Parental perspectives of diabetes management in Alabama public schools.

OBJECTIVES: The purpose of this study was to assess parental perceptions of the current state of care for children with diabetes in the Alabama public school system, identify existing disparities, and determine what resources would most improve diabetes management in this setting. There is a significant need for such information because of the paucity of published data on the current state of diabetes care in Alabama public schools. METHODS: We based our survey on the American Diabetes Association guidelines and collected responses on the Internet via SurveyMonkey and by paper surveys. We distributed surveys to parents of children with diabetes through the Children's Hospital endocrinology clinic, a diabetes camp, and through the Alabama Association of School Nurses e-mail listserv. RESULTS: A majority of children had type 1 diabetes mellitus. Students who could conveniently check their blood glucose levels (BGLs) at school were significantly more likely to participate in all school activities and their parents were significantly more likely to be satisfied with their child's diabetes care at school. Compared with minority students (defined as all races other than white), white students were more likely to be able to conveniently check their BGLs at school. CONCLUSIONS: The accommodation and care for children with diabetes is highly variable within much of the Alabama public school system. The ability to conveniently check BGLs at school is key for participation in all school activities and for parental satisfaction with diabetes care at school. Institution of a uniform, statewide diabetes training protocol for school personnel could improve care and parental satisfaction.

An unusual case of high altitude-like retinopathy caused by anemia and thrombocytopenia at recreational altitude.

PURPOSE: To report an unusual presentation of high altitude-like retinopathy at recreational altitude after chemotherapy-induced anemia and thrombocytopenia. METHODS: Case report. RESULTS: A 43-year-old man undergoing chemotherapy for testicular cancer traveled to an altitude of 2,930 m and subsequently developed significant visual deficit in his right eye and was later diagnosed with bilateral severe high altitude-like retinopathy pathology with associated retinal hemorrhages. CONCLUSION: Altitude-related illnesses like high-altitude retinopathy result from rapid physiologic adaptation to altitude-induced hypoxia. These illnesses are typically experienced at altitudes above 3,000 m, with high-altitude retinal hemorrhages observed above 4,270 m. The patient participated in no strenuous physical activity but had severe enough retinal hypoxia from chemotherapy-induced anemia and thrombocytopenia that he experienced visually significant retinal hemorrhages. The occurrence of high-altitude retinopathy in such patients could portend the development of high-altitude cerebral edema at lower altitudes than traditionally reported and without exposure to known risk factors. Therefore, funduscopic examination should be performed on patients with anemia and thrombocytopenia who are complaining of decreased vision after traveling at high altitude.