KURIR DRIVE! LET’S INTRODUCE PROTOCOLS FOR DIABETIC CHILDREN TO SCHOOLS This is how our neighbours do it!

Unlike many European countries, including our neighbour Croatia, there are no official protocols for children with diabetes at Serbian schools during teaching hours, not even in the most severe, urgent cases. It is time for children with diabetes in Serbia to receive the same careful treatment, which Kurir advocates.

After the Minister of Tourism Husein Memić, whose child suffers from Type 1 diabetes, who has been making use of his post in the Government of Serbia for the benefit of children with this illness, the drive has also been supported by the Minister of Health, Professor Danica Grujičić.

“We will take a range of measures to implement educational programmes for both teachers and students on the topic of diabetes. The Public Health Sector is currently working on developing the measures and the drive, aimed at educating, changing the habits, and raising awareness of diabetes of the entire population. The Ministry of Health will dedicate its full efforts to this, and I am sorry that more hasn’t already been done. I believe that, in addition to the Ministry of Education, we’ll be joined by the entire Government of Serbia, as well as many social systems,” Grujičić said, among other things, in her conversation with Kurir

Marijana Čalamać from Novi Pazar, mother of a girl in the sixth grade, knows how difficult it is to live with Type 1 diabetes. She points out that the entire school staff is very forthcoming and helpful, but they are not trained, nor have they received official instructions as to how to act, especially when the child starts feeling unwell.

“Protocols regulating the treatment of these children should be introduced, and teaching staff should be educated about what to do if a child’s blood sugar goes up or down, because he or she can go into a coma if there is no immediate and appropriate response to hypoglycaemia (low blood sugar) or hyper glycaemia (high sugar level),” Marijana explains for Kurir.

THREE ACTION LEVELS AT SCHOOL

LEVEL ONE – Basic requirements: educating everyone on diabetes, as well as the authorities tasked with intervening, monitoring the psychophysical condition of the student, adapting the teaching to their condition, and adapting the diet if there is a school canteen, with an active involvement of the student in all the activities.

LEVEL TWO – Everyday activities in monitoring the student: ensuring privacy for the purposes of measuring BG (blood glucose), allowing the use of toilets as required, intensifying the monitoring of the student during school tests and examinations (situations of increased stress), as well as during physical activities.

LEVEL THREE – Procedures in cases of acute complications – detailed actions in the event of a child going into hyperglycaemia, mild to moderate hypoglycaemia, or severe hypoglycaemia, which includes providing water or juice, food, or, ultimately, injections.

* Source: The Protocol on the Treatment of Children Suffering from Diabetes at School, The Croatian Society for School and University Medicine

The worst of all, as she points out, is that you don’t know what affects sugar level, or when it will go up or down.

“And no school has glucagon injections, which the child must take immediately if the blood sugar level drops significantly and the child goes into a severe hypoglycaemia. Even if they had some, I don’t know that anyone would know how to use them. Luckily, I work near the school and have an injection in my fridge, just in case, so that I can run to the school and administer it to her if she needs one. Believe me, I myself am not sure how well I’d do, even though I’ve gone over it a hundred times in my head, because the injection, the vial, needs to be shaken first, and then administered using a large needle. Not to mention the fact that Serbia doesn’t have registered nasal sprays used in such cases, which anyone can do, and the sugar level goes up. You save the child in a blink of an eye,” Marijana says, adding that children should become familiar with the fact that they have diabetic friends in their midst, “rather than telling them that they’ve been chipped, as they have done to my daughter because she carries a sensor for continual monitoring of her blood sugar levels.”

Unlike Serbia, in Croatia – which Minister Memić cites as an example – there are protocols regarding the actions to be taken with diabetic children, organized into three levels. Evidently, Croatia has school doctors in, but the fact that we don’t doesn’t change the fact that teaching staff can be trained and taught what to do – starting from what needs to be done to ensure the child has an appropriate diet and physical activity, to emergences, when a glucagon injection must be administered.

ACTIONS TAKEN IN THE EVENT OF ACUTE SITUATIONS

1. HYPERGLYCAEMIA – the measured value of BG (blood glucose) is 15 mmol/l and more

Symptoms and signs:

- increased thirst

- frequent urination

- dry skin

- trouble concentrating

- irritability

- lethargy

They are often absent, but a BG measured at 15 mmol/L and more requires an intervention!

What to do:

- do not leave the child unattended

- rehydration: drinking 1-2 glasses of water (not juice!)

- contact the parents; consulting regarding the use of insulin

- measuring the BG again

2. MILD TO MODERATE HYPOGLYCAEMIA - the measured value of BG (blood glucose) is below 4 mmol/l

Symptoms and signs:

- hunger

- trembling

- sweating

- irritability

- pale skin

- increased heart rate

- headache

- increased breathing rate

- stomach pain

- incomprehensible speech

They are often absent, but a BG measured at 4 mmol/ and less requires and intervention and taking the described actions!

What to do:

- Do not leave the child unattended

- Administer 2-3 glucose tablets in the amount ensuring 15 g of simple (fast-acting) carbohydrates

- 2-3 teaspoonfuls of honey/sugar/jam

- A glass of fruit juice

After 10-15 minutes, measure the BG again.

- if it is still low, repeat the procedure

- if it is returning to normal levels, give the child a meal rich with complex carbohydrates (e.g. 30 g of brown bread, a cake, pasta)

If there is even the slightest suspicion of mild/moderate hypoglycaemia, apply the procedure above in order to stop the occurrence of severe hypoglycaemia!

3. SEVERE HYPOGLYCAEMIA

Symptoms and signs:

- pronounced disorientation

- adversely affected consciousness

- inability to swallow

- skeletal muscles cramping

- seizures resembling epileptic ones

- loss of consciousness

What to do:

If the student has lost consciousness, administer first aid immediately: clear their airway of obstructions, move them onto their side, and call the ambulance and their parents.

Administering a glucagon injection at school in the event of a severe hypoglycaemia: Glucagon is a hormone secreted by the pancreas which triggers the conversion of glycogen in the liver, thus resulting in the increase of BG. Administering a glucagon injection is simple and can be done, in the event of an emergency, by an appropriately trained person even though they are not a medical professional. The school doctor in charge provides education on the use of glucagon.

* Source: The Protocol on the Treatment of Children Suffering from Diabetes at School, The Croatian Society for School and University Medicine

TRYING THEIR BEST TO GET THE SENSORS

Like all children with Type 1 diabetes, Marijana’s daughter is entitled to the sensors that monitor the blood sugar level around the clock. But this family, not unlike many other families in Serbia, has been buying the state-of-the-art sensors, which are not even registered in Serbia, on the black market.

“The sensors that we get are quite large and stick out from under our child’s clothes. She’s in puberty, so she is bothered by this. It’s been enough that other students have been picking on her saying that she’s been chipped. Besides, calibration must be performed at least twice a day. We’ve been buying the unregistered ones right from the start, although I don’t know why they aren’t registered. The cost is really high, and it’s not easy to get them. I have a friend in France, so when she or one of her family members comes over, they bring us one, for the price of 45 euros. When she isn’t around, we pay 70-75 euros for one on the black market here,” Marijana explains, adding that a new problem has arisen because France and Germany have restricted the purchase of these sensors, which makes it even more difficult to get hold of them.

Kurir.rs/J. S. Spasić