Teaching and Diabetes


(Jm1977) #1

I am a teacher with T1. I eat breakfast before I go into school, and as soon as I head towards school my blood sugar begins to rise and goes too high during the time I am in the classroom. As soon I get to the end of the four periods that I teach, my sugar immediately starts to come down. I have upped my basal a little, changed my carb ratio, but my sugar still spikes. At the weekend I lower my basal as I am out the classroom and my sugar isn’t crazy. In class, my students are great. I love teaching and am not “stressed” in the classroom. However, my sugar spikes seem to be linked to the classroom. I want to stop my sugar from going so high when I’m in class, but am not sure whether to attack my basal or my bolus. Additionally, considering that as soon as I finish class, my sugar heads back down, I want to avoid lows as well if I do up my insulin. Where do I start?


(joe) #2

hi @jm1977,

I get it you like teaching. I like my job too but I can get stressed from traffic, from schedule compression, or from … i’ll be nice… insensitive bosses.

for a long while I had 2 basal patterns… “work” and “other”

imo (because you should maybe ask your doctor), here’s what I would do. on a morning where my bs was on target. skip breakfast. at about 11:30 test my bs. if my bs goes up (or down) it’s basal, if it stays good during this time frame, it’s bolus.

when the weather changes I sometimes hove to re-test my basal. a CGM is perfect for this but you can use finger sticks… you just need more of them.

basal and bolus test protocols can be found in the book “Pumping Insulin”

cheers and good luck


(Linda) #3

Do you tend to drink more coffee on work days than on the weekends? Something to consider. I have to bolus 10 grams of Carbs per cup of coffee even if I don’t eat any breakfast. And that’s for black coffee.


(Jm1977) #4

Thanks. I will do that this week.:+1:


(Hbull89) #5

Hi @jm1977 - I had a similar issue. My doctor suggested adding more protein to my breakfast to slow down my spikes. It worked for me, but defiantly ask your doctor. Hope this helps! Good luck!


(mikefarley) #6

If your diet is consistent and the blood sugar rises are consistent, I suggest trying a temporary basal rate with a percentage increase. For example you might set a 120% temp basal to begin one hour before start of class and end about an hour before the end of class. If that helps, you can slowly raise the percentage. You’ll need to test frequently to make sure the temporary basal doesn’t cause low blood sugar.


(wadawabbit) #7

A diabetes nurse educator may be able to help you. I’m no expert but if you use a pump, one thing you might want to do is use an extended bolus rather than delivering the insulin all at one time.


(Fancy-Nancy) #8

Hi there. I too am a teacher with T1D (32 years). I teach Gr. 3 part-time (I found after I had kids, between motherhood and teaching, my T1 took a back seat, which was counterproductive to overall wellness, so now I work .3). I have had the same issue with the morning rise. What do you eat for breakfast? I changed my meal because I found what I was eating had too high a glycemic index. Breakfast cereal and oatmeal are especially wicked for me. I have added protein and decreased my overall carbs in the morning, and it has helped a ton. A standard workday breakfast is now plain Greek yoghurt with super seed mix (hemp, chia, buckwheat), small piece of fruit, piece of whole grain toast with peanut butter. I also have to bolus for a cup of coffee. When I test at recess, I’m usually around the 8.0 mark, which is where I want it.


(Dennis J. Dacey, PwD) #9

Hi @fancy-nancy, Have you heard the term “morning phenomenon”? There is also fancy medical terminology for this, but what happens [in my lay-man’s language] is that the wake-up substance released by your body has the duel effect of causing your liver to release glucagon; and in addition, the increased adrenaline release cause higher levels of glucose on blood and body - this higher glucose is present in us as well as in people not blessed by diabetes.

This is relatively easy for PWD who employ a pump to manage: I have my pump basal rate increase at 3:30 AM and increase again to a higher basal rate at 5:30 and stay higher until about 8:00 AM. I also have my most intensive bolus ratio set for the hours when I usually eat breakfast. These two tweaks have worked wonderfully for me.

Prior to using a pump, as powerful as 1 unit of insulin for every 7 grams of carb; my daily normal ratio was 1:16.


