It is important to understand the effect diabetes has on a particular student and how that student’s diabetes is treated.
Diabetes can be a disability and can have substantial impacts on a student’s academic performance and safety at school, but it does not affect all students in the same ways.
Diabetes can affect students in several ways:
First, diabetes must be managed 24 hours a day, 7 days a week.
Diabetes care requires an ongoing treatment regimen.
The treatment regimen affects the student’s daily schedule and, if appropriate provisions are not made, may impact the ability of the student to have equal access to all school-related activities.
Second, blood glucose levels that are not kept in target range may result in hypoglycemia or hyperglycemia .
Hypoglycemia is the most common and immediate concern for school-aged children.
Severe hypoglycemia can result in loss of consciousness and is life-threatening.
Both hyperglycemia and hypoglycemia can affect a student’s cognitive functioning and, thus, school performance.
Finally, even where blood glucose levels are maintained within reasonably acceptable ranges fluctuations can affect a student’s ability to concentrate and learn.
In addition, diabetes may have an adverse impact upon the ability of a student to provide self-care or to engage in daily living tasks such as eating, communicating, or even walking.
Effective diabetes care is essential for a student’s immediate safety and ensures a student will be able to participate in all school activities.
Under equality laws, schools have a duty to make ‘reasonable adjustments’ to prevent any child or teen with a disability, from being placed at a substantial disadvantage compared to non-disabled children.
While children or teens with diabetes and their parents may not consider diabetes a disability, they are still covered by these laws.
The following are examples of simple adjustments that a school could make to ensure that a child or teen with diabetes fulfils their academic potential in an exam:
1.Allowing the child to bring their blood glucose monitor and testing strips in to the exam, and to test whenever necessary during the exam.
2.Allowing the child to bring hypo remedies in to the exam (this might include a sugary drink, sweets or a snack. The parent or Special needs teacher will advise on the most suitable hypo remedy for a child).
3.Allowing them to bring in water (hyperglycaemia can cause excessive thirst).
4.Allowing them supervised toilet breaks, as frequently as they need (hyperglycaemia can cause frequent urination).
5.Allowing the child to sit in the place that is most appropriate for them, eg sitting close to a teacher if they would like someone to keep a closer eye on them in case of a hypo/hyper.
6.Allowing extra time in case of a hypo/hyper.
7.Making sure that the examiner/s know that there is a child with diabetes sitting the exam and what adjustments to usual procedure have been agreed.
8.Making sure that the examiner/s understand about diabetes and how it can affect a child in an exam.
For many young people, starting 3rd Level means many familiar support structures (family, friends who’ve known them for years and are familiar with their diabetes, local diabetes team, home cooked meals, supervision by parents and teachers etc) may no longer be in place. These support structures provided students up to now with a vital margin of safety.
The transition to college leads to changes in relationships with family and friends, alters health behaviors, and may impact psychological well‐being.
Adolescents often move away from home, eat less nutritious meals, drink alcohol, and face stress from schoolwork and changes in relationships and living situations.
These changes can be particularly problematic for adolescents with diabetes as they could affect how they take care of their disease and, subsequently, their diabetic control.
The college environment may not be conducive to good self‐care of diabetes for several reasons.
Firstly, parents are less able to watch over an adolescent’s self‐care behaviors, making sure they make good choices.
Second, college is associated with a deterioration in diet, an overall erratic schedule, not getting enough sleep, possibly binge drinking, and trying or using drugs—all of which could adversely affect diabetes.
A study of female college students showed that there was a decrease in total caloric intake over the first five months of college, including a decrease in consumption of vegetables, bread/pasta, milk, meat, grams of carbohydrates and protein.
Students reported finding it inconvenient to carry food and eat in class and did not frequently plan for meals or snacks.
One diet‐related behavior that is especially relevant to those with diabetes is alcohol because drinking alcohol lowers blood sugar levels and could lead to hypoglycemia.
Alcohol not only directly affects blood sugar, but may detract from other self‐care behaviors such as testing and eating properly that could affect blood sugar.
