June 11, 2001
School and Daycare
Question from Montgomery, Alabama, USA:
Your site has several references to data which suggests high and low blood sugars interfere with brain function and have an effect on schoolwork. I’ve noticed that my 11 year old son has difficulty concentrating and completing his assignments in the classroom when his blood sugars are extremely high. His teachers seem to want to believe his problems are not diabetes-related, but rather due to his ‘immaturity.’ Where can I find this data so I can work with his school and possibly modify his IEP?
This is an area that is not completely understood (or agreed upon). I am aware of one study published in 1996 that looked at high blood glucose (hyperglycemia) and school performance in children with type�1 diabetes. (The reference is: Acute hyperglycaemia impairs cognitive function in children with IDDM by Davis EA – J Pediatr Endocrinol Metab – 1996 Jul-Aug; 9(4): 455- 61).
The authors studied only 12 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 months, range: 6.3-11.1 months) under randomized conditions of high glucose (360-540 mg/dl [30-50 mmol/L]) on a single occasion and more normal glucose levels (90-180 mg/dl [5-10 mmol/L]) on the other. The results indicated that no significant learning effect was present. However, there was a reduction in performance IQ at the higher glucose level compared to the more normal glucose level (106 +/- 4.3 vs 112 +/- 4.5 IQ points respectively). Under hyperglycemic 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 hyperglycemic, which was independent of duration of diabetes and long term metabolic control assessed by hemoglobin A1c.
The study concluded that acute hyperglycemia results in impairment of complex cognitive function in children with type 1 diabetes, and that this may have important implications for school performance.
Keep in mind that this study is very small and therefore not definitive. I would suggest that if you have issues regarding your school’s accommodations for your child’s learning, that you request an Individualized Educational Program (IEP) meeting, which is your right.
Additional comments from Dr. Donough O’Brien:
You are entirely correct in supposing that both hypoglycemia and hyperglycemia can interfere with cognitive development. However, before planning any specific intervention, I think that you need to discuss what can be done to eliminate these periods of ‘extremely high’ blood sugars. with your son’s diabetes care team. Then if problems persist, you might ask for an evaluation by the school system’s psychologist to make sure there isn’t some underlying issue like a mild dyslexia rather than just immaturity that is being exacerbated in times of high blood sugars.