Teachers and Diabetes

I’ve just finished reading Teacher by Gabbie Stroud and it left me crying in a heap at the end of my bed. It is the most simultaneously heartbreaking and heartwarming account of teaching I have ever read. Stay with me, this pertains to diabetes in school and the new Diabetes in Schools program, I assure you!

This book brings to life the overload of pointless paperwork combined with the fun and vivacity of working with young people. The incredibly rewarding moments in between meetings where management reluctantly enforces governmental policies onto us to ensure we are ‘accountable’, as though the piles of student work and discussion are irrelevant. The mental breakdowns where your friends swoop in to take your class as you uncontrollably cry at your desk, and the feelings of euphoria where you teach a class that gets your kids thinking about the people they are, how they can make the world better,  and why we need to question things around us. The classes that nearly tear you apart, and the classes you love so much you wish you could teach them every subject, every day.  This is what teachers do day in and day out, and this needs to be remembered when creating policy. We don’t have the time to understand diabetes inside and out, but we always have the time to care for and love our students.

Diabetes Australia is bringing in a Diabetes in Schools program, aiming to make management of diabetes in schools clearer for everyone – students, teachers, and parents. It will be the first national consistent training program delivered to teachers & school staff at schools who have students with type 1 diabetes. This is incredibly exciting, but it’s also incredibly important that it’s done in the right way. The survey has already closed (ironically, I was working in the school holidays and haven’t had time to promote it on here before it did), but Diabetes Australia would value anything you have to say.

It’s not meant to replace any of the resources out there already, but just make it clearer re: rights and responsibilities To borrow from Renza, “It will be the first time that Australia has a nationally consistent training program delivered to teachers and school staff at every school with students with type 1 diabetes. The program will cover, (amongst other things), safe administration of insulin, hypo management, and reducing diabetes-related stigma.”

NOW. This is where we need to get it right. To ensure safety and happiness for the students within our care, this program for school staff needs to be practical, realistic, and clear.

It needs to be concise and practical.

As a teacher, I don’t need to sit through an hour long presentation by a health care professional who, although well meaning, has never worked in a school and doesn’t understand the utter craziness of each day. If she’s talking to me about the biology of diabetes and throwing words like ‘beta cells’ out there, I’m probably sitting there filling out paperwork and incident reports. I have so many kids in my head already…Bobby has ADHD, Naveen has autism, Mark has recently diagnosed Chron’s disease and is really struggling, Sarah and Nishani are both anaphylactic to peanuts, Lucas is severely asthmatic, Muhammed comes from a background of trauma and is having meltdowns in class*… I teach up to 150 children, they are all equally important, and I am expected to and should know how to support these students. It is less important that I know what the pancreas does, and more important that I know how I can help Georgie with her diabetes. Give me a quick and practical online module that I can do in a planning period so I know what a hypo is, what she might look like if she’s low, and why she needs to pee all the time. We are very good at picking out what we need to know, and what we don’t. There is a reason that we all perk up at the end of a presentation when it comes to “How to navigate this in the classroom” – that’s the only slide we need!

A teacher is a teacher, not a DNE.

Often, we wear a nurse’s cap. We tend to wounds, know how to use Ventolin and Epipens, and clean up bodily fluids regularly (I’m still scarred from the vomit in my hair from a certain year 7…). But we should not be expected to learn the ins and outs of insulin administration and then deliver a potentially fatal drug to a child. This ‘safe administration’ of insulin needs to be purely administration, and have nothing to do with calculating. The teacher, parent, AND student need to talk together, and it needs to be made easy and straightforward. If your child is at an age where the teacher needs to administer insulin, the teacher will also have at least 24 other little charges running around who also need supervision. I could be injecting your child while another one decides to hit his classmate or stick a crayon up his nose. Put a post-it in the lunchbox with the units needed, and ALWAYS be contactable. I am loath to recommend insulin administration to anyone but teachers/school staff with the youngest of students. I’ve seen six year olds injecting and dosing themselves –  they are amazing little humans. Teachers can and will happily check with your kid before dosing, help them figure out any immediate problems (“Miss! I can’t see the screen of my pump properly!”), but to expect them to count, calculate, and dose insulin is a HUGE ask. I’m obviously type 1 myself, yet I would be wary to do it – kids are so unpredictable, and if the worst possible scenario happened and a child died because of my insulin decision, I would never mentally recover from that.

