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Running head: Kylie Reeves, Kristy Snell, Kate Harper SLEE104. ASS1: GROUP REPORT

Assessment 1: Group Report Kylie Reeves, Kristy Snell, Kate Harper Swinburne University SLEE104: The Healthy and Active Child Jeannette Keser 14th April, 2013.

Running head: Kylie Reeves, Kristy Snell, Kate Harper SLEE104. ASS1: GROUP REPORT

Introduction Until the invention of insulin in the 1920s, every child with diabetes died (Rolley,2008 ). Diabetes is sadly the 6th leading cause of death in Australia (Diabetes Australia, 2011). In this report it will include three media articles covering the following components; key issues surrounding diabetes in children, how these key issues align with the dimensions of health discussed in SLEE104 Week One learning material, the implications for this health issue in relation to inclusive policies and practices in educational settings and a conclusion for these three subjects on diabetes. Key issues cover the different types of diabetes children face, causes, prevention (if any), symptoms and management of the two types of diabetes. Health dimensions can include, but are not limited to the following areas; physical health, emotional health, environmental health, social health, intellectual health and spiritual health. The implications for diabetes such as the environment, administering of finger prick tests, treatment and raising awareness for educators are discussed in relation to inclusive policies and practices involving the child and family in education settings. Rationale for health topic and media articles This report includes three media articles about diabetes. The articles have been selected because they outline the key issues surrounding diabetes, dimensions of health with diabetes and the importance of inclusive policies and practices for children in education settings. The first article highlights the importance of being educated about diabetes, the different types and is called School Policy and Advisory Guide http://www.education.vic.gov.au/school/principals/spag/health/pages/diabetes.aspx. The next article provided is about dimensions of health and outlines the challenges children face through

Running head: Kylie Reeves, Kristy Snell, Kate Harper SLEE104. ASS1: GROUP REPORT dimensions of health and coping with having diabetes. http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Diabetes_issues_for_children_an d_teenagers. The final article is called Keeping a Child Safe from School, http://forecast.diabetes.org/school-aug2012 and it investigates the issues that children with diabetes face, their parents and teachers, if proper communication and policies are not put in place to ensure the childs safety and inclusivity at school. Key issues surrounding diabetes Type 1 Diabetes Type 1 Diabetes is when a person stops producing insulin and cant produce glucose (sugar) from foods into energy. It is predominantly seen in children (Diabetes Australia, 2011). There are two forms of diabetes: immune-mediated diabetes, where the immune system destroys or tries to destroy the cells in the pancreas that produce insulin and the idiopathic type which is a rare form of the disease without unknown causes ( Boston Childrens Hospital,2011). The cause of Type 1 diabetes is unknown. Health professionals suggest that it could be something as simple as a viral infection that triggers the condition which the person has a predisposition for (Australian Diabetes Council, 201). Symptoms are thirst, urination, weight loss, weakness, irritability and fatigue (Australian Diabetes Council, 2013). Living a healthy lifestyle is important to manage the condition (Better Health Channel, 2013). A sufferer needs insulin injections every day, a healthy diet, to monitor their blood glucose, exercise and regular checks from a Doctor. The childs blood glucose levels need to be as close to the normal range as possible, every day to stay alive. The child needs insulin every day though injections or a pump and finger prick tests to ensure glucose levels are at a safe range (Juvenile Diabetes Research Foundation

