Going back to school.

Going back to school after you're told you have diabetes might freak you out. You might be worried about what your friends think, will everyone notice, will they think you're different?

When you first go back to school, here's some things you can do to make it a bit easier.

• Get someone to talk to the teachers at the school about diabetes and what they have to look out for (e.g. hypos, testing, sport). You or your family can do this or ask your diabetes educator to visit the school.
  
• At first you might not want anyone to know that you have diabetes, this is understandable but it's safer if someone knows. Depending on how you feel you might want to explain simply what diabetes is to your friends and classmates. You can show them a DVD or video. You can get these from Diabetes Australia.
  
• Make sure that your friends know about hypos and what to do if you have one. This might seem embarrassing, but it could be more embarrassing if your hypo goes untreated.
  
• Talk to your diabetes team about your usual school timetable and how to fit your diabetes into this without too much hassle.
  

How to manage diabetes at school

Testing

Testing in the classroom can actually help your class mates to better understand diabetes, and it's safer than waiting to the office or sick bay.

Injections
If you need to do insulin injections at school, you'll probably have to go to the office or sick bay to give your injection. Some schools like you to leave your syringe or pen in the office, other schools will let you carry it with you. Remember to be careful when carrying your syringe or pen and make sure that you don't leaving any sharps lying around. Don't forget that you need to eat straight away after you've had your insulin.

Hypos
A hypo is when your blood glucose level goes too low. When this happens you might feel sweaty, shaky, sleepy, angry, weak, find it hard to concentrate or have a headache. Everyone is different - you need to know how you feel when you have a hypo. Hypos can be caused by lots of different things, like exercise, not eating enough at meals, skipping meals or too much insulin. Common times for hypos at school are just before recess or lunch, during and after sport, but remember they can happen at any time.

When you have a hypo you need to quickly eat or drink something sweet straight away and then eat something else to stop the hypo from coming back. If it's just before recess or lunch, eat or drink something sweet then eat your recess or lunch. Don't leave the classroom to treat your hypo and make sure you have a full hypo kit with you at all times. It's important to always tell someone when you have a hypo. Don't be surprised if you don't feel the best for a while after having a hypo - it can take time to feel better.

It's important not to ignore a hypo even if you're worried about drawing attention to yourself. No one likes to be embarrassed, but ignoring a hypo can make you feel worse and can be more embarrassing if you don't treat it.

Don't forget to wear some form of ID that says you have diabetes, like a necklace or bracelet. There's also an ID card available to carry in your wallet. This is important just in case someone doesn't know you have diabetes and you have a hypo or get sick.

Highs & Sick Days
Sometimes your BGLs can go too high. This can be when you:

• feel sick or unwell
  
• are stressed, worried or excited
  
• are less active than usual - eat more than usual
  
• don't have enough insulin in your body (e.g. you forgot your insulin injection or didn't give the right dose)

Sometimes high BGLs happen for no reason at all. If your BGL is above 15mmol/L you should test for ketones. Click here for more info on ketone testing.

If your BGL is above 15mmol/L at school, you don’t have ketones and you're feeling OK , you can do all of the things that your friends are doing, but it's not a good idea to play really active sports like football until your BGL comes down. Drink plenty of water and do another test if you're not feeling well.

If your BGL is above 15mmol/L at school and you're feeling sick, you might have ketones. High BGLs and ketones can make you really unwell and give you stomach pains, make you feel thirsty and want to go to the toilet a lot. This means that things are out of balance in your body. When you feel like this, you need to tell a teacher that you're not well, test your BGL more often, drink plenty of water and sit quietly, but don't be on your own. If your BGL is high and you’re feeling unwell the school should contact your parents to see if you need to go home early or visit the doctor. If they can't contact your parents, they should speak to your diabetes educator for advice. If your BGL is above 15mmol/L and you have ketones, you are likely to need extra insulin to help you feel better - your parents or someone at home can help you with this.

If you start vomiting you should tell a teacher and they can call someone at home. It's really important that you and your family talk to your diabetes educator about what to do for sick days.

Sport
Teenagers with diabetes can play all sports and do the same activities as those without diabetes, you just have a few extra things to think about. Being active usually lowers BGLs but sometimes BGLs may be higher before and after sport because of being nervous or stressed. Sometimes BGLs can drop low and stay low later in the day or night after sport.

