Alicia: UnLeashed! July 2018 monthly article

We are heading back into the school year and this brings a LOT of preparation for students with Type 1 diabetes and their families. 504’s, IEP’s, doctors visits, meetings with schools, teachers and nurses. There is a LOT going on!

This is a really tricky time for maintaining blood sugar stability. We are coming back from camps; sports are either winding down from the summer or gearing up for the school year. And on top of that we have the emotional whirlwind of starting back to school! Excitement to leap into another year of adventure or the anxiety of entering a new world can push blood sugars up. However that same excitement or anxiety can reduce appetite and feed lows. Going from a sedentary summer to an active fall can increase insulin sensitivity. On the flip side going from a super active summer to sitting at a desk all day can increase basal needs. Students and their care teams put a lot of energy into this time of year!

But as we settle into the school year and the changes of these first few weeks we often see rises in blood sugar or changes in eating patterns that seem to defy control. We strongly encourage care givers to create and maintain open communication with the students in their lives! Stress raises blood sugars. Acute stress can look like a meal on one’s CGM data.  Is your student struggling with a class and so anxiety mounts at around the same time every day? Is your student having an interpersonal issue with a teacher or coach so interactions are causing blood sugar changes, or eating changes? Is your student being bullied?  The social world of a school is so much more complex than it has ever been before! As young people are plugged into social media, the stresses of the classroom can follow them home. Kids with diabetes not only have all the same vulnerabilities and targets that all their peers face, they also have diabetes. From wearing devices, to having to step out of class or activities for blood sugar checks and blousing, to the cultural stigma that comes with the word diabetes, these students have another button that people can push.  It is important that our students have a safe space to report these hurts. No one would ever tolerate a child in a wheel chair being made fun of. It would be unacceptable for them to be laughed at for taking the long way to class to get to an access ramp. But often children with diabetes are expected to just brush off a jab about leaving class to correct a low, or for wearing a piece of technology on their body.

As supports for young people living every day of their lives it is our responsibility to make sure that these students have a safe space to express their struggles and triumphs! We can never make life fair, but we can allow our young people safe spaces, emotional support and open sounding boards that make it easier to live with this disease in their dynamic social environments.  It is also important to remember that when blood sugars are variable emotions peak. We become more emotionally labile when blood sugars are high or low. This is also compounded because many of us with diabetes are striving for blood sugar “control”. So now the situation that is upsetting them (That they can not control) and their emotional state (That they may not be developmentally able to control) is causing a loss of blood sugar “control”. These are the times when support systems, connections to others with diabetes, and effective emotional outlets are critical! These kinds of pressure build ups can put strain on academics, social interactions, and physical wellness.

Back to school with Type 1 Diabetes…. Some great ways to help:

• Have tough conversations BEFORE they are needed!
  • Meet with your student’s school administrators, counselors and teachers to discuss diabetes stressors, bullying and what to be on the look out for and agree how these things will be handled before it becomes an issue and emotions flare.
  • Discuss with your student how to cope with and respond to these stressors in advance so they know they have safe places and people to turn to.

• Find Healthy Pressure Releases
  • Exercise, sports, dance, writing, singing, having permission so shout it out for a set time, help your student find their pressure release!  Encourage them to reach for it in good times and in bad! These skills help young people find healthy stress relief for a lifetime!

• Beware Diabetes Pressure
  • Remember that goals should be mutual, set by the student first! Healthcare providers and care givers play a role in goal setting, but imposing and enforcing a goal puts a lot of stress on a student (because academic pressure, athletic pressure, peer pressure, and growing pains are not nearly enough right?!). Too much pressure increases the risk of diabetes burn out, denial, rebellious behavior, anxiety, and even disordered eating. Keep in mind, diabetes management is a life long marathon, demonstrating to your student that temporary set backs are to be taken in stride is critical to helping them become healthy well managed adults.

• CELEBRATE WINS!!!!
  • One of the best self care habits we can teach young people is how to celebrate wins! From a good grade, to an improved A1C to making a new friend and showing kindness to others! Life should be a lot more Carrot and a lot less stick. Remember to celebrate the good to diminish the long term impact of the bad.

• Connect for Support, and Survival
  • Helping your student connect to other students with diabetes can be really helpful, particularly if they were not young at diagnosis and missed out on growing up going to “diabetes camp”. Diabetes management can make a young person feel different, and the last thing most kids want to be is “different”!!  Connecting through JDRF walks, online groups, or educational groups at medical centers is a great way for young people to support one another. Leaning on one another for support helps build skills by learning form and supporting others. It also lets your student see that they, just like other people with diabetes, have an identity that is so much more than a diagnosis, an A1C, a GPA, or position on the team. They are an awesome individual!!!
• Meet challenging behaviors with support
  • Children, particularly young children often meet stressors with anger and outbursts. One young patient I was working with described the stress of living with diabetes like “It makes me itch and twitch all the time, in my head”. A more apt description I don’t think I’ve ever heard! But in a school room that demands one be still silent and controlled, these feelings can often lead to being disruptive, angry outbursts, or aggressive behaviors. In older students it could even lead to substance abuse, high risk behaviors, skipping classes and defiance. One thing we can not forget is that We can NOT expect our CHILDREN who are still developing their mental wiring, to react to life in a more mature and healthy way that WE WOULD! We have to give them the room to react to life’s stress. We have to give them permission to be young, to make mistakes, and to find their way through.  When we see behaviors, rather than addressing the behavior (which typically leads to labeling the student) we should first address the PERSON. Start asking questions about stress, feelings, needs being unmet and how we can work on those areas. Once a student is labeled it can be very hard to undo that label. But when stressors and needs are discussed they can often be met and resolved.

Let’s go into this school year with a new and increased awareness of how amazing our students are! I know I am pretty amazed that I made it to adulthood without a smoking piled of devastation in my wake! And I did it without a diabetes diagnosis. (My diagnosis came a bit later)  And surround your students and yourselves with supports and encouragement!

Her eat IDS we work with the entire family, encouraging and empowering students and their care givers. We also have mental health professionals with diabetes knowledge and experience to help our patients through the challenges of growing up with type 1. We take the entire lives of our patients into consideration and know that treating the mind and the body together is the only way to achieve long term success in diabetes management.