T1D and exams


(Kimberly) #1

I am really frustrated at the moment. I applied for testing accommodations for the CA bar and I received a letter stating that I have a “temporary disability”. I have no words for how irritating that was reading, considering T1 is a chronic disease. I am allowed traditional medical equipment, syringes, meters, test strips, etc. but the letter is very vague as to whether I can have my cgm. I cannot have my phone held in the testing facility and I cannot have someone nearby to help administer glucagon if I need it. I just found out I have diabetes about two months ago and I barely made the deadline to apply for testing accommodations. The CA bar wont let me appeal anything unless I take the test again and wont make any exceptions even though I sent in my application as soon as I got out of the hospital.

My biggest concern is not having my phone in the same room or held in a locker to notify anyone in case of an emergency or to simply call for a cab. They suggest I keep it in my car or hotel room, however, I am flying from Philadelphia to take the exam and will not have my car with me. The hotel where the test is to be administered for people with testing accommodations is going to cost $300 a night. The test is two days long, 10 hours each day. I am going to end up having to find the way to pay for that so I can leave my lunch and phone in my room.

The amount of hurdles placed makes it so much more difficult for anyone with a medical condition to pass the bar. I don’t know why the bar does not give a special group rate for this hotel considering it is practically forcing people to stay there. The expenses of taking the exam and how I also feel so much pressure to pass in order to keep my job and good health insurance is weighing heavily. The exam is in less than 2 weeks. I guess I just needed to vent because the stress has been piling up.


(Bill) #2

Kimberly,

I took the New Mexico psychology exam back when glucose meters were not available. Prior to insulin pumps, too. And then there was the oral. Ugh! I was licensed in four different states. Been there, done that.

My suggestion to you is this (just my suggestion - do what you and your physician decide is right for you):

Wear your CGM sensor (don’t take it off) but don’t carry in anything that looks like a cell phone or communications device.

Take your blood glucose meter with you, with plenty of test strips. Take appropriate snacks, water, and several packets of glucose gel. Check your blood glucose level before the test begins, hourly, and at each “official break.” Consume carbohydrates as needed to prevent hypoglycemia (anything under 100 mg/dl). Don’t touch your pump (i.e., take a bolus) unless your blood glucose is wanting to creep above 180 mg/dl or thereabouts.

Get up and move around every “official break.”

Under the stress of the exam your blood glucose level is going to rise from the combination of stress and sitting still. It is nothing to panic about. Just don’t let it get too high and, then, continue to run high.

The most important thing is to finish the two days of testing without experiencing a hypoglycemic episode. Hypoglycemia will make it difficult to perform cognitive tasks - that’s the last thing you need. End of suggestion.

After the second day of the test you’ll be worn out - watch your blood glucose level and treat accordingly. It will take a couple of days to “recover” from the stress and inactivity.

Yes, all the expenses and travel are a real pain. But it will be done and over with.

Focus on keeping your blood glucose levels between 100 and 180 mg/dl and you’ll perform well. Pass the exam! And then “recover.”

You can do it!

Bill


(Dennis J. Dacey, PwD) #3

Hello Kimberly @kimberlyelaine , I second most of what @BillHavins suggested. Only difference is that if you are constantly going “low” is to either suspend of enter a temporary basal rate in your pump - if you use a pump. And if you have a CGM dedicated receiver, such as the Dexcom G5 receiver, that is a meter - as any attorney would know.
And when you pass this exam and are admitted to the bar - I have confidence in you, write a letter to the president of the CA Bar informing her of ignorance - P.L. 101-336 specifically states that TypeOne Diabetes is a permanent disability. When that law was written in 1990, T1D was the only disease identified by name.


(sneathbupp) #4

I would add that trying to maintain a 100 to 180 range is a potentially stressful for a recently diagnosed (or any) T1D during an exam. I run in the 200s sometimes at doctor’s advice when gigging with my rock band or kayaking. It is very temporary and often a response to exercise or excitement. Talk to your doc or CDE for advice.


(Bill) #5

The problem when dealing with a state licensing board is their policies and procedures are usually established by the state legislature. And, as we are all aware, the pace of legislatures and legislation often moves very, very slowly. State boards are often many years behind when it comes to dealing with people who have special needs.

State boards also often use “national exams” as part (but not all) of their examination packages. The procedures for administering “national exams” are often very tightly-controlled and, generally, impervious to “individual exceptions.”

Unless you are well-known (and well-respected) by members of the board you absolutely don’t want to “make waves.” Slip in, take the test, and get out.

Given the “time frame” of Kimberly’s diagnosis and, then, bar exam date, all that can be done is a “band-aid solution” - something that will help her get through it. Nothing fancy, in my opinion.

Bill


(Kimberly) #6

After the exam I’ll send a respectful letter about this. Their administrative process is not efficient at all and very unfair. It took days for me to apply for the accommodation just for me to be able to bring orange juice into the testing room. A bit extreme considering the various other items the bar allows into the exam room and the necessity of this item for someone with T1D, especially for someone in a similar situation as me who was just diagnosed, still hitting lows and highs relatively frequently, and was hospitalized for a week with an A1C of 16%. I definitely would prefer to get in and out without causing a stir but this is something worth bringing to their attention. If I am unable to advocate for myself and for other’s with my condition then that would truly be ironic for someone in my profession. Feedback is necessary for this sort of thing to be improved.

