#548 Diabetes Variables: School

September 24, 2021Scott Benner

Diabetes Variables: School

Scott and Jenny Smith, CDE share insights on type 1 diabetes care

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Scott Benner 0:00
Hello friends, and welcome to Episode 548 of the Juicebox Podcast.

Hey everybody, this is the next episode in the diabetes variable series. So it's going to be me and Jenny Smith. Jenny, of course, is a 30 plus year type one, a CDE, a nutritionist, she says a whole bunch of stuff. And she's here today to talk about a new topic, something that might come up in your life that very well may impact blood sugars. Today, the variable that we'll be talking about is school. Please remember, while you're listening, that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan are becoming bold with insulin. On the front page of Juicebox Podcast comm a lot of the series that are within the podcast have their own space, like on the website so you can see them because I know there's a lot of episodes, and today I've added the variable series. So that's there now as well. So if you're looking for a certain episode, you're not sure what episode number it is head there and do a little scrolling. You'll find it after this brief advertisement. We'll get started.

This show is sponsored today by the glucagon that my daughter carries g vo cuyp open, Find out more at G Vogue glucagon.com forward slash juicebox. Can we do school as a variable? Because not only is it that time of year right now. But a lot of children are going back to school for the first time after COVID right now. And the internet is full of new parents who are astonished that their children's blood sugar's don't look the same when they go to school as they do when they're at home. Yes. So I can start by saying that for Arden even though she's a fairly chill person, the first couple of days going back to school in person every year forget COVID are not Arden's insulin needs go up. There's some sort of either underlying adrenaline anxiety, maybe, I don't know, maybe she's, I don't know, I don't know what it is the hydrated, like maybe she's rushing, I couldn't even begin to tell you, I can just tell you that for the first few days. I find myself fighting to use more insulin, and then suddenly, it's just okay. And I don't know, when

Jennifer Smith, CDE 2:51
does it even out to her typical normal nun school needs then or do other things change?

Scott Benner 2:59
know, if you're coming back from the summer vacation, then? Well, it can go to it can go two different ways like so if she's sedentary during summer vacation, she might need a little more insulin to begin with. But if she's going back to this, like now she's walking more, right? Like there's so much to change is first of all, you're up earlier. So you run into more feet on the floor, like the life thing, which you may have been controlling with basil while they were sleeping in during the summer. Right? Like there's there's that. But I always just at at its face. To me, it seemed like anxiety, adrenalin, stress, excitement, and then it kind of goes away. But in fairness, Arden's bales are typically a little stronger during the school year than they are. Otherwise, yeah. So but I'm, I'm assuming that everybody's could be different, like, you know, you might be maybe somebody's suddenly going to be more active because schools there are suddenly getting exercise on days where they didn't have or, or I guess, if you're super active at home, maybe you end up getting less exercise because you're going to school.

Jennifer Smith, CDE 4:09
Right? That's true and or more, you know, especially I see this as a difference. Kids have gone through high school, understanding kind of what their insulin needs do with school days and that kind of thing. And then they go off to college, in which they may have a huge campus that they're now walking across from class to class or back and forth, which brings in a very different structure than to their insulin needs, comparative to the last four years in a very, very structured day to day schedule, not walking all over the place, etc. I find that when kids go back to school, more often than not, I see issues with it's funny like the foot on the floor, I call it the foot in the school. I guess soon as they are either like On their way to school for some kids, or as soon as they put set foot on the school property, and they're heading in, up goes the blood sugar. Yeah. 900 less common for the drop. It's more common for a rise.

Scott Benner 5:13
I when the world was normal, I would drive Arden to school every day. And as we would pull out of the house, I'd make us I'd ever make a small Bolus. Yeah, it was for nothing other than I could see your blood sugar one day of 20 or 30 points as we were approaching the school and she was getting in there. But it's, it's um, it's just kind of fascinating to think about all the different implications that could happen, just changing. You know, your physical spot. This is my life here at home. This is my life at school. And it changes but I'm talking about like, for the moment, I'm talking about that first couple of days, like you can call it whatever you want, you know, I would assume, listen to me, I don't know about you. The day before school started every year, I cried. Like I would like I was like, I don't want to do this. I don't want to go there. I want to go back to school. Oh my god, no, I hated school. Like with a burning passion. I hated going to school. And a lot of your kids might feel that way and not be telling you, you don't mean like I just I could not have

Jennifer Smith, CDE 6:18
that's totally not my kids. My boys already have their backpacks already for the first day. And they're very, very excited.

