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Concerned about a pupil

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MrsMabel

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Hi everyone, I have just registered today as I believe this is the best place to post my questions.
I am a Teacher Assistant in a school and there is a 15 year old boy with T1.
He is able to inject himself but refuses to. I have recently joined the school and I am concerned that he says I do not need to inject as I am not going to eat anything....
Any advice? I am really worried about hypoglycaemia....

Thanks in advance
 
MrsMabel said:
Hi everyone, I have just registered today as I believe this is the best place to post my questions.
I am a Teacher Assistant in a school and there is a 15 year old boy with T1.
He is able to inject himself but refuses to. I have recently joined the school and I am concerned that he says I do not need to inject as I am not going to eat anything....
Any advice? I am really worried about hypoglycaemia....

Thanks in advance
Click to expand...
You should get good advice here from type ones but I thought that I'd just point out that insulin is not used to treat hypoglycaemia, that requires something to eat or drink which will raise the level of glucose in the blood.
 
Hi, @MrsMabel. He is correct, in that if you aren’t going to eat anything, you don’t need to inject. Injections of short acting insulin are matched to the food you eat, when you eat it. If you think he isn’t telling the truth and he is eating, then it is a concern, but the school should have a care plan in place for him, and there should be a named person who knows what the plan is, and can intervene.
Hypoglycaemia is low blood sugar, which comes from having too much insulin circulating, and this is when a Type 1 needs to eat some glucose fast. This can be dangerous as the person can become disorientated and unable to help themselves if their blood sugar drops too fast and too far. (It is not the right thing to do to administer insulin in this case, despite what most people have seen on TV soaps!) Hyperglycaemia is high blood sugars caused by not taking enough insulin.
 
He is correct that he does not need to inject insulin if he is not going to eat anything. When you say he refuses to.... Who is asking him to inject. At 15years old he should be able to assess if he needs insulin or not unless he is very newly diagnosed.

Just to be clear, modern insulins are split into 2 different types, one for background insulin and one to cover food. Background insulin is normally injected morning and evening at home, so he would only need to inject his fast acting insulin to cover the food he is going to eat (if any) or if his Blood Glucose levels went very high to help bring them down.

He would go hypo if he injected insulin when he wasn't going to eat any carbohydrate, so he could have a meal of meat and veg with no bread/potatoes/rice/pasta and still not need to inject insulin if that was his choice.

Gone are the days when people had to eat 3 balanced meals a day and used a mixed insulin to cover it and if they missed a meal they risked their levels dropping too low. Now we can eat when and as much or as little as we like as long as we balance our insulin to what we eat. It takes a lot more thinking about but it enables a much more flexible lifestyle.

Hope that explains it for you.
 
MrsMabel said:
Hi everyone, I have just registered today as I believe this is the best place to post my questions.
I am a Teacher Assistant in a school and there is a 15 year old boy with T1.
He is able to inject himself but refuses to. I have recently joined the school and I am concerned that he says I do not need to inject as I am not going to eat anything....
Any advice? I am really worried about hypoglycaemia....

Thanks in advance
Click to expand...

My advice would be to read up on Type 1 and increase your knowledge. That would stand you in good stead for future pupils too. What you’ve written suggests you have some confusion about diabetes and Type 1 in particular.

As said above, at 15 he’s old enough to manage his own diabetes. No, he wouldn’t be injecting if he wasn’t eating. Are you responsible for him in some way? What prompted you to speak to him about injecting?
 
I knew this forum would be useful- I feel I have learnt so much already.

I am interested in doing a training course about diabetes so I can help the students manage in school. I will look into thar.

I understand he is at risk from hyperglycemia if he eats and doesnt tell us that he is eating.

Am I correct in thinking that he should be monitoring his blood sugar levels? And that they should range between 5 and 12?
Around the 5+ mark if he hasnt eaten
Around 12 and under if he has eaten
And certainly no lower than 4...

Thank you to everyone who has replied. Really appreciate it.


@Inka
I am getting to know the pupils and will highlight this as a safeguarding concern. No one has told me to give him insulin but I reminded him before lunch to go into the office and get his medical pack.
 
Please don’t take this the wrong way but if when I was 15 somebody was reminding me to inject, blood test eat etc I would have rebelled. My belief is that at that age he should be able to deal with it himself unless advised differently or newly diagnosed. Is there a reason why feel you should be involved with his management of diabetes?
 
MrsMabel said:
I knew this forum would be useful- I feel I have learnt so much already.

I am interested in doing a training course about diabetes so I can help the students manage in school. I will look into thar.

I understand he is at risk from hyperglycemia if he eats and doesnt tell us that he is eating.

Am I correct in thinking that he should be monitoring his blood sugar levels? And that they should range between 5 and 12?
Around the 5+ mark if he hasnt eaten
Around 12 and under if he has eaten
And certainly no lower than 4...

Thank you to everyone who has replied. Really appreciate it.


