Support for students

[Ivostas66]

I was diagnosed in my early 40s and so have no experience of childhood diabetes. Where I teach, we currently have about 5 students with type 1 after years of having none. One of the students is finding things tough and I was interested to hear from people who may have ideas/ experience. He is in his mid teens, uses a pump, but finger pricks to test.

• The senior teachers on patrol have to go to each of his lessons (every hour) and remind him to check, he then tells the teacher if he needs to treat.
• If a result is above 10, Mum has insisted that she is contacted by the school nurse and will tell her what to do (usually a corrective dose, which I must admit does worry me).
• Today was the first time that my patrol coincided with a check - he did not wash his hands, he pricked the top/ pad of his index finger and squeezed tightly (things I was always told to avoid as they would significantly affect a BG result). He was just below 10 and looked at me with a look of helplessness. I scanned my arm, smiled and said "I'm 10.2, you win". This seemed to cheer him up and he continued with his lesson. The nurse has said that she is going to remind him about how to check his BG tomorrow.

Should his mum have so much control over things/ should he have more autonomy over his condition? Is this creating learned helplessness? Our TAs and the school nurse head into panic mode if he is above 10 - recently he registered 14 (an hour earlier he was 10 and had just eaten lunch). He was taken from his lesson to the medical room, made to test for keytones (0.0!) and Mum was called, who told them to increase his insulin as she 'always want him below 10'. I told the nurse that this wasn't particularly helpful behaviour - a glass of water and a walk around the school may help him, but she was adamant that she had to contact Mum. Some members of patrol have stated that he becomes annoyed/ upset when they arrive and ask him to check his blood. To be honest, thinking back to my childhood, I think I would have hated people invading my privacy in this way.

 

[Sally71]

How old is he?
Sorry just saw you said mid teens. Um... i think my daughter would be a bit fed up if I stuck my nose in that much and unless the lad has learning difficulties I’d expect him to know a bit more about his condition by now!

Having said that, it is very individual. There are two 6 year old diabetics at the school where I work. One seems pretty clued up on her condition, the other has no idea at all, he just grins and lets you do whatever! My daughter does a lot for herself now but not everything (basal changes for instance we have to do together). At 14 she got a new pump which is not remote controlled any more which prompted her to do a lot more for herself, she even does the refills all on her own (I don’t know how to do that one!). She was diagnosed at 6 and did her own finger pricking right from the start (under supervision of course) and then was pretty much left to get on with it in the junior school, which alarmed me slightly at first but she’s got to learn and she managed very well so it wasn’t a problem. I had to provide the carb count for her lunch every day but she did most of the rest herself, teachers just had to know what to do if she was very low or very high (mid teens or above).

In mid teens I would expect the child to have some control over his own carb counting and boluses and so on. Mum has unrealistic expectations if she thinks he can be kept below 10 all the time, I don’t know what you can do about that though. Does he have a care plan? Could you perhaps work with his mum to alter this so that it explains what to do if he’s too high so that she doesn’t have to be called all the time? How long has he been diagnosed, is it perhaps all new to him, in which case it’s a bit more understandable if he hasn’t got the hang of things very well yet.

 

[Ivostas66]

I think he was diagnosed 5 years ago and joined us from another secondary school just prior to Covid/ lockdowns etc. I can understand parents being protective of younger children in this way or someone who is newly diagnosed, but this lads condition seems to be really rather stable.

I teach a boy who is just a year older (Year 11) who was also diagnosed about 5 years ago. He is adamant that he wants to be in charge of his own body and had serious words with a TA who was being very overprotective of him last year; he scanned, saw he had spiked to around 14, adjusted his pump, mentioned quietly to me and I allowed him to pop to the water fountain. The TA appeared in a total flap with her phone, which is linked to his Libre/ pump as part of his EHCP, panicking and shouting at him "You need to inject, you need to check for keytones! Do it now!" I was about to ask her to step out of the room as she was embarrassing the young man and her behaviour was making a situation that was completely under control into an unnecessary drama. He did it for me though, telling her he had had enough of her fussing around him and making him worse "Stressing me out is going to make my levels rise. I've got this. I've had enough, it's too much!"

 

[Thebearcametoo]

Is it possible to get the diabetes nurse involved? The mum sounds scared and so is overreacting and that will cause issues for both school and the kid. It may be that there are reasons for her being scared so I don’t want to say she’s wrong but she is making life harder for herself and her kid.

 

[C6H12O6]

Covid has a lot to answer for - there seems to be a pretty solid link between c19 and new diabetes diagnoses. I'm a teacher in a hospital and we have seen a real increase over the last couple of months.

