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August 20, 2003

School and Daycare

Question from Tucson, Arizona, USA:

We want to know how fast a child recovers full mental function after a low or high (both moderate and extreme). Our child's school is requesting this for the 504 Plan to determine how long after a high or low a child can reasonably be given a test. We have been told the next day at earliest but need authority (and/or literature references) on this question.

Answer:

There are varying sources and responses so no hard and fast rules can be applied. Since most youngsters with type 1 diabetes have frequent episodes of hypoglycemia, it would be impossible to postpone all testing or school work just on the basis of hypoglycemia. However, a reasonable response from the school would require that any testing that produces unexpected results based upon the child’s usual performance would be suspect and repeated. This would be prudent and reasonable, especially if hypoglycemia was documented within a few hours before such an examination,.

The best evidence comes from data from work by groups in Pittsburgh (Ryan, Becker, Drash are senior authors usually), Charlottesville (Cox and Clarke) as well as St Louis (White), Zurich (Schoenle) and Scotland (Frier) if you need to do literature search on PubMed or Google. The American Diabetes Association and Juvenile Diabetes Research Foundation have good school position papers that also may be helpful. I just edited and published a new pediatric diabetes textbook entitled Pediatric and Adolescent Diabetes (SJ Brink and V Serban, editors) and Linda Siminerio and I (Stuart Brink) co-authored a school and diabetes chapter. This is not likely in any medical libraries yet so would have to be purchased.

SB