Scott Benner 6:24
thing made me nauseous. Kids are buying stuff. They're excited. I got new pens, not me. I looked I was like, Oh, this now I gotta go over there. Listen to these people. Well, I hate this. Like I just I there was nothing about school that I found attractive, except for the social stuff. Sure, I just I mean, I'll talk to anybody. So like, I'm good with that, like super smart people, girls were cuter. You know, like Rick, you don't need like the nowadays like I'm I'm think you're allowed to look at each other anymore. But in the 80s, we were pretty touchy feely, like going both ways. Like everyone was exploring, you know what I mean? And so there were a lot of friendly boys and a lot of friendly girls. And nobody said anything about it. And it was that part of it was fun. But the rest of it was

Jennifer Smith, CDE 7:11
more anxiety inducing just the class component and all that kind of stuff.

Scott Benner 7:16
I wish I could put myself back in my own head to tell you if I was anxious or not, I just didn't like it. Like, I don't know that if I was I don't think I don't know, if I was anxious like this several times. Like I felt like, I don't do well with this. And maybe Sure, maybe we would call that anxiety today. But I just I think

Jennifer Smith, CDE 7:34
that brings in another one in terms of school is the impact of one class versus another. And how the child sort of feels about that class or that type. or that type of learning, right? You know, the people who really love their math or really love their science or really don't, they'd rather be in English class or writing or doing more, you know, self kind of guided stuff then. So those are pieces. I was when I talking when I'm talking to parents, I talked a lot about knowing what your child's schedule is going to look like right? Where is there going to be PE Where is there going to be recess? Where are the classes that you know as a parent know that they kind of struggle in again math, English, writing whatever it is. Because those may be the times that you have to do something to offset what you see is happening.

Scott Benner 8:30
Yeah, I'm excited you brought that up because during COVID I learned

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I learned that during biology Arden's blood sugar went up she hated that teacher. She really dislike teacher, like on a visceral level did not like being with her. And because of that, I would I would see that the climb and it was it was that real steady, slow like 8595 103 110 120 and it was just go and go and go and go and like what is happening right now. It took me a while to figure out that she just did not enjoy that hour and a half. Like you know, yeah, she and she was I irritated the minute she thought about it, and then I think aggravated the entire time when she was there. Sure, she might have had like a low level of like, anger or I don't know, like, but some emotion that's pushing her up. You know, to me, that's what this variable is about. Like it's it's more about the impacts of school like I don't want to talk about, you know how things change when you have to go to the nurse's office and your Pre-Bolus your Pre-Bolus Singh is different, like I don't know, that fits here. That's not a variable. That's, that's just, you know, circumstance, I will drop in here for anybody listening, that episode number four of this podcast is called texting diabetes. And it is me telling you how I got our out of the nurse's office. So Arden is a senior this year, and has not been to the nurse for something diabetes related since her last day of second grade. And I accomplished all that with just texting. So I just managed her remotely, even when she was little. And you know, there

Jennifer Smith, CDE 11:03
and you have had a benefit of being a dad who has the time to follow as close as you do.

Scott Benner 11:10
Yeah, yeah. I mean, it's not like in the middle of a business meeting. I'm like, hold on everyone. My daughter's 120 diagnol. Up, we have to manage this right now. I, I had the I tell people all the time. Like, if you enjoy the podcast, part of the, you know, part of the thanks goes to Kelly, because I've been a stay at home dad, and I've been able to focus on this stuff for so long. But yeah, I mean, but there are a number of people who have the opportunity. And if you do, it's, I'll tell you to you don't have to go to the nurse's office, suddenly, you can Bolus on better schedules, you can fix Lowe's more quickly, with less, less of an impact and causing, you know, maybe avoid causing a high later, there's a lot about managing at school, that is difficult because of the time gaps. The I have to realize this is happening, then I have to ask somebody, if I can leave, then I gotta walk down to the nurse's office, then I have to wait in line till the nurse can get to me. And by the time all that happens, your your you know, wherever your alarm is, you're 30 points higher, or maybe 20 points lower, you know.