(Julie) #10

I am also a teacher with Type 1 Diabetes and I’m having a similar problem. My A1C is over 11 right now and over the past year I have chosen to run high so that I can avoid going hypo during my drive to work, during meetings, or in front of my students. Obviously, as my A1C proves, this thought isn’t working for me. I feel so overwhelmed and I have started this week being more vigilant with my bolus. My endo told me that as a T1D we need to be using around 60% of our insulin as bolus and can’t rely on the basal insulin to do the job. Since I started “being better” I’ve had two lows in front of my students this week. Yesterday, I dropped down to 35 at the end of the day with 27 students in front of me. I’m struggling. I know I need resources and that I can’t do this alone and I have asked to have another adult in the room, but have been denied. I’m sorry that I have nothing to offer you, but I joined this group to find another person who is dealing with this struggle. If anyone has any ideas please let me know. I’m struggling.


(lepley) #11

Mine does something similar. When I go to the doctor and print out my BG trend charts, you can pick out exactly what hours I work due to my BG going up right as I head into work and then lowering as I leave work. My doctor and I kind of laugh about it. I am not stressed at my job, and I like what I do. So I agree that I don’t feel that it’s the “stress of my job” playing much of a factor. For me it’s definitely a basal issue that we are working on. I don’t generally eat breakfast until 9am and my BG is already elevated at that point, so that ruled out insulin to carb ratio.

I think Dennis has a point about morning phenomenon; it gets me at 3am and around 6 when I wake up. We just continually work on my basals until we get it right.

Sorry it’s not much of a help, but I think it’s a pretty normal Type 1 thing.


(lepley) #12

Hi Julie,

My suggestion would be to consider a continuous glucose monitor. I think this would give you peace of mind to be able to bolus appropriately. With the CGM, it will alert you if your BG is starting to go low so you can catch it before it gets dangerous or affects your work.

Sometimes I have meetings that I know I will be going into that would be VERY inconvenient to have a low during. To prep for this, I will check my BG before hand and eat a high protein snack. If at this BG check, I am already trending towards low, I will eat a low carb snack…around 10g. This makes me pretty confident that I can make it through the meeting. Thankfully I can feel my lows when they hit right about 70; so if I am in said meeting and I feel that I’ve become low I will correct with a snack that I brought or quietly excuse myself. I would say don’t be afraid to be diabetic…to do what you need to do even in front of your students.

My last suggestion is that if you are truly going to be diligent about bolusing correctly, call or visit your doctor and ask them to look at your readings and adjust your basals. It’s likely that your basals have been increased to make up for bolusing mistakes, so now that you are bolusing correctly, you are going to go low. Don’t back off your bolusing, instead work with your doctor to correct those basals. I’ve been guilty of this myself and my doctor has been gracious to work with me.

I’m sorry that you are struggling. Hopefully some of these tips help!


(Julie) #13

Thank you. I have been working with my endo and a diabetes educator (CPN) pretty closely for a bit. I am currently seeing one of these two practitioners every 3-6 weeks. I have used the Dexcom CGM (4) for a year, but it very often does not send the signal to my phone at work and I THINK it’s because of a weak wireless signal in my classroom. I have been in contact with Dexcom through my CPN and they are sending me the updated 5 transmitter, so I will see if that offers any relief. I just felt that inserting the CGM was leaving with me bruises all over my stomach and it was working less than half of the time, so the hassle of it wasn’t worth the reward that it was supposed to deliver.

I have been T1D for four years and I am a single mom and I work full time. I have been aching to find some support and find some people to talk to about this. Even after four years I am still struggling with how to balance it all. It’s even more frustrating to see people who have been dealing with this for years still trying to figure things out.