Alcohol consumption is more prevalent among college‐ age students than other age groups and is more prevalent among youth who attend college than those who do not.
Adolescents also may decrease the amount that they exercise when they enter college, which can have negative consequences for metabolic control among those with diabetes.
College may also lead to a decrease in the amount of sleep that students receive.
First, the increase in schoolwork that occurs in college compared to high school could detract from sleep.
Second, greater opportunities for social interaction and fewer parental constraints may lead to a decrease in overall sleep or more irregular sleep.
The decrease in sleep is probably similar for college students with and without diabetes, but the decrease in sleep may have more hazardous health consequences for those with diabetes.
The transition to college may be accompanied by changes in the amount or nature of social support received, which could have implications for health.
Because students are constantly surrounded by peers and friends, they may experience an increase in peer social support compared to levels in high school.
However, adolescents with diabetes may not experience the same increase in peer support as their healthy counterparts when they go to college.
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Those with diabetes meet new people who do not know they have diabetes and are faced with the decision as to whom they tell about diabetes and how much they tell them.
Although students with diabetes want to tell their friends about diabetes so that their friends know what to do in an emergency, some worry what people will think about their diabetes and that others will treat them differently.
One study of college students with diabetes tried to address this issue by meeting in groups to discuss diabetes‐related topics.
During the sessions students with diabetes reported that they felt comfortable expressing feelings that they had considered unacceptable to share with non‐diabetic peers.
College may be associated with an increase in stress and, subsequently, depressive symptoms. There are multiple sources of stress.
Stress could arise from increased pressure from schoolwork, feelings of loneliness from leaving family and friends, and trying to fit in a new social environment.
These sources of stress are similar for students with and without diabetes, so there is likely to be a similar increase in depressive symptoms for both groups.
Stressful life events result in a worsening of diabetic control for students with diabetes,
One variable that may affect how adolescents with diabetes transition to college is whether they are on an insulin pump or not.
Those who use pumps report less stress, more life satisfaction, and better self‐care behaviors.
An insulin pump aids in the adjustment to the changes that occur at college.
Pump use allows for increased freedom and is less intrusive than injections.
For instance, students using insulin pumps have flexibility in meal times, which can be quite variable in college because of varying schedules.
Students can then focus on work or spend time with friends and not have to leave these activities to eat at a specified time.
Students might also feel more comfortable interacting with new peers if they do not have to inject in front of them or leave these interactions to inject.
Doctors might, therefore, want to consider placing adolescents entering college on the pump as it seems to improve some aspects of psychological well‐being.
Most third level institutions have Disability Support Services –students with diabetes are not disabled but have access to the service.
The activities of these services vary from college to college, but they generally provide information, act as advocates and organise the provision of necessary supports for students.
They often have an important role in creating a higher awareness of the needs of students among the teaching staff of the college, and generally making the college a more accessible place for students with diabetes.
IMPORTANT POINTS FOR COLLEGE LIFE
1.Talk to your diabetes team as part of your planning for college life.
2.Whatever you take for hypo’s, buy it in bulk. That way, you won’t think twice about sticking a handful into whatever bag or coat you grab.
When you go to a party, make sure that someone you know will be there – someone who knows you have diabetes and what to do in case of a hypo.
3. If you don’t have relatives or friends nearby, have your parents’ network through their friends to find someone who can act as an emergency contact when needed.
4. Make the decision to ALWAYS wear identification e.g. Medic Alert bracelet. There are many different styles available.
5.Photocopy insurance and prescription cards, in case your wallet is lost or stolen. Your parents should keep a copy. Keep another in your room.
6.Have your sick day regime up to date and accessible in your room and your locker in college.
7.Have two blood glucose meters, in case one malfunctions, and extra batteries.
8. Make sure you have a safe system for discarding needles and strips.
9. Check your diabetes supplies every three months. Be sure to check periodically and stock up before you start to run low. As a safeguard against running out of insulin, make sure your prescriptions are on file at a local pharmacy.
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