Intensive insulin therapy for children in early primary school : the narratives of parents, school teachers and diabetes educators

Abstract

Type 1 diabetes mellitus is a metabolic disorder characterised by a deficiency in insulin secretion leading to hyperglycaemia. The number of early primary school children (aged 4–8 years) with type 1 diabetes rises each year. The current recommended treatment regime for children with type 1 diabetes is intensive insulin therapy supported by carbohydrate counting and regular blood glucose level monitoring. An insulin injection, or two insulin pump boluses, and blood glucose testing are usually required during the school day. Young children typically rely on their parents to provide diabetes care. Therefore, children attending early primary school require more planning and resources from parents, school personnel and diabetes educators than older children do. Furthermore, school encompasses a significant proportion of a child’s day; hence, diabetes treatment at school needs to be optimal to lower the risk of health complications. Although there are several international studies of type 1 diabetes in the school setting, there are few published Australian studies. Research focusing on the particular needs of early primary school students is lacking. The aim of this study was, therefore, to explore the experiences of parents, school teachers and diabetes educators who support intensive insulin therapy use in the early primary school setting to identify the facilitators and implications of this support. The findings of this study indicate that the Australian education system lacks appropriate health support structures required for children with type 1 diabetes to participate fully and safely in the school experience. The majority of schools do not have a full-time school nurse to assist students with chronic health conditions. Consequently, diabetes care is negotiated on a case-by-case basis and is dependent on the availability of a school staff member to volunteer to administer or supervise insulin therapy. To facilitate diabetes care at school, healthcare plans are simplified, non-nursing staff are trained to administer or supervise insulin and the overall responsibility is transferred onto mothers. There is an obvious disconnect between mandatory school attendance, accessing education on the same basis as others according to the Disability Standards for Education 2005 (Cth), and the availability of school nurses to legally administer insulin. An appropriately qualified nursing workforce from both health (diabetes educators) and education (school nurses) is required to effectively facilitate intensive insulin therapy in the early primary school setting. If current practices, dictated by insufficient resources, continue, the Australian Government will assume that existing systems are adequately meeting the needs of students with type 1 diabetes.

Date of Award	2021
Original language	English