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Support for children and young people with diabetes mellitus during school hours
  1. Juliana Chizo Agwu1,2,
  2. Jan Idkowiak3,4,
  3. Theodora Papanikolaou1,
  4. Roshini Tharmaratnam1
  1. 1 Paediatrics, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
  2. 2 Institute of Clinical Sciences, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
  3. 3 Institute of Metabolism and Systems Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
  4. 4 Paediatric Endocrinology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Dr Juliana Chizo Agwu, Paediatrics, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B71 4HJ, UK; chizo.agwu{at}

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Children and young people (CYPs) with diabetes mellitus (DM) require support during school hours. School-aged CYPs with type 1 diabetes are usually managed with intensive insulin regimens in order to achieve good glycaemic control and to reduce their risks of developing long-term complications. Intensive insulin regimen involves a complex set of actions which include regular glucose monitoring using a blood glucose metre or continuous glucose monitoring sensor, insulin administration either through subcutaneous injections (multiple-dose injection therapy) or continuous subcutaneous insulin infusion (insulin pumps). The dosage of insulin required before a meal depends on many factors, including the carbohydrate content of the meal. CYPs who are being managed by intensive insulin regimens have to estimate the amount of carbohydrate in the food they wish to consume (a skill popularly called ‘carbohydrate counting’). They then use a predetermined insulin: carbohydrate ratio to calculate the amount of insulin to administer before the meal. CYPs spend a significant part of their day in school, and many will require adult supervision and help to ensure that their diabetes control is optimum during school hours. The degree of supervision and help a child will require will depend on their age, level of maturity and development.

In 2009, we undertook an audit of care of children in school, and this showed that parents rather than school staff were responsible for supporting the majority of children with insulin administration while at school.1 In a UK-wide qualitative study, paediatric diabetes specialist nurses described the difficulties they faced trying to convince school staff to support CYPs with diabetes as they had to negotiate diabetes care on a case-by-case basis with individual schools.2 Anecdotally, we are aware of parents (usually mothers) who had to give up work or change their work patterns so that they are available during lunchtime …

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  • Contributors JCA planned the original audits, contributed to the design, analysis of data, writing and revision of manuscript. TP contributed to the data collection, analysis of data and writing of the initial manuscript and review of the editorial. JI contributed to data collection, analysis of data, writing of the initial manuscript and review of the editorial. RT contributed to the data collection and review of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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