Managing School: Tips for Teens with Diabetes

Am I the only one?

It may feel like you are the only kid in the world who has to worry about these things. You're not. Although you may be the only
one in your class. And this might make you feel very different and alone. If you look around your class, you will see a room full of differences. Big, little. White, brown. Talented, clumsy. Different languages, religions, beliefs, interests, and abilities. These things often make other kids feel different and alone, too. They may not have to worry about insulin or blood sugar levels but their worries make them feel alone too.

Some people find that talking about diabetes reduces the feelings of being alone and different. Sometimes they find someone else has diabetes. Or the people you talk to learn more about diabetes. They understand how you handle it and they realize this is just another part of you and your life. It's important for some people in your life to know what's going on in case you need
some help. But remember that for the most part, you get to decide who you talk to about your diabetes. Do what is comfortable for you.

Let's talk about some things you can do about those worries and concerns. Things that will help you manage your life as a person with diabetes.

Your Diabetes Team

Before we go any further, we should talk about your health care team. Everyone who has diabetes should build a health care team. You, with the help of your parent/guardian, should be the team captain. Other team members might be your doctor, nurse, diabetes educator, or dietitian. Your team might also include others who teach you and help you make decisions about your diabetes.

It’s very important that you be an active player on your diabetes team. It’s easy to leave diabetes care to your parents and not
pay much attention. But the more you participate in your care, the more healthy and confident you will be. Only you can know how you feel while you’re on your plan. If you often feel a little low after school, you should bring that up to your team and work together to make some changes. Being the captain of your team doesn’t mean that you do everything yourself. It’s up to you to work with your team to take care of your diabetes.

You Be the Teacher

Most people don't know much about diabetes, especially how young people deal with it. As you learn, you can help teach others. By doing that, you’ll make them smarter and the time you spend with them easier.

To help your principal, school nurse, teacher, and coach learn about what's going on with you, you and your family can put together a packet of information for them. The American Diabetes Association can give you suggestions on what needs to go
in the packet and point out some of the legal do’s and don’ts. Call 1.800.DIABETES and ask for an education discrimination packet. This packet explains diabetes, how it's treated, and how to recognize hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar). You should add your personal information to the packet. This includes a description of your diabetes plan including a list of times you need to do a blood check, and the insulin or medication you take and when you take it. You should also include daytime phone numbers for your parent or guardian, and instructions on when to call them.

When you and your parent/guardian meet with your teacher, school nurse, coach, and principal, give them the packet and tell them your plan for taking care of your diabetes during school.

Your school needs to make sure that you are medically safe at school and that you can be a part of all school activities. Depending upon your age and how long you’ve been dealing with diabetes, you may be able to do all or most of your
diabetes care on your own. Or, you may need help from an adult at school who’s received training in diabetes care. Either way, at school you should be able to:

• Check your blood sugar any time you need to.
• Stick to your eating plan. This might mean snacks during class and changing your lunch period.
• Treat your low or high blood sugar any time.
• Give yourself insulin shots or other medicines that you’ve described in your diabetes plan.
• Get help if you need it.
• Go on field trips.
• Participate in sports and other activities.

The medical stuff, like when to check your blood sugar, when you need insulin, should be written down and signed by your doctor. You and your family might also choose to put other things down in writing ahead of time, like what happens on field
trips, that you can play on sports teams, and what to do if your blood sugar is really high or really low when its time to take the
final exam. Your plan should also cover after school detention, just in case, and your teachers should include information
about your diabetes care plan in their notes to substitute teachers.

So, you can see there are a lot of bases to cover in order to let everyone know what's going on with your diabetes at school.
That's why you should be sure to make diabetes education an annual thing with everyone at school.

You Have to Do WHAT?

Let’s talk about how to make taking insulin less of a big deal at school.

Taking insulin is the thing that seems to confuse people most about diabetes, because taking insulin means taking shots.
No one likes shots. Many people are uncomfortable watching someone take a shot. And some people might even confuse
taking insulin with using illegal drugs. But remember this: you know you are taking insulin for your diabetes.

You may be perfectly comfortable doing insulin injections with others around. Or, you may want to choose a place where not
everyone in the world is watching you inject. But never put off taking the medicine you need just because it makes someone else
uncomfortable.

