As a mother of a son with Type 1, I tend to focus on the big picture when it comes to managing his diabetes. By this I mean I want to ensure that he doesn't have a severe hyperglycemic low that renders him unconscious or, on the other end of the spectrum, doesn't overindulge on carbohydrates and end up in the ICU in DKA.
Now that the school year is in full swing and charging towards the end of the first grading period, I find myself finally stepping back and looking at the smaller, albeit important, details of managing diabetes on a day-to-day basis. I'm coming to understand and appreciate the magnitude of the impact that diabetes can have daily living for a school-aged child, particularly in terms of schoolwork.
My son is an eighth grade middle schooler. He carries a full load of honors classes and my husband and I expect him to earn good grades. Like many of his counterparts, he can possess an aversion to homework, particularly if he's having a tough time in the class. He's struggled of late in a class or two, and upon listening to him as to what has been affecting his grades, I realized the myriad of ways, sometimes subtle, that diabetes affects his day.
First are the lows, which are the most obvious because of the almost immediate threat they have. Almost all those with diabetes loathe a BG low - the feeling of being out of control coupled with the threat of being embarrassed by passing out. He's gotten to the point where he can come to expect and even prepare for BG lows, particularly on the days that he has the late lunch scheduled or he runs the mile in gym. However, there are those unexpected lows that can throw his whole day off: he's late for the bus and forgets to eat the banana that he corrected for at breakfast or it's much colder than he expected on the way to school and his BG levels plummet. Experiencing a BG low wins him a ticket to the health clinic.
Next are those highs, which I hadn't really considered as an impact to his daily life because they are not as threatening. This is one area of diabetes management that it has taken my sometime to come to terms with how much high BG levels can impact one's academic performance. My son describes having a high blood glucose level (which for him is any reading above 300) as feeling like he is poisoned; his head pounds, nausea threatens, he feels dizzy. If you've ever been hung over or pulled an all-nighter with too much caffeine, you can probably relate.
We've all felt the stress from taking a test. To exacerbate the feelings of pressure are the spikes in BG levels that accompany this stress. Taking an exam or even a quiz can be nearly impossible with these symptoms, so he therefore must reschedule to take the test for another day and again make a trip to the clinic to drink water and take a corrective dose of insulin. High BGs, for my son, often take longer to correct than a BG low, so he can feel lousy for much of the day.
Finally, there is the consideration of lost time. Like I mentioned above, when my son experiences a BG low or high, he must go to the health clinic to correct the situation and have it monitored by the clinician. From the time he gets to the clinic, takes his glucose tablets, waits the fifteen minutes to retest his BG level, and then returns to class, that can constitute 20 to 25 minutes out of class. This translates into almost half of a 55-minute class period and not quite a third of a longer 90 minute class period.
My son is lucky; he can test his BG in the classroom. I had talked to one mother who said that she had calculated that her kindergarten aged daughter had spent twenty-five percent of her days traveling back and forth to the nurse's office in order to test her BG levels or to administer insulin. That translates into about an hour and a half per day.
We've been fortunate this year, my son's teachers have been very accommodating and understanding. I will say that I started off the year by contacting all of my son's teachers with a lengthy email detailing my son's diabetes and what it can be like for him to experience a BG low or high. We also have a 504 plan in place that helps to ensure my son's safety as well as working to level the playing field for my son when it comes to the periodic adjustments he needs to make to incorporate a BG high or low into his schoolwork.
Yet I know from talking to other parents of Type 1 children that our good fortune is not always the case. Unfortunately, there are teachers, administrators, classmates, and sometimes even parents who may be well meaning but end up making an already tough condition to live with even tougher. This can include teachers not allowing a child to test BG; or having classmates request that he leave the room to test, thus increasing the amount of time that he is out of classroom; or the militant hallway monitor that demands that the child go to the clinic rather than his locker to obtain the much needed glucose tablets to offset the feeling of an oncoming low.
We are soon to start insulin pump therapy, and I know that managing the device will add another component of impact to his daily life. Not easy for an almost fourteen-year-old; not easy for any-year-old. But at least we have the opportunity to manage the condition, with the benefit of ongoing medical advances occurring regularly - unlike our counterparts only a quarter of a century ago.
Published On: October 22, 2009