Diabetes Advocacy...School Policies in Canada


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School Board Policies...

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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.  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 was written with the input of professionals and parents. 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 us  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 let us know

Diabetes Advocacy has also created a more general "Chronic Illness" policy that would apply to all children with a chronic illness who would require an individual medical care plan in school.

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.

The effects of acute hypoglycaemia on memory acquisition and recall and prospective memory in type 1 diabetes.

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.  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. 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

People working to change school policies and their stories

Let schools help with insulin, B.C. family says  (August 2010)

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