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Re: [IPk] Exam Stress/ management

I agree whole heartedly Di! We have so many restrictions forced upon us and I 
definitely do seem to spend a fair amount of time telling people that I can do 
 pretty much what I like in my life, I just need to plan ahead more than most
be aware that things aren't always as straight forward as they might be for a 
"normal" person!
 One example of being restricted (kind of )I have experienced recently is that
husband and I are in the process of moving house and we have had to take out 
life insurance for our mortgage. Seeing as I have pretty good control and no 
major complications (only background retinopathy) I thought that I my premium 
wouldnt be loaded too heavily..... when they came back with my quote they had 
 loaded my premilu by 225%!!!! When I questioned them about this, they said that
 it was beacuse my HbA1c was over 7% (it is 7.3%), I have been diagnosed for
15 years (15 years and 1 month) and I have background retinopathy (hasnt 
everyone after 15 years od diagnosis??) I was sooo cross, I asked them if they 
took into consideration the fact that I exercise daily,  have very low 
cholesterol, normal BP, healthy BMI, few hypos, etc etc, in fact I am the 
fittest person I know... And they said that the important things were HbA, 
length of diagnosis and any complications.
So yes, it makes me cross too when people use diabetes as an excuse!

From: Diana Maynard <email @ redacted>
To: email @ redacted
Sent: Wed, April 27, 2011 10:50:49 AM
Subject: Re: [IPk] Exam Stress/ management

 I'm going to be controversial here. But this is a genuine concern. And of
everyone is different in their needs - I'm not criticising anyone for their 
behaviour here.

 First of all, I'm aware that things are rather different these days for kids in
school, and that of course, nobody wants their exam results to be affected by 
their health. But when I see people asking for such special treatment (and I'm 
not just talking about diabetes, I know there are a lot of other health issues 
 where people also request special treatment) I find it unsurprising that people
 with diabetes are not always treated equally and that people impose
on us (such as the old driving licence issue, jobs such as firefighters and 
pilots and so on, "dangerous activities" such as scuba diving and so on, which 
people have fought to be allowed to do despite diabetes, even just potential 
employers wary about taking on a person with diabetes). We spend half our time 
convincing people that we're just as capable as anyone without diabetes and we 
 shouldn't be restricted, but then we turn round and say "I need do my exam at a
 certain time of day and I need extra time if such and such happens and I need a
special room to do it in". If we're fighting a fire we can't suddenly say 
"sorry, I need a bit of extra time, my blood sugar's high and I can't think 
straight" or if we're saving a life as a medic we can't suddenly say "Sorry I 
let that person die, but my blood sugar was low, can I do it again when I 
 haven't been within an hour of a bolus?" Of course, that's a bit extreme, but
 almost any job we have to make decisions which could affect people's lives,
our company large sums of money, and so on. Whether our blod sugar is high or 
low. After all, if you can only perform well enough in an exam under "perfect" 
 conditions, how does that look to an employer? Somehow, I think we have to find
some kind of balance between proving we're as good as everyone else, but 
 minimising risk of problems. It may mean we have to work a bit harder or faster
so that we can take the time to test and deal with errant blood sugars, but 
isn't that the case with normal life as a diabetic? We constantly have to deal 
with life / jobs / family / travel / whatever when our blood sugars aren't 
 perfect. If I wake up with a blood sugar of 19, having had a massive hypo in
night and only got 4 hours sleep as a result (as I did today) and I've got a 
meeting at 9am, I'm going to have to go to that meeting feeling like a used 
teabag. sorry, but that's life.

As I said, everyone's different, but personally I want no special treatment in 
exams or anything else because I'm diabetic. I spend my life proving that 
 diabetics can do (almost) anything that normal people can do. So personally, it
frustrates me when I see people asking for special treatment. The one that 
always infuriates me is the restaurant scenario "I'm a diabetic and my blood 
 sugar's low so please serve me first." Yes I've heard many people come out with
this. That's what glucose tablets are for.....


On 26/04/2011 23:58, Karen Persov wrote:
> We have put a lot of thought into exam taking and diabetes management, and
> although not ideal, these are my daughter Sarah's views and protocols:
> 1. Stop the clock is essential: It is far more useful for a low than a
> high.. a low can be corrected usually within 15 to 20 minutes.. and she can
> get back on track.. whilst a high takes a few hours for the insulin to work
> and leaves her lethargic and affects vision.
> 2. A bad hypo .although not welcomed..is something more
> considered/understood as a medical emergency, so if really necessary, would
> warrant a re-take of the exam or extra marks if borderline. (there's always
> the chance of the type II  invigilator (or whose great grandmother is
> "diabetic" ) who thinks being 15 or something is ok),Therefore aim low.
> (under 7).. and keep a sweet drink for sipping throughout the exam (as well
> as snacks).
> 3. Adrenaline and other stress hormones are counter-regulatory anyway, so a
> dangerous low/hypo during exams is less likely anyway, so avoid over
> -correcting if a little low with insulin on board. Most
> people experience some stress/anxiety during exams regardless of whether
> they think they are stressed.
> 4. Routine is essential during exams... get timetables in advance and plan,
> if necessary arrange to sit exams earlier/later (you have a separate room,
> so this shouldn't be an issue), so that snack times and meal times are
> constant during exam periods (this is more manageable and removes some
> variables). where possible, try to sit the exam more than 1.5 hours after a
> bolus..so insulin has peaked and you have a reliable test prior to the exam.
> 5. Don't be hesitant to use the "stop the clock".. it is there for the
> purpose... and so what if it gives the odd advantage sometime.. life is hard
> enough.. ...
> 6. At least plus 50% basals for at least 2 hours before the exam,  plus more
> insulin pre-meals along with regular frequent testing.. again use the stop
> the clock to test.. take out 5 mins each hour, check blood glucose...and
> write it down, so it helps plan for the next exam.
> 7. Always make sure the site/canula is working ..which is another reason to
> try to schedule exams one and half a hours after bolus.
> Good luck..
> Karen Persov
>   Mum to Sarah aged 14, diagnosed 13 years ago ..HbA1c today 6.6% (Animas2020
> and Dexcom7plus) (also hypothyroid plus other autoimmune stuff... and David
> (age 19) ..First year Medical Student at UCL.
> .
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