I am not on the pump and am still using syringes and pens. I am buying a frio pack to take with me into the exam room since there most likely wont be a fridge for me to use to store my insulin. Are they any good?

I was thinking about buying compression socks since I have been having trouble with circulation and my legs swell pretty visibly after an hour of sitting. Does anyone have any suggestions about which brand is the most reliable and useful?

I wake up with blurry vision sometimes although it adjusts after a while. Should I use eye drops?

Also, does anyone have any recipes or examples of breakfast/lunch foods that will keep me steady and energized for a few hours? I was thinking of having eggs, bacon, and a slice of wheat bread for breakfast and a salad and BLT for lunch. I also like to drink a lot of caffeine so I will probably have coffee and diet soda. I just found out that caffeine spikes your sugar but I wasn’t sure to what extent?

Also, I just want to say thank you to everyone who responds, its great knowing that someone else has gone through all of this and succeeded. Although it would be preferable if no one had dysfunctional pancreases.

Thanks again!


(Hollie) #7

That’s so unfair that the process puts you at such a disadvantage! It makes it all so much more stressful.
I’m jealous you’ve got a CGM after only 2 months! Are you in the US?
I use the frio bags and they’re really good! Literally just soak them in water and then they stay cool for like 2-3 days it’s amazing!
And I often have porridge as my pre exam food and then take plenty of snacks as personally I find the stress of exams and sitting still makes me go low!


(bsteingard) #8

Hi, @kimberlyelaine,
There’s definitely a flaw in the system and you’re right to be frustrated. You’re also kind of lucky, though. I was denied all accommodations when I took my Laboratory Animal Technician exam. I wasn’t allowed to bring anything in with me. Not even glucose tablets. I love @BillHavins’ advice. Very similar to advice I’ve given other students in the past. And pretty much what I did for my certification (except my meter and snacks were in a locker in the hallway). I agree with @sneathbupp, too, though. If 180 is a difficult target for you, don’t stress too much if you wind up in the 200’s. It’s more important that you avoid low blood sugars during the exam.

I use frio packs for traveling and they work pretty well. It won’t necessarily keep your insulin cold, but it will prevent it from getting warm. Honestly, though, unless the exam room’s a sauna you don’t really need to worry about refrigerating your insulin during the day. I carry my humalog around in my backpack during the day and refrigerate it overnight. I’ve been doing that for decades and I’ve never had a bottle of insulin go bad. I like the frio packs for traveling, though, because they protect the glass bottles in transit and are a decent alternative if I find myself in a hotel room without a refrigerator.

Your breakfast and lunch ideas sound pretty good to me. The protein and fat will help keep your blood sugar steady. Not really sure what to tell you about caffeine. I’ve never noticed it have an effect on my blood sugar but I don’t consume that much of it.


(Kimberly) #9

Hi Hollie,

I live in the US and I bought my free style libre mostly out of pocket. I am not sure how much my insurance covered but it ran me 300 for a months supply from what I remember. It was more expensive since I had to buy the reader too. I paid about 60 bucks per sensor. Now I have had to switch insurance companies for my gap in coverage so I am not sure how much they will cover. I am kind of scared to find out because I’ve become so reliant on the thing. The frio bags did the trick! Amazing product. I found out that I spike pretty high on exams :nauseated_face: but I finally went through my exam and only hit one low during the two days of testing.


(Kimberly) #10

I am very glad that I was able to bring tablets in with me even though I had to go through a whole petition process and it was like I had to plead a case to let them bring them with me. A bit excessive in my opinion but I went through the hoops.

During the exam I went through sky rocket highs and one pretty bad low. Today I am more stable than I was then. At the time I was recently diagnosed my a1c was 16% and I went through a pretty extreme case of dka according to my docs so I was going through roller coaster bgs. It was really hard for me to get to 180 and stay there. I would drop and spike so suddenly and very drastically. I still have so much to learn but now I am more aware of how I react to things. I was given a half unit pen since I am very sensitive to insulin and drop really quickly at times.

The frio bag was perfect! I really can’t get over how good of an invention it is.

I’m a caffeine fiend especially when I study so it has a noticeable effect. I think it might add to the stress Im under when studying since it makes me hyper. Otherwise caffeine doesn’t do too much to me but I normally don’t drink as much as I do under testing conditions.


(bsteingard) #11

I’m glad you got through the exam. It’s a tough situation right after diagnosis, but it sounds like you’ve learned a lot and next time (if there’s a next time) it will be easier. I’m also glad the frio pack helped. You’ll get the hang of the swings eventually. Get as much data as you can (blood sugar readings, nutrition records, exercise logs, etc) and go over everything with your health care team as often as possible. Try to address one thing at a time, making small changes every few weeks, and gradually things should smooth out. Good luck!