Running head: Kylie Reeves, Kristy Snell, Kate Harper SLEE104. ASS1: GROUP REPORT Australia, 2013). Children must learn to be prepared for hypoglycemic (low blood sugar) and hyperglycemic (high blood sugar) reactions, which can be life threatening (JDRFA, 2013). Type 2 Diabetes Type 2 Diabetes is when the pancreas stops making insulin needed for converting glucose into energy or when cells fail to respond to insulin (JDRFA, 2013). Its not common in children and when diagnosed, its often obese children with a possible genetic influence. It is often children who are sedentary and particularly when the child carries weight around the abdomen (ADC, 2013). Its estimated that around 60% of diabetes could have been prevented through lifestyle choices such as maintaining a healthy lifestyle, managing blood pressure and cholesterol levels and not smoking (Diabetes Australia, 2011). Symptoms are excessive thirst, lethargy and tiredness, passing a lot of urine, hunger, wounds healing slowly, itching skin, thrush, blurred vision, putting on weight, mood swings, headaches, dizziness and leg cramps (BHC, 2013). Sufferers eventually need tablets and possibly insulin injections due to the pancreas becoming exhausted and not producing as much insulin anymore. It can be managed with a healthy diet, physical activity, medication and regular health checks by a general practitioner (DA, 2013). Insulin treatment and recognizing high and low blood glucose levels in a child The aim of diabetes treatment is to maintain blood glucose levels within the normal range which is 3.5 to 6mmol/L before meals and 3.5 to 8mmol/L two hours after meals which will help to prevent long term problems to the heart, blood vessels, eyes, kidneys and nerves ( BHC,2013). If a person is experiencing low blood glucose levels (BGL) it is called hypoglycemia and their BGL is less than 4mmol/L with symptoms such as shaking, paleness, dizziness, sweating, behavior change, tearful, irritable, lack of concentration, headache, hunger, heart pounding, numbness around mouth and fingers.( Australian Diabetes Council, 2007).

Running head: Kylie Reeves, Kristy Snell, Kate Harper SLEE104. ASS1: GROUP REPORT A High blood glucose level is called hyperglycemia and can lead to Ketoacidosis which needs to be treated as serious medical emergency. Symptoms are rapid breathing, sweet acetone smell on breath, flushed cheeks, abdominal pain, vomiting and dehydration (Diabetes Australia, 2011). Key issues aligned with the dimensions of health outlined in Week 1 Diabetes is mostly rather manageable, but still has the potential to affect all dimensions of a childs health (Donatelle, 2013). Diabetes can affect a childs physical health in a multitude of ways (Department Education and Early Childhood Development, 2012). Short term complications from lack of insulin or low blood glucose can lead to comas or even death if insulin and blood glucose levels are not brought back to a normal range (ADC, 2013). If a childs diabetes is not regulated and blood glucose/ insulin are not maintained at normal levels, constant stress is put on the body when insulin or blood glucose is too low or too high (ADC, 2013). This has the potential to cause major physical health complications, such as permanent damage to internal organs and higher risks of strokes, heart disease, neurological problems, digestive diseases and depression (DEECD, 2012). A childs emotional, intellectual, social and spiritual health can be negatively impacted by diabetes in many ways. For example, if the condition causes them to miss out on time in class, opportunities to bond with their peers or spending time with others is missed due to either physical effects or exclusion (State Government of Victoria, 2013). These negative impacts can occur if children attend a school or childcare centre that may exclude them from being able to participate in school activities or excursions if their diabetes is deemed as a liability, or if an activity would make the manageability of their condition difficult (Neithercott, 2012). Institutions may believe the safest option is to deny a childs attendance if they are unable to

Running head: Kylie Reeves, Kristy Snell, Kate Harper SLEE104. ASS1: GROUP REPORT have a medically trained educator attend the excursion (The Nemours Foundation, 2013). Exclusion can affect a childs emotional, intellectual, social and spiritual health and lead to feelings of low self-esteem; low self-confidence; anger towards themselves and their condition; and loneliness at being unable to form strong friendship bonds on excursions with their peers (Donatelle, 2013). Absenteeism due to illness or exclusion, puts the child at a disadvantage intellectually, lesson plans and the opportunity to reinforce classroom learning are missed (The Nemours Foundation, 2013). Inability to form bonds and healthy friendships with peers from exclusion, or nonattendance, when peers are forming these skills is a severe disadvantage to these dimensions of health (Donatelle, 2013). Environmental health involves the protection of yourself and others from potential hazards within the environment that you live and play (State Government of Victoria, 2013). Children navigating life with diabetes need guidance at a young age with respect to for environmental health and how to protect themselves from potential dietary and physical exertion risks that could negatively affect their condition (Donatelle, 2013). It is vital for a child to be aware of dietary requirements, foods that are best for consumption (namely those that do not cause spikes in glucose/ insulin levels), foods to avoid, the importance of exercise and how to maintain blood glucose/ insulin levels after exercising (ADC, 2013). These daily tasks are vital for a child to learn so it becomes second nature when learning about their diabetes in relation to their environment and health (MD Health, 2013). Implications for diabetes in relation to inclusive policies and practices in an education setting The implications of inclusive policies and practices involving diabetes in an education setting can be challenging for the child, their family and the service involved. A safe environment is one