(joe) #14

@Juliepb hi Julie,

it is common for some people to have trouble with the CGM it’s not perfect by any stretch. I actually hate CGM because of the reliability and on/off again readings, What use is an instrument that is not 100% reliable anyway? but I have one and I use it from time to time.

morning stress hormones helps “normal” people wake up. for us it means highly irregular blood sugar. some more than others. call it whatever you want…

I found that an old school strategy of doing exactly the same thing on a work morning to be the most helpful. very low carb breakfast (16 g max for me and zero fast carbs: no cereal, no fruit, etc.) and watch coffee because it can cause insulin resistance in some people. getting up much earlier than I have to is also a plus because I can do a routine and give myself time to see if my bs is flat rising or falling. (using a CGM or finger stick).

a little mild exercise like walking can reduce stress hormones or the effects.

using basal or bolus or mild exercise to counter morning insulin resistance is a personal choice. not any 1 is any more “right” than any other.

running your a1c up to 11% just because you have anxiety that you will be low is not good or bad. do not be too hard on yourself. we’re all trying the best we can for today.

the 60/40 is a very broad brush and is not exactly right for everyone. my generality is this: if your basal is more than 50% it’s time to do a little figuring.

carbs plus fat or carbs plus protein makes the carbs “slow release”. that’s what they use in T2 drinks like “glucerna”. cheese and crackers for example, will delay the absorption of the carbs in the crackers. This is why pizza or ice cream can give you high blood sugar 4+ hours after you’ve indulged.

the key to control is testing. test before and after you drive (it’s a safety thing to test before you drive anyway). test at class changes or during class if you have to. very fast carbs like glucose tabs can raise your bs in 10-15 minutes so even if you get a little low, give em’ a reading assignment and chew some glucose tabs.

please don’t get discouraged. normal blood sugar is a very tiny target to hit, and no one is perfect at it.


(Julie) #15

That was a really positive and helpful message, Joe.


(Faye) #16

I’m newly (one day) diagnosed and new to all of this, but I’m also a teacher and really relate to your post. I really love teaching, and I do worry about my ability to take really good care of myself. I had a couple of dramatic blood sugar events at work that led to my diagnosis.


(Jm1977) #17

On the JDRF site they have a free newly diagnosed care packet that I found really helpful 3 years ago. You can sign up for one on the JDRF site. Also Think Like a Pancreas is a read I recommend with probably every other T1.
I felt terrible at diagnosis, but felt so much better physically once on insulin. I also took a week off school after hospital to adjust to injecting, unfamiliar carb counting, experiencing lows etc. I hope you feel back to your normal self soon. I found the boards really helpful and still do.
I teach high school. My kids are great and the school is supportive. I have snacks and glucose in my classroom. Make sure you pick up glucose tablets from the pharmacy. I don’t go anywhere without them.
I hope this helps. Use the boards to question, reply, and vent. This is a huge community that will help you as you need it and be there for support. Wishing you the best. -Joanna


(Faye) #18

Thank you so much for this, Joanna! It’s all really new for me, and I’m not on insulin- I haven’t even met with my dr. Friday, I saw the results that he seemed to expect. I don’t have a treatment plan yet and am failing at my goal not to over think it. My story has not been dramatic like others, and this was the last thing I imagined I had, though it makes retina detachments and some other things make more sense…I knew it was in my family, but i didn’t know the part about getting it later.

I feel worried about work, but mostly about appointments and complications- though maybe I will have less complications with my blood sugar under control. I teach fourth grade.

Was the diagnosis hard for you to accept in the beginning?
Faye


(Jm1977) #19

Everyone responds differently. For me it was a mixture- It was a relief to find out what was wrong and to finally feel better, and shock at pricking myself daily and bewilderment at realizing T1 is with me from now on. I am not a stressy person and really try not to let things stress me too much. I read a lot at first and this helped. I have used the boards many times when I’ve had questions or had to vent, kept regular endo appointments and seen a diabetes educator when I’ve needed too. The diabetes educator was really helpful when I was first diagnosed. I will say there have been times when it’s got me down and frustrated. Last time I got frustrated I couldn’t figure out why my sugar was rollarcoasting so visited a diabetes educator to get me back on track. It is life and I have to deal with it. I just have to look after myself. (Easily said than done!)


(SuperSam101) #20

@momoftwins do you have sugar in your black coffee. I don’t see why you should have to inject if you don’t? Stress from coffee? XD