes are less well defined. Acute hypoglycemia has
been shown to impair visual information processing in nondiabetic
human subjects and has now been examined in 16 adult subjects with
type 1 diabetes. All subjects had normal visual acuity and no
diabetic retinopathy, and their median (range) age was 24 (18-47)
years with a median (range) duration of type 1 diabetes of 8 (2-18)
years and a mean (SD) HbA1c of 8.5 (1.3)%. A hyperinsulinemic
glucose clamp technique was used to maintain arterialized blood
glucose at 5.0 mmol l(-1), and on separate test days, either
euglycemia was continued or hypoglycemia (2.6 mmol l(-1)) was
induced. During each condition subjects performed tests of visual
processing and cognitive function. Hypoglycemia caused a significant
disruption in general cognitive ability as assessed by digit symbol
(p < 0.001) and trail-making B (p < 0.05) tasks. Conventional
measures of visual acuity were unaffected by hypoglycemia, but
visual information processing deteriorated significantly as indexed
by inspection time (p < 0.005) and visual change detection (p <
0.01). Contrast sensitivity tended to deteriorate during
hypoglycemia (p = 0.06). In conclusion, hypoglycemia impairs
important aspects of early visual information processing and
contrast sensitivity in adults with type 1 diabetes. Further
research is needed to evaluate the functional relevance of such
changes for everyday tasks that require the intake of visual
information at speed and under conditions of low contrast
-
High Blood Sugar, As Well As Low, Slows the Mind
on Tuesday,
December 28 @ 13:41:30 EST Virginia researchers say a temporary rise
in blood sugar levels in people with diabetes can inhibit their
ability to think quickly and
solve problems. Dr. Daniel J. Cox stated that, “most people with
diabetes are aware of problems when their blood sugar levels drop
too far.” However, patients also often report not feeling well when
their blood glucose levels are high.” But lacking "a clear theory as
to why that happens, patient complaints were typically being
ignored," he said.
While laboratory studies have shown that mental performance
declines
when blood glucose is artificially raised, "this is not a realistic
environment," the researcher added.
Cox, at the University of Virginia Health System in
Charlottesville,
and his colleagues therefore conducted a field study with 196
subjects
with type 1 diabetes and 34 with type 2 diabetes.
The team instructed the participants to complete tests assessing
verbal
and mathematical skills using hand-held computers immediately
before
routine self-monitoring of blood glucose, three to four times
daily.
Approximately half the subjects made more errors and had slower
responses when blood glucose exceeded a certain point, the
researchers
reported.
Cox pointed out that to avoid a drop in performance associated with
low
blood glucose, people often load up on carbohydrates before
"cognitively sensitive procedures," such as exams.
"But they in fact could be doing themselves a significant
disservice,"
he said, and would perform better by avoiding both high and low
extremes of blood glucose levels.
Roughly 55 percent of the people in the study showed signs of
cognitive
slowing or increased errors while hyperglycemic, suggesting that
the
consequences of hyperglycemia vary among individuals.
However, among those whose cognitive performance deteriorated when
blood sugar levels rose, the negative effects consistently appeared
once levels reached or exceeded a certain threshold.
Diabetes Care, January 2005
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