There are some important things you need to think about before, during and after sport, these are:

• Testing - it's important to do extra tests to see what different sports do to your BGLs. It's a good idea to test before, during and after sport.
• Insulin - you might need some changes to your insulin dose when you have sport at school, especially sports carnivals. You usually need to lower your insulin dose for exercise. This depends on things like type of activity, duration and your individual response to the activity. Try not to give your insulin in the area near exercising muscles, as it's absorbed more quickly and may increase the risk of hypos. Your stomach is the best place to give your insulin. It's a good idea to discuss insulin adjustments for physical activity with your diabetes team.
• Carbohydrate Foods - when you play sport, you usually need extra carbohydrate foods to stop your BGL going too low. It's a good idea to have a carbohydrate snack like a piece of fruit, juice or muesli bar before sport and extra carbohydrates to top up during and after sport.
• Hypos - when you do sport your BGLs can sometimes drop too low and you have a hypo. When you have a hypo you need to quickly eat or drink something sweet straight away and then eat something else to stop the hypo from coming back. It's important to have your hypo kit with you at all times. Remember that you can still be hypo a long time after sport, so you may need to eat extra carbohydrates later in the day and before bed.

Food at school
Healthy eating is important for all teenagers, including those with diabetes. It's important that you eat the right amounts of healthy carbohydrate foods at recess and lunch to help keep your BGLs mostly within the normal range. Remember not to skip recess or lunch or you might have a hypo.

On the bus.
When you have diabetes you might sometimes need to eat on the school bus. Some buses that you go on might not let you do this. You and your family should speak to the bus company so that they understand why you might need to sometimes eat on the bus. Diabetes Australia-NSW has a bus card that helps to explain this to the driver.

Excursions
Excursions are a bit like sports days and can make your BGLs go high or low. You might need to make changes to your insulin dose and don't forget to take your testing kit and insulin, plenty of carbohydrate foods and a full hypo kit.

School Camp

Going to a Diabetes Camp can help you feel more confident about going to school camps

You don't have to miss out on school camp just because you've got diabetes. It's really important that the teachers and staff who are going to camp know about diabetes and that a management plan is in place. You'll need to be responsible for your diabetes care like finger pricks, injections, ketone testing and treating hypos. Going to a diabetes camp first can help you and your family feel more confident about going to school camp.

Exams
School exams can make a difference to your usual timetable at school and sometimes cause BGLs to go high or low because you might be worried or stressed. Make sure that you have your testing kit, extra carbohydrate foods and a full hypo kit with you. It's important the teachers know that you might need to stop and eat or go to the toilet more often during the exam.

There are "special provisions" for year 10 and 12 state exams conducted by each states board of studies (see list below). In New South Wales there are four programs which deal with illness / misadventure and exam conditions for students with any difficulty.

1. School assessment policies Determined and ruled by individual schools/colleges. They include arrange¬ments in case of illness (hypo during an examination).
2. Special examination provisions Run by the Board of Studies for the School Certificate Reference tests and HSC examinations.
3. Illness/misadventure program Run by the Board of Studies for the HSC. It involves illness or misadventure immediately prior to, or during, the examinations.
4. Special access to universities Run entirely by universities. Students who have experienced difficulties during Year 12 should contact each university to whom they wish to apply, and ask for information on their special access program.

In some States the school is required to send an "Application for Candidates with Disabilities" form together with a medical certificate, to the "Special Provisions for Students with Disabilities" Program at the Board of Studies. It's a good idea to send these forms in at least six months before the examination.

During exams you're usually allowed to:

• Take bite-sized carbohydrate foods like dried fruit (but no noisy wrappers) to 'top-up' blood glucose levels throughout a lengthy exam.
  
• Be seated near an exit so others are not disturbed if you have to leave the room.
  
• Take your blood glucose meter and test strips into the exam room.
  
• Have a maximum of 5 minutes extra time per half hour of exam time for toilet breaks.
  
• Have a maximum of 20 minutes extra time per exam to treat any problems (eg. hypos) if required.
  
• Sit in a separate room with a supervisor.
  
• Take your insulin pump into the exam room and operate it as your doctor advises.

Special provisions are made on an individual basis with recommendations from your diabetes doctor. If you have a hypo during the HSC (or equivalent) you should apply to be treated as an "illness or misadventure case". If this happens, you can usually receive a mark based on a school assessment instead of the exam.

You can get further information from your school, Diabetes Australia in your State or Territory or The Department of Education. These are listed below.

Detention
Being on detention or being kept in class during breaks will make a difference to your usual timetable at school. If you are on detention, make sure that the teachers knows that you have diabetes and must have your testing kit, extra carbohydrate foods and a full hypo kit with you at all times. Don't skip lunch or recess because of detention.

Bullying
Sometimes teenagers who don't understand diabetes hassle anyone who's different from them. If this happens, try and ignore them, although it's hard to pretend you don't care what they say - eventually they'll get fed up if you don't react. Your friends can also help out by backing you up and supporting you - they like you for who you are. Remember no one really likes bullies!

Don't use diabetes as an excuse
Sometimes you might have to eat in class, leave class and do things your friends don't have to do. It's important that your teachers and friends understand this, but remember that diabetes isn't an excuse to get out of things you don't want to do. If you use diabetes as an excuse, people might start to think that you can't do all the things that everyone else can do - then you'll be the one that feels different and misses out in the long run!