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December 8, 2008

Other, School and Daycare

Question from Arlington Heights, Illinois, USA:

Do you have any information on the cognitive effects of type 1 diabetes in the school setting? My daughter has to make frequent trips to the nurse's office and is missing a lot of class. She is in special reading classes to supplement her work, but the school seems to think that she may have learning disabilities. She is the only diabetic in the school and we have found that they just don't understand how it impacts her concentration when her sugar is too high or low. Her diabetes nurse educator told us that she could have impaired cognitive abilities up to two hours after a low sugar reaction and that we should have a 504 plan and IEP plan to protect her. She has frequent high sugars, also, mostly due to stress. Her A1cs are higher than we'd like and we are attempting to get her on an insulin pump. We hope her variances in sugar won't be as great and she will have better concentration. We are meeting with the school next week. Do you have any information that would help us explain cognitive abilities and diabetes?

Answer:

Most kids with diabetes do not have significant problems with learning unless there is a separate learning problem. Clearly, with extremes of high and low blood sugars, at those moments, there can be some problems but the overall impression of most pediatric diabetes experts is that the day-to-day schooling issues should not be major factors vis-a-vis diabetes. Research studies look at much more subtle problems and the best studies come from the Zurich Children’s Hospital group headed by Professor Eugen Schoenle.

So, if your child is having problems with missing class time, then you should go back to your diabetes team and see if you can problem solve to reduce such problems. Similarly, if your child is having other learning problems, then a good family history will likely find some others with similar problems. These issues are often genetically determined. And, a good neuropsychological evaluation will answer the question as to what learning difficulties exist, such as dyslexia, general inattentiveness, etc. These are common and co-exist with diabetes but one makes the other more difficult to manage. Then, a 504 education plan can be put into place with special assistance as defined by pediatrician, pediatric diabetes team, parents, teachers, counselors and neurologists, psychologists, etc.

SB