Help the teacher empower the students with diabetes 

Kids with diabetes are a lot more capable than we give them credit for. The teacher’s role is to support your child with diabetes, not to be a substitute parent.

Give the teacher enough knowledge that they can say “Oh you’re hypo Georgie? No worries, just eat your jellybeans and you can jump back into the activity when you’re ready”. If the student is in a bad way, give them and other staff the knowledge to know that this kid needs to be taken to the office and watched (with potentially a call to a parent if they’re younger) until their levels come back up. The student does not need to be (and doesn’t want to be!) fussed over and have classes stopped.

Show the teacher that having diabetes devices in class is the best way for their student to manage their diabetes. Show them how they might prick their finger, scan their arm, or look at a CGM, and that their student isn’t off task but just attending to their diabetes. Show them how the student is able to essentially do most of this themselves, but sometimes might need a bit of support.

Support the teacher in holding the student accountable if they abuse their situation. I’ve taught kids with diabetes who tell me “It’s not my fault I threw that shoe, my blood sugar is high”, before their face totally drains of colour as I pull out my insulin pump and call them on their nonsense. Support the teacher in making sure that the student is both aware that their diabetes is not an excuse for anything, but is at the same time an obstacle that sometimes needs to be negotiated!

What there needs to be

The training program needs to tell us:

  • What hypos can look like
  • How to navigate hypo treatment in your classroom (treatment in pencil case? Teacher’s desk?)
  • Different sorts of diabetes devices
    • The amount of teachers who have told off kids with diabetes for having a phone when it’s an insulin pump is huge…this isn’t their fault, they haven’t been told what it is, they’re usually mortified when they find out, and schools often have strict mobile phone policies. This needs to be one of the first things mentioned – avoid the situation in the first place!
    • Include pictures of real students wearing CGMs and/or pumps, checking BGLs etc.! We need to see what it looks like in real life.
  • How to adapt assessment for kids with diabetes (extra time etc.)
  • How blood sugars can affect your student’s mood and performance
  • Scenarios in the classroom – case studies of actual experiences of students with diabetes
  • Additional modules on physical activity and diabetes
  • Misconceptions around diabetes (bust those diabetes myths)
  • The best language choices when talking about diabetes in the classroom and to the student

There should NOT be

  • a long section on the biology of diabetes
  • irrelevant modules (i.e. working through scenarios of five year olds having a hypo when I teach high school, and vice versa)

This program also needs to be different for primary and secondary. As a secondary teacher, I probably see my student with diabetes three to five times a week. That student has up to ten other teachers, all of whom need to know a bit about their diabetes and how it relates to their context. I manage diabetes differently in my French classroom than the P.E teacher does in theirs. In the primary context, the teacher will have your child all day (with the exception of some specialist teachers), and because of their age may need to take a more active role in management. We need to have the different ways we interact with the kids taken into account.

Most importantly, there needs to be input from students. I was a student with diabetes, and it was HARD. You need input from the students to help form this training program into something that will help them feel valued, safe, and able to speak out if something isn’t working for them or they’re feeling discriminated against. I regularly found myself being asked by teachers at my last school whether this behaviour was ‘normal’ for someone with diabetes, or what a hypo was, or why this student kept beeping. Lots of kids just want to keep their head down and get on with their life, they don’t want to be an educator and an advocate. We need input from them so we can get down to the business of teaching and let them manage their diabetes in the way that’s best for them.

Teachers are compassionate and want to help. We literally give kids our jackets when they’re cold, our food when they’re hungry, and comfort when they’re upset. My coordinator, when I returned to school after my diagnosis, pulled me aside into her office and fed me tissues whilst I cried at her desk and sobbed “It’s not FAIR”. That was a shared office, and I distinctly remember the whole group of Senior School teachers grouping around me, giving me hugs and pats on the back, with comforting words and practical ways we could make the stress of this new diagnosis a little bit easier. My own staffroom has done the same thing for any student that has come in upset, angry, or needing someone to talk to. We’re there for our students, but we’re also under a whole lot of pressure.