Your health care team will work with you to figure out how much and what kind of insulin you need to take, and how often you’ll need it. Then its up to you and your parent/guardians to share that information with your teachers, coaches, school nurse, and principal. Agree on where in the school you’ll inject, where you’ll keep your insulin and syringes, and who if anyone needs to help you or be with you when you take your medicine. You may need help taking your shots at school. If so, be sure you, your principal, teachers, parent/guardian, and health care team agree on who you’ll count on for help. And remember, it took you a while to get
used to taking shots. Give people around you a little time. When they see that it doesn’t scare you and makes you
feel better they’ll get used to the idea.

A Different Kind of Test

When you check your blood sugar levels, you will find out which of your friends will make good nurses and which ones will work better with machines than living things. Blood checking is something that gives many people the heebie jeebies. In fact, some people faint at the sight of blood. That's okay. It's just evidence of another one of those differences between people. Your
teacher, coach, school nurse, and principal should be involved in working out a plan for you checking your blood sugar. They need to know that some days it will be necessary to check more than other days. And since you never know when you will feel low and need to check your blood sugar, all your teachers, even the one you see only once a week, should know this plan.
Where you go to check should also be covered in the plan. But remember you should never go anywhere by yourself if you think your blood sugar level is low.

What’s important here is making diabetes a natural part of your life at school. That starts by knowing what your blood sugar is, and knowing what to do if it’s too high or too low.

Uh-oh, Too Low

One of the scariest things you’ll have to deal with at school is “hypoglycemia.” That’s a medical word for low blood sugar.
It can happen all at once. And it can make you think and do weird things.

Do you know what happens to you when your blood sugar goes too low? Some people get cold, some get clammy. Some
kids eyes do a double whammy. The important thing isn’t what happens to other people. It’s what happens to you. Pay
attention and learn what you feel like when you’re low. Tell your teachers ahead of time what you may act like when you have a low blood sugar.

Be sure to include information about low blood sugar and how you will deal with it in the plan for your teacher, principal, school
nurse, and coach. If everyone understands what happens when you have low blood sugar, and what you and they need to do
about it, everyone will be a lot less nervous when it does happen. Always have a blood  sugar meter close by. Make sure the adults at your school understand that when you need to check you need to check now, not in five or ten minutes or at the end of the class period.

Just remember, never, never be without some kind of sugar to pull your glucose level back where it belongs. Carry glucose
tabs or gel, some sugar candy (the hard kind that won’t turn to mush in your backpack), or a can of sugar soda (or a juice box) just in case. Make sure the people who you tell about low blood sugars understand you need sugar free soda when your blood sugar is normal and sugar soda when your blood sugar is low. It’s so confusing!

Don't over-treat. Low blood sugar doesn't give you the excuse to eat everything you want. Doing that will only lead to high blood sugar levels later. So, be smart when you treat.

Another important thing to remember: Your teachers, your coach, and your friends can be on the lookout for times when you go low, but it’s your body. Although the adults around you will help, you are in the best position to watch out for low blood sugar levels because you’ll probably be able to feel the symptoms before other people can see them. You’ll feel strange before anyone else knows what’s going on. When you feel that way, check your blood sugar. If it’s too low then treat to raise it, wait a little bit (15
minutes or so) and check again. Remember, never ever be by yourself when you think you’re low.

A final thought: it makes sense that some things are going to trigger low blood sugars more than others. So know what your blood sugar levels are before you start recess, PE, or sports. Then check again afterwards. Know what time of day you’re likely to be low. And talk to your health care team about any patterns you see in the lows of your blood sugar readings.

Oops, Too High

Let’s talk highs. “Hyperglycemia” is when blood sugar readings are too high. Your health care team will have set your target range so you will know what is too high for you. You probably already know that getting much above your target range makes you feel grumpy, tired, and bad.

The good news is when you’re at school, high blood sugars are not as terrible as low blood sugars. Low blood sugars can make you pass out. Up to a certain point, high blood sugars will only make feel so bad that you wish you could pass out.

Dealing with high blood sugars starts the same way as dealing with low blood sugars: talk to your doctor and health care
team. They may want you to take extra insulin if you are higher than your target range. Or they may work with you to make
changes in what you eat or your activities.

Your health care team will tell you that at a certain high blood sugar level there is a risk of “diabetic ketoacidosis.” This is not only a very long medical term but is also something you need to see a doctor about right away. Since this is pretty serious, a part of the plan you make with your school should deal with what to do when your blood sugar reaches that way-too-high level. Get advice from your health care team and put it in your plan.