I would see if the specialist diabetes nurse could come in and advise the staff and mum as well as the young person. They are usually much more matter of fact which might calm the staff who are anxious. Whilst their worries are totally understandable they are not helpful. Could thd SENCo have a meeting with him, mum, nurse, you if appropriate and start to introduce the Preparing for Adulthood agenda? Independent living is a huge part of this and sometimes parents feel more comfortable and are more co-operative if there is 'official guidance'. I certainly wouldn't be advising or supporting hourly reminders for a secondary child with no additional learning needs. I'm surprised he's tolerated it for this long!

 

[Lily123]

I’m not going to expose my age ( I know some of you do but I’m still in school and you may not want to take advice from me) but I think that the students mum is being a bit too strict with numbers as being slightly above 10 isn’t very likely to kill him. What happens if his number is above 10 before PE? Does his mum still insist on a corrective dose?

 

[Leadinglights]

I’m not going to expose my age ( I know some of you do but I’m still in school and you may not want to take advice from me) but I think that the students mum is being a bit too strict with numbers as being slightly above 10 isn’t very likely to kill him. What happens if his number is above 10 before PE? Does his mum still insist on a corrective dose?

I think you are in a good position to give advice as you are actually in a similar situation to the student being referred to. You must have a good idea of how they might feel about over zealous attention. Equally staff need to know what to do in an emergency.

 

[Lily123]

I think you are in a good position to give advice as you are actually in a similar situation to the student being referred to. You must have a good idea of how they might feel about over zealous attention. Equally staff need to know what to do in an emergency.

The way I manage it is just leave the lesson before lunch 10 mins early and go to the medical room. No big fuss made. I tend not to do correctives at school as then I will end up hypo. I feel bad for the student as 5 years and his mum is still extremely strict with BG

 

[C6H12O6]

Lily123 on the contrary your advice is invaluable. Your approach sounds very sensible and workable in a school day. That's a good idea actually - Ivostas66, would some/all of your students with diabetes get together and do a presentation to staff (could be recorded or on Teams if nervous), have a peer support group or similar? As we know from here there's no better group to talk to than those with similar experiences.

 

[Lily123]

@Ivostas66 when you said about “Im 10.2 you win.” I think this is such a nice thing to say and to show the fact that being above 10 isn’t the worst number in the world. Kinda makes me wish I wasn’t one of only 2 T1 diabetics in the entire school.Is it possible that his mum is being so strict on keeping BG below 10 because he could have gone into DKA at diagnosis?

 

[Bexlee]

It sounds to me like a bit of training is needed on all fronts - school staff in terms of what levels young people with diabetes should be at. The idea that testing shortly on arrival at school (after breakfast!) before break and then not long after break which is usually only a couple of hours at most before lunch….. throw in hormones and children in secondary school with diabetes are usually higher like 9-11 and more most of the time. Especially with the carb food temptations that canteens provide !

It sounds like Mum is a bit nervous of consequences of high levels - maybe there is a reason no one is aware of.

Maybe a meeting with mum and you as a diabetic teacher @Ivostas66 (who could maybe try and guide the child and be seen as oh life’s ok x is managing to be normal etc) senco and nurse who I assume isn’t a diabetic nurse so won’t probably fully understand.

We have a few diabetic kids. 2 manage just fine. 1 tries but levels erratic and 1 sounds similar to your student. Mum is firmly making child take on more but does like to be contacted if 14 or over just to reassure and check staff are ok dealing with. I’ve kind of taken child under wing and happily point out to the semi uneducated of course they’re a bit high it was break an hour ago and pizza was eaten !

It also reassures child that it is all normal and there’s not a need to flap if it is a bit high for a little while.

The chasing in lessons isn’t great for the old street cred bless him and he will I’m sure become resentful and then maybe a bit rebellious.

The kids at my school are used to seeing me duck out just before lunch and be covered for 5 minutes which seems to be similar to @Lily123 leaving early.

Maybe the child could report levels to you? Might take away the feeling of ‘threat’ and nagging and Mum be reassured someone knows what they’re doing is involved.

We recently had DSN from hospital in to do some training with staff - Very valuable.

Good luck. It’s horrible when diagnosed as a child as all you want is to be like everyone else. The main thing is the children aren’t made to feel different or even worse nagged at.

 

[Sally71]

Most pumps have a bolus wizard which works out correction doses for you so it's almost impossible to get it wrong, so my daughter has always just done whatever dose was advised by her pump including corrections. Her care plan included instructions on how to do a correction if high, what level to do it at probably changed over the years but it only involved a few button pushes so was easy to do and if you tried to do another correction when one had only just been done the pump wouldn’t allow it so it was safe. Then I would go through the meter memory every evening and make a note of all her numbers throughout the day to keep an eye on things and check whether any adjustments might be needed to basal or ratios.

My daughter has the same system at her school, she goes to the medical room just before lunch to do her insulin and then straight on to the dinner hall where she has a queue jump pass. She would quite happily not be supervised any more and just do it on her own; the school like to keep their own records though (probably just to cover their backs if anything goes wrong, but fair enough!).