Work with us, talk with us, acknowledge the huge amounts of work we do and the pressure we are under, and we’ll end up with a training program that makes life at school with diabetes a lot smoother for everyone!

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I got through type 1 diabetes and my final year of high school by having amazing and compassionate teachers with high expectations (Hi Ms. McAlpine, you’re still one of the best teachers I’ve ever had!), and friends who supported and helped me stumble along in that first year of learning about my diabetes and what it would sometimes do to my body. At one point I had a huge hypo in one of her Revs classes, and this teacher did exactly what I wanted her to do – came over to quietly enquire how I was, then let my friend take me out into the hallway so I could hypo (I tended to cry when I hypoed back then) in peace. She listened to what I wanted and respected that. Listen to teachers, they love their students and want the best for them. 

*obviously these are all made up names, but not made up scenarios!


8 thoughts on “Teachers and Diabetes

  1. I also just read ‘Teacher’ – and loved it! Gabbie Stroud put into words so well a lot of the things I’ve been feeling about teaching. Great post, Georgie. I hope whoever is designing the diabetes program for schools gets to read this x

  2. I have not read that book, but I have faced many parents in 2 US school district’s who have been upset at their child’s 504 Hearing (it is the hearing to outline the individual education plan). My message is much like yours. We need to empower students with diabetes to care for themselves as much as possible and we need to look out for them when we cannot. Many parents instead wish to ignore the child’s responsibility or instead parents wish to ignore that teachers are our first line care.

  3. Great comments Georgie! I really wanted to tell you though that the type of training modules you refer to, with the content you outlined as necessary, already exits. In late 2017, 3 exceptional online training modules were released by the T1D Foundation, completely free of charge and can be accessed at t1d.org.au. These were developed in conjunction with medical professionals, teachers, parents & students, using the experience of other bodies like Allergy & Anaphylaxis Australia, through the generosity of Lou Richards Memorial. They are based on international school guidelines that can be accessed at https://www.ispad.org/news/420540/ISPAD-Position-S

    The modules cater for the various types of training you refer to, being different at different ages and stages of education, and those with primary care of the child or adolescent. Unlike the Federal Funding proposal that only targets students to the age of 14, these training modules are inclusive of all students, and entirely appropriate in other educational settings, family settings or workplaces where knowledge is necessary to ensure the safety of an employee or family member.

    I would encourage you to explore the modules at http://www.t1d.org.au and ask the questions I am asking, as a mother and a taxpayer, why both our State and Federal governments have ignored approaches by The Type 1 Foundation and The Australian Paediatric Society and not supported or advertised the internationally endorsed programs already available. Data already exists to prove there are significant improvements in students educational experience and staff understanding, student A1C improvement, parent and student wellbeing improvements, and reduced fear for teachers.

    1. Hi! Thank you so much for your detailed comment, I really appreciate it. I actually never knew these existed (I like the three stages, very useful) , how were these promoted to schools? I’m quite active in the DOC and haven’t seen them (totally my fault if I missed them though!) , I would have loved to promote them at my old workplace as it’s what we needed.

      Speaking as a teacher I do think there are some aspects missing in these modules going from what you’ve outlined to me (That’s purely my opinion as I know they’re based on the ISPAD guidelines!) but I also agree with you – I would like to know why I didn’t know these existed and why these resources haven’t been integrated/used (to the best of my knowledge anyway) I would also love to have a look at that data if you have it handy and accessible 🙂 we know it improves wellbeing etc but I’d love to see the studies. Working together seems the obvious notion to me, so I do wonder what’s going on!

      1. Georgie. They were promoted via families of the endos involved, through Australian Paediatric Society, through patients, and by T1Foundation but were sadly rejected by our peak bodies. Your input as a teacher and a T1 I’m sure would be greatly appreciated. I will enquire how best for you to connect but contact via the contact section on http://www.t1d.org.au will link you to the team involved. I will make them aware you will be in contact if thats ok. All working together is definitely the key to providing the right support to all T1s and getting the money where its needed as you say mental health is huge for T1. CGM is a game changer too. Its impact on A1C and wellbeing of the patient and their family is immeasurable
        Thanks for taking the time to look at the program. Spread the word far and wide

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