Running head: Kylie Reeves, Kristy Snell, Kate Harper SLEE104. ASS1: GROUP REPORT of the few things children with diabetes require during the day, while maintaining secure and supportive relationships is of high priority when dealing with individual routines for a child with diabetes. Its important to understand the nature of the illness so people can be more cognizant of how children with diabetes may feel (Neithercott, 2012). Chronic health conditions do not necessarily fit within definitions of disability or special needs, making it more challenging to incorporate into the educational setting (Theis,1999). The childs glucose levels need to be monitored throughout the day, involving a prick test conducted by a trained adult, if the glucose levels are too low (hypo), the risk of diabetic ketoacidosis is high. Treatment for a hypo is quick acting carbs, such as jelly beans or fruit juice, which are usually effective within10-15 minutes (Diabetes Australia, 2011). The third article examined, discussed how administration stood firm in the belief that caring for childs diabetes wasnt the schools job and that only a nurse could test Lorettas blood glucose and inject insulin or glucagon. Implications arose; the mother was forced to choose between her daughters safety and education (Neithercott, 2012). Educators may need to test levels, follow appropriate hygiene practices (HEYTS, 2012) such as wearing gloves and disposal of the tested strip, parent and doctors contact details readily available, a glycemic index of high, medium and low levels, and the appropriate treatment plan in place to refer to. The American Diabetes Association argues that school personnel who arent health care professionals canand shouldbe trained to provide diabetes care. Policies and procedures in any environment are put in place for a reason- to ensure majority of aspects are being met within the situations requirements to look after the interests of the child, family, organisation and the teachers are being looked after. Diabetics are fortunate that the treatments are available to help manage diabetes, but the reality is that its still a killer disease (Virtual Medical Centre, 2013).

Running head: Kylie Reeves, Kristy Snell, Kate Harper SLEE104. ASS1: GROUP REPORT Raising awareness amongst the education setting and providing resources enables the families, children and teachers to become more familiar with diabetes. Allowing the diabetic to talk about their condition, ensuring they are not excluded from activities and interactions. How well a service implements their idea of partnerships will show in the support families receive with a child who has diabetes. The influence of child development and child centered discourses has been identified by researchers as being central to shaping the work of teachers and families (Griffith, 1995). Research suggests that responses by mainstream schools to the educational needs of young children who are absent for long periods/experiencing multiple interruptions due to their condition, are highly dependent on the responses of individual teachers, rather being supported within a coordinated system of services (Dockett, 2004). These findings provide challenging and differentiating indicators that serious diseases such as diabetes lead to many complications, problems and obstacles on the issue of inclusion in education settings. Conclusion Through understanding the impact and complexities of young people living with long-term health conditions and how to improve their quality of life, (Emond et al, 2004) educators need to be aware of key issues, the dimensions of health, and the implications for inclusion in the education setting. 208 Australians develop diabetes every day (Diabetes Australia, 2011.) with diabetes affecting 347,000,000 people worldwide (WHO, 2013). This is becoming a global epidemic. As stated earlier, 60% of cases, of type 2 diabetes, could have been prevented (Diabetes Australia, 2011) through lifestyle changes and healthy eating, educators need to ensure an appropriate program is developed and maintained. Diabetes has the potential to cause major health complications which last a lifetime. Through the findings in this report it is evident that providing a range of information and initiatives on healthy eating, regular physical activity and

Running head: Kylie Reeves, Kristy Snell, Kate Harper SLEE104. ASS1: GROUP REPORT on overweight and obesity issues to assist all Australians to lead healthy and active lives is paramount towards helping people avoid Type 2 Diabetes. There are initiatives such as 'A Healthy and Active Australia', Population Health Division, the Australian Government Department of Health and Ageing, Juvenile Diabetes Research Foundation Australia, Diabetes Australia, Australian Diabetes Council and many other government organizations available to help people prevent chronic illnesses such as diabetes, to support the dimensions of health surrounding the challenges of diabetes and to educate professionals, patients and parents about the conditions to essentially prevent exclusion in educational settings for children.