Finally remember this: diabetes changes day-to-day. It’s affected by what you do, what and how much you eat, and how fast
you’re growing. if you’re fighting the flu or a cold, this affects your diabetes. When your food, activities, and insulin get out of
balance and your blood sugars are too high or low, talk to your health care team.

Food, Food, Food

To kids who don't have diabetes, a snack during class sounds great. But sometimes when you have to eat because it is part of
controlling your diabetes, it feels pretty weird. After you explain diabetes and your diabetes plan to your teacher, he or she will
understand why you need something to eat. Then, if you and your teacher think it makes sense, one of you can tell the other
students why you’re eating peanut butter crackers.

On the other hand, there will be times other kids get candy or some other treat that you will have to turn down. That will feel
pretty weird, too. You might want your teacher to keep to some "alternative" treats for you to eat at these times.

Time to Get Moving

When time for gym class, recess, or the after-school game rolls around, you might be tempted to skip the whole thing. It means paying special attention to your diabetes before, during, and after the activity. But don't give up. Remember that exercise not only keeps your heart and lungs in good shape and helps control your weight, it also helps your insulin work better. The following
tips need to become a normal part of physical activity for you, not reasons to sit on the sidelines.

• Make sure the people around you know you have diabetes. This is not the time for secrets! If you have sudden low blood sugar, you want your coach and teammates to know you have diabetes and take insulin. Always make sure you are wearing your medical ID bracelet or necklace. Some kids worry that their ID bracelet or necklace will poke, jab, or strangle them while they play. If this is a concern for you, look into getting a nylon & Velcro wristband ID. These are specially made for sports, have no metal parts, and won’t poke or jab you or the other players.
• Remember to check your blood sugar. You should check before you start (do you need a snack for low blood sugar?), after you have been exercising extra hard or for a long time, or when you have any sign of low blood sugar. If you start to feel shaky, weak, dizzy, irritable, or any ofyour usual symptoms of low blood sugar, eat some sugar right away. Don't
  be tempted to wait!
• Keep snacks or glucose handy. You may want to ask your gym teacher to tape glucose tabs to her or his clipboard.
• Drink lots of water. You should drink before, during, and after the activity. Exercise uses up a lot of the water in your body and you don't want to become dehydrated. It's no fun. While going on a field trip may not be nearly as strenuous as playing a game of soccer in gym class, the very same tips are important to follow. Following these tips can make sure you are part of the group activity, not stuck on the bus because you don’t feel well enough to participate. The number one thing to remember: Never go anywhere without some way of treating insulin reactions.

Dealing With Normal

For some kids “normal” is using a wheelchair. For some it's normal to speak Spanish or Chinese. For others it's normal to wear a hearing aid and use sign language. Having asthma is normal for someone just like having diabetes is now normal for you. They aren’t things we’ve chosen. But they’re a part of our life. All of your different traits add up to make you the person that you are.

Normal doesn’t mean you can take these traits for granted. It means you have to find a way to work these things into your life that
let’s you get on with things. So it's up to you to find your own ways of dealing with the issues and responsibilities that come with
diabetes. As you learn to successfully deal with your diabetes, it will become a regular part of your life. Just like dealing with
math tests, book reports, try-outs for the team, and after-school activities. But dealing with diabetes is far more important. Because only when you are successful in dealing with diabetes will you be able to deal with sports, studies, parties, and the other bazillion great things in your life.

To Learn More:

• If you don’t already have them, get the American Diabetes Association Wizdom™ kit and the education discrimination packet. They’re both free, so get permission from a parent or guardian and call 1-800-DIABETES (800-342-2383) today.
• Log on to our Web site at www.diabetes.org, or check out the new ADA Wizdom Youth ZoneSM Web site just for kids and teens—www.diabetes.org/wizdom. If you don’t have a computer at home, ask at school or check out your local library, YMCA, or Boys & Girls club.
• Want more Wizdom? We've got titles on discrimination and type 2 diabetes in kids, with more on the way. Call us at 1.800.DIABETES to get copies or for more information.
• For more advice and answers, log on to our Parents’ Place Community Forum at diabetes.org. Click on “Community and Resources,” then “Community Forums.”
• Questions or comments? Send us an e-mail at wizdom@diabetes.org