And I really don’t understand all this obsessive ketone testing. The only time we’ve ever had more than just a trace of ketones is when either we're having pump or cannula problems and no insulin has been delivered for a while, or if she is ill and isn’t eating properly. So those are the only times we ever test for ketones now, the strips are 10 times more expensive than glucose ones and it seems a real waste to use them more often when you can pretty much predict what the result will be. A brief spike to high numbers which then goes straight back down again isn’t dangerous.

 

[Ivostas66]

@Ivostas66 when you said about “Im 10.2 you win.” I think this is such a nice thing to say and to show the fact that being above 10 isn’t the worst number in the world. Kinda makes me wish I wasn’t one of only 2 T1 diabetics in the entire school.Is it possible that his mum is being so strict on keeping BG below 10 because he could have gone into DKA at diagnosis?

Potentially. I have a student in Y11 who doesn't become worried or agitated when he scans and sees he is around 14 - just looks at me and says 'I'm a bit high' it prompts me to scan and we compare. He always smiles and I usually allow him to go for a walk or have a glass of water. Another student in the school is also ADD and finds it very challenging to deal with low or high readings. Interestingly the younger students in years 8 and 9 don't seem to have any issues at all with managing their 'condition' in school.

 

[Ivostas66]

Most pumps have a bolus wizard which works out correction doses for you so it's almost impossible to get it wrong, so my daughter has always just done whatever dose was advised by her pump including corrections. Her care plan included instructions on how to do a correction if high, what level to do it at probably changed over the years but it only involved a few button pushes so was easy to do and if you tried to do another correction when one had only just been done the pump wouldn’t allow it so it was safe. Then I would go through the meter memory every evening and make a note of all her numbers throughout the day to keep an eye on things and check whether any adjustments might be needed to basal or ratios.

My daughter has the same system at her school, she goes to the medical room just before lunch to do her insulin and then straight on to the dinner hall where she has a queue jump pass. She would quite happily not be supervised any more and just do it on her own; the school like to keep their own records though (probably just to cover their backs if anything goes wrong, but fair enough!).

And I really don’t understand all this obsessive ketone testing. The only time we’ve ever had more than just a trace of ketones is when either we're having pump or cannula problems and no insulin has been delivered for a while, or if she is ill and isn’t eating properly. So those are the only times we ever test for ketones now, the strips are 10 times more expensive than glucose ones and it seems a real waste to use them more often when you can pretty much predict what the result will be. A brief spike to high numbers which then goes straight back down again isn’t dangerous.

Keytone testing is something that I think we are all guilty of forgetting - I had a period a few weeks ago when my BG jumped to the high teens around 1am, my alarm did not go off and I remained high throughout the night. I tested for keytones and was 0.1. It really is something that I think the SEND department at our school worry about unnecessarily, but they are just covering their backs - especially if we have parents who have such high expectations of the school in terms of overseeing students management of their condition.

 

[Lily123]

Potentially. I have a student in Y11 who doesn't become worried or agitated when he scans and sees he is around 14 - just looks at me and says 'I'm a bit high' it prompts me to scan and we compare. He always smiles and I usually allow him to go for a walk or have a glass of water. Another student in the school is also ADD and finds it very challenging to deal with low or high readings. Interestingly the younger students in years 8 and 9 don't seem to have any issues at all with managing their 'condition' in school.

The highest I have read at school was 31.4 lucky thing that was a dodgy glucose strip. I do the same and just say “I’m a bit high”

 

[Lily123]

@Ivostas66 do you know if the student has to do a corrective before PE is he is above 10?

 

[helli]

@Ivostas66 do you know if the student has to do a corrective before PE is he is above 10?

I have not been a student for many years but I still do a lot of sport.
I was advised against exercising if my levels were above 9mmol/l and, if I try, I find I am very very sluggish resulting in my levels rising further.

 

[Lily123]

I was advised against exercising if my levels were above 9mmol/l and, if I try, I find I am very very sluggish resulting in my levels rising further.

If that’s what works for you but it does differ. If I have PE I will always go low so I was wondering about if the student @Ivostas66 mentioned had to correct before PE if above 10

 

[helli]

If that’s what works for you but it does differ. If I have PE I will always go low so I was wondering about if the student @Ivostas66 mentioned had to correct before PE if above 10

Before I used a pump, I was advised to start exercise between 6 and 9. Any lower and I risk hypo. Any higher and I risk hyper.
Obviously takes some trial and error to work out what works for you with different types of exercise but I would definitely not start exercise in double figures.

 

[Lily123]

Before I used a pump, I was advised to start exercise between 6 and 9. Any lower and I risk hypo. Any higher and I risk hyper.
Obviously takes some trial and error to work out what works for you with different types of exercise but I would definitely not start exercise in double figures.

I’ve never been told that. All I was told in regards to exercise was to have a snack if below 7 as my numbers seem to rise then drop and then I end up hypo. That might just be me tho