@Inka
I am getting to know the pupils and will highlight this as a safeguarding concern. No one has told me to give him insulin but I reminded him before lunch to go into the office and get his medical pack.
Click to expand...
What are you highlighting as a safeguarding concern? I was very independent with my diabetes at 15 and wouldn’t have wanted it any other way unless I needed to ask for help - which I didn’t. Like most teenagers I didn’t want to be singled out from my friends or other pupils. Why would you think differently with this pupil. I appreciate that you’re trying to be helpful
 
It’s great that you’re taking an interest. He should have a written care plan and that would be the first place you would get information.

In general with type 1 4 is the floor - anything below that is hypo and needs treating immediately. Usually the target range is 4-7 or sometimes 4-10. Anything over 16 should have ketones checked. Fast acting insulin usually has a peak around 1 hour after injection but stays in the system for 4-5 hours so the person may go high after food but come back within range by the end of the cycle. Generally a high (hyper) can be dealt with at the next meal and whilst it’s not good to be high long term that’s not something you would have to deal with as it would be something the diabetes team would deal with in changing ratios of carbs to insulin or correction factors etc.

One thing that may be worth exploring with him if he is open to it is why he’s not eating at school. Missing meals can sometimes be a way to avoid doing finger pricks and/or injections either because of being fed up of doing them or because they don’t want to be different to their peers. There’s nothing wrong with him missing lunch if he’s not hungry and as others have said if he’s not eating he doesn’t need to inject. Talking to children/teens about their chronic illnesses can be a difficult balance. They are already monitored by the diabetes team and their parents so school may be one place where they feel free from hassle about it but as with all things teen diabetes can be something that they find difficult. Tread gently. Learning more about diabetes can be really useful for the school and to able to support pupils who want the help but obviously everyone is different about the level of involvement they want.
 
@MrsMabel Is there something you’re not telling us about this 15yr old? It is NOT a safeguarding concern, and I fail to understand why you’re getting so involved. He’s 15. He’ll look after his own diabetes. I presume the School have some kind of care plan for him and people who know what they’re doing.

Unless there are additional factors here, it’s not your concern to monitor him so much, to tell him to test or to take control of his diabetes. You didn’t even know that he shouldn’t inject if he wasn’t eating. Be very careful about how involved you’re planning to get here.
 
Welcome to the forum @MrsMabel

There is a section of the Diabetes UK website with a general overview of what good care looks like, links to information for schools, and various resources which you might find helpful?

Diabetes in Schools

We believe that every child with diabetes deserves the same education and experien
www.diabetes.org.uk www.diabetes.org.uk
 
Hi @MrsMabel , welcome to the forum. The school will already have a care plan for this pupil and the appropriate staff will have already been informed /trained . Tbph until unless you have been trained , you should not be involved in his diabetes management except in one aspect and that’s alerting the teacher or sending for the nurse if he becomes seriously hypo and unable to manage it himself.
We mostly deal with hypo’s ourselves.

If he is not eating carbohydrates he doesn’t need to inject any mealtime insulin .

He may be using a Freestyle Libre or a CGM so does not need to do regular fingerpicks to check his blood glucose levels.

Unless the lad has some special needs , at 15 he may well have been managing his diabetes himself for some time, perhaps years, but even if he has only been diagnosed a few months he will be an expert on his diabetes , so please heed what he says. also the early to mid teens are often difficult times for young people, push him too hard or too often and it’s very likely he will rebel.

He will also be under the specialist diabetes team at the hospital and having loads of regular checks.
 
Hi @MrsMabel
Probably best to raise concerns with the SENCo and or mention to form tutor / pastoral team. Check care plan for child. As others have said the more “hassel” they get in school.... test/ eat / what is level / should you be that high etc...
The less likely they are to be “sensible” and do the “right” thing

Nice to take an interest and I know some schools do ask TA’s to take charge and monitor (especially in covid times one “less” thing for pastoral or teachers to do when doing lots extra) without giving them full training. In our school some children go and log their reading at break and lunch with the office / pastoral / TA etc as that’s the parental wish other are just left to it asking for help when needed. See what care plan says and speak to SENCo
 
@MrsMabel
You need to be careful about inserting yourself into this pupil's medical situation.
Medical information and privacy is still legally protected even for someone aged 15.
A care plan is special category information under the GDPR and should only be accessed by those who have been expressly authorised to access it and only for very strong reasons.
You run the risk that if you are too 'helpful' the pupil could complain, his parents could get involved and it may adversely affect your position and career as these things can so easily go pear-shaped.

While it is a good thing to generally educate yourself so you can spot if a pupil is in trouble medically (although one would hope you would have procedures and trained staff in place to follow if any pupil was ill regardless of the cause) it is not perhaps wise to overly involve yourself with specific pupils.

The best thing is to chat informally with the safeguarding lead in your school and take their advice if you have concerns still after the information you have learned here.
 
I applaud your reaching out Mrs Mabel, and its great you are kind enough to care and wise enough to find out what’s what.
 
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