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Running head: Kylie Reeves, Kristy Snell, Kate Harper SLEE104. ASS1: GROUP REPORT Reference List Australian Diabetes Council. ( 2013). Retrieved from http://www.australiandiabetescouncil.com/About-Diabetes/Type-1 Australian Diabetes Council (2007). Website for kids and teens with Type 1 Diabetes. Retrieved from http://www.diabeteskidsandteens.com.au/living_with_diabetes_5.html Balch, J.F and R.Y, Stengler, M (2011).Prescription for Natural Cures: A Self Care Guide forTreating Health Problems with Natural Remedies Including Diet, Nutrition, Supplements and Other Holistic Methods, Revised Edition by James F Balch, Mark Strengler and Robin Young. Better Health Channel, (2013). Retrieved from http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Diabetes_Type_1_or_juv enile_diabetes Boston Childrens Hospital, (2011). Retrieved from http://www.childrenshospital.org/az/Site1797/mainpageS1797P1.html Department of Education and Early Childhood Development. (2012). Retrieved from http://www.education.vic.gov.au/about/research/Pages/071diabetes.aspx Diabetes Australia. (2011).What is Diabetes. Retrieved from http://www.diabetesaustralia.com.au/en/Understanding-Diabetes/What-is-Diabetes/ Diabetes Australia ( 2011). Hyperglycemia. Retrieved from http://www.diabetesaustralia.com.au/Understanding-Diabetes/What-is Diabetes/Hyperglycaemia/

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Running head: Kylie Reeves, Kristy Snell, Kate Harper SLEE104. ASS1: GROUP REPORT Dockett, S. (2004). Everyone Was Really Happy To See Me! The Importance of Friendships in the Return to School of Children with Chronic Illness. Early Childhood Donatelle, RJ. (2013). Health- The Basics. Illinois: Pearson Education Inc. Emond, A & Eaton, N. (2004). Supporting Children with Complex Healthcare Needs and Their Families. An Overview of the Research Agenda. Child Care, Health and Development, 30(3):195-9. Griffith, A.L. (1995). Mothering, Schooling and Childrens Development. In Knowledge, Experience, and Ruling Relations: Studies in the Social Organisation of Edited by Campbell, M.L. and Manicom, A. 108-21. Healthy Early Years Training Strategy. (2012). Module 2, Topic 7, Illness in education and care. Retrieved from http://childcaresupport.org.au/HealthyEarlyYearsTrainingHome Juvenile Diabetes Research Foundation Australia. ( 2013). Retrieved from http://www.jdrf.org.au/living-with-type-1-diabetes/what-is-type-1MD Health. (2013). Dimensions of Health. Retrieved from http://www.mdhealth.com/Dimensions-Of-Health.html Rolley, J., Salamonson,Y., Davidson, P. ( 2008). Australian Nursing Journal. Retrieved http://search.informit.com.au.ezproxy.lib.swin.edu.au/fullText;dn=280010013091 60;res=IELHEA Neithercott,T. (2012). Keeping A Child Safe At School. Diabetics Forecast. The Healthy Living Magazine. Retrieved from http://forecast.diabetes.org/school-aug2012 The Nemours Foundation. Kidshealth. (2013). Retrieved from http://kidshealth.org/parent/diabetes_center/diabetes_basics/feelings_diabetes.html from Knowledge. Australia Inc.

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Running head: Kylie Reeves, Kristy Snell, Kate Harper SLEE104. ASS1: GROUP REPORT Thies, K. M. (1999). Identifying the Educational Implications of Chronic Illness in School Children. Journal of School Health, 69 (10): 392-7. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10685375 Virtual Medical Centre. (2013). Retrieved from http://www.virtualmedicalcentre.com/news/australians-in-diabetes-denial-despite national-epidemic/18470