Jennifer Smith, CDE 12:17
And the thing you learned early on, though, given that it was you know, second third grade that she no longer had to go to the nurse was you learned early on to navigate that like school health treatment plan, right? To be able to say, this is what we will be doing. This is how we will be navigating her blood sugar management at school. And unfortunately, a lot of people don't, they don't have that type of very specific plan. Or sometimes the school systems just they don't support it

Scott Benner 12:51
really resistant, and they're tough to get past some of them can be really difficult to get past I'm a little more forceful. And Arden's 504 plan is like rock solid. We have good doctors who will write things in like I've had a sentence and I Arden's 504 plan forever that just says, parents make the last decision. Like I don't care what this this document says if the parent says do something differently, that's what you're doing. That was very helpful. Having ardan cell phone designated as a medical device was very helpful. There's there's a number of different things that you can do.

Jennifer Smith, CDE 13:28
Those are all really helpful little I just that sentence that you have in your 504 because there are a lot of parents who are frustrated in terms of management, because their 504 says things like only only able to treat and or adjust, you know, for blood sugar changes. If blood sugar is here, and or like the whole iob thing. If there's no iob then you can take care of this 300 level blood sugar. Well, you know, to get past that parents will make the final decision period like bold highlight and yellow.

Scott Benner 14:08
Yeah, then then what we're doing is we're satisfying the legal requirements of the document, but putting ourselves in a common sense, ability to make decisions, right? Because in the end, those those ranges are set up, so no one gets in trouble. And, and, you know, some school nurses are like, Look, I don't want to get in trouble. The paper says this, I'm doing this. And they might even know it's the wrong thing. But they're not going to go against the document. So suddenly you put yourself in control. And that's it. Yeah, schools different. Maybe one day I'll have to do a 504 episode. I bet that would go over very well. I don't know. I remember writing that thing. Initially. And it's morphed since then and grown and changed, but I don't know. I remember the day I did it the first time I was still like I don't want to tell like going to school is like I don't want to do yes and no and there was no help back then either. You would just go online and look for like the ADA had this forever document you're like this. This is too much, you know, so I read it and I highlighted things that I thought might be important. And then every year we'd given take a little in horse trade and get rid of some stuff, add some stuff and that was it, but Okay, well, I really appreciate you doing this. Thank you.

Jennifer Smith, CDE 15:23
Yeah, absolutely. Awesome. Hope you have a very nice weekend. You too. Thanks.

Scott Benner 15:38
This show is sponsored today by the glucagon that my daughter carries. g vo hypo Penn. Find out more at G Vogue glucagon.com forward slash juice box. My friend Jennifer Smith has been living with Type One Diabetes since she was a child she was diagnosed over 30 years ago. She holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian and certified diabetes educator and a certified trainer on most makes and models of insulin pumps and continuous glucose monitoring systems. She also works at integrated diabetes Comm.

Guys, I really appreciate you listening to the show. If you are a US resident who has type one diabetes or a US resident, who is the caregiver of a child with Type One Diabetes, please consider going to T one d exchange.org. forward slash juicebox and completing their survey. When you do, you'll be adding important information, important information to the lives of people with type one diabetes and you'll be supporting the podcast. It's literally easy to do. There are no big questions nothing will be asked that you don't know the answer to it's completely HIPAA compliant. 100% anonymous and takes less than 10 minutes you can do it right there on your phone. Your tablet, your computer really is easy. I hope you try it. T one d exchange.org forward slash juicebox. Thanks so much for listening. I'll be back soon with another episode of the Juicebox Podcast.