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[IPk] In reply to exam stress management and other issues



Di

I mean no disrespect..but this is an important issue. to allow children and
students the time and means to manage their diabetes during exams is
essential. (I have put the relevant parts of your post in italics and
numbered them..) I hope that makes it easier for you to follow.

1. You have to remember what this list is about - it's a place where we can
discuss issues relating to diabetes and pumps. Just as in ordinary
conversation, one subject leads to another, so gradually the topic of
life insurance evolved as another discussion.


Yes, I agree..but if someone is asking for help and advice..then surely, we
should use that subject heading to give it?  It is helpful if entirely
different subjects, such as the unfairness of life insurance premiums be
headed separately. Instead of Sandie getting the support she asked for..she
got made to feel she was making a fuss because she is diabetic..


2. I don't understand what you mean about pensions - I pay exactly the same
amount into my pension
as a non-diabetic, I don't see how I benefit from being a diabetic in
this respect? Maybe I'm missing something.


When the time comes for you to draw your pension you will be given various
options.. based on lump sum payments and/or a set amount payable for the
remainder of your life. They work this out (in simple terms) by looking at
how much money is in the pot and spreading it over your expected life. To do
this the actuary will assess the risk and..believing your life expectancy to
be lower (due to diabetes).. will expect payouts to cease earlier, it will
result in a higher monthly payout than a non-diabetic with the same amount
of pension funds. This is why men get offered higher monthly payouts than
women..because they are expected to die sooner. The point I was making is
that life or indeed any insurance premiums are based on assessed and
estimated risk and sadly, diabetics, statistically have a lower life
expectancy than non-diabetics. Of course statistics are based on past data
and as glycaemic control improves, so hopefully will life expectancy. One
way is to do this to keep BGs within target as much as possible.


3. On the subject of exams, there are several separate issues. One is
having a major hypo or high during the exam - and there is no reason why
this should not be taken into consideration if it affects the ability to
perform well. Of course if you have a major hypo, you should either be
allowed extra time or to resit the exam - that's the same as any illness
that happens during an exam.

Isn't this is shutting the door after the horse has bolted? This means
asking for a re-sit or trying to prove you didn't perform as well because of
it.. and no, these days exams rules are different, resits are not so
available. Either you are too ill to sit an exam.. in which case a doctor's
certificate is required or you are deemed fit. Asking for concessions after
the event is difficult and more likely to lead to protestations of unfair
advantage for diabetics. The point of "stop the clock" is that, with advance
agreement/notification that this may be required when someone's blood sugar
levels are out of range or for testing. The clock is stopped and they have
that time out to recover. They do not leave the exam room, but cannot
write/read during that time. They notify the invigilator and the time is
noted. They do not need to make a fuss or prove that it affected them
adversely. It is only used if needed, they are not just given extra time per
se.


4. Otherwise, I'm sorry but personally I don't
see the need for extra time - it takes less than 30 seconds to test your
blood sugar from start to finish. It takes about 10 seconds to eat some
glucose tablets or drink some Lucozade. 5 seconds to adjust your pump.
Even if you needed to do that several times in a 3 hour exam, that's
less than a minute out of the whole 3 hours. it's very different from
requiring extra time for being
dyslexic.

The point here is that your focus and attention has moved away from the exam
material and it may take some people several minutes to get back on track. A
comprehension  passage, for example, may take a good 5 or so minutes to
read. Stopping for a blood test, you would have to go back and reread from
the beginning. Similarly, a long  calculation may require some reworking.
It's no different if you are working on something and the phone rings, you
lose more than the time taken to answer the call, it's the overall
disruption.  So even with the stop the clock provision, time out to test
puts you at a disadvantage. Maybe your pump can be adjusted in 5 seconds
(Sarah's can't- scrolling down to bolus, entering her BG..inputting the
bolus amount..maybe even setting a temporary basal..all takes a lot longer).
Maybe you can open a pack of glucose tablets and eat them in under 10
seconds and you are the Sterling Moss of blood testers. For many, the
reality of doing a blood test  (lancet change, opening test strips,
pricking, reading results) and then properly reacting to the results via
pump or snack is more likely take a few minutes, a bit of disturbance and
another few minutes to get their "head space" back into exam mode.. In an
average three hour exam you should accumulate (to get full marks ) 0.55
marks a minute, so over this time the loss of say 6 minutes may equate to
approximately 3-4 marks. which multiplied by say 3 tests could be 10% of
available marks. is significant on most grading scales..


5. And if other students are going to be disturbed by you having a drink or
eating a glucose tablet,
then they really have an issue - it's no more distracting than someone
sneezing. You can turn your pump to silent if the beeping is going to be
distracting.

I am sorry Di, but this comes across as "I'll do what I want and not give a
s**t how it affects others". Each person has the right to quiet and
undisturbed exam conditions so they can perform at their best. Yes sneezing
is distracting.. but is unavoidable.. (having said that I know of a child
who suffers badly from hay fever, who is separated for that reason), but
testing and adjusting..is a paraphernalia, it does make noise and cause
distraction and many kids are upset by the sight of blood. Yes, they may
have issues, but during their exams is not the time and place to address
them. I have fought long and hard and in some instances bitterly for Sarah
to be able to blood test (and previously inject) in public. I have had
battles with schools who wanted her to leave the classroom for blood tests
and loud arguments with waiters who wanted me to take her to the toilets to
inject her prior to the pump.. but when it comes to exams, all reasonable
precautions should be put in place to prevent disturbance to everyone.

6. but the main point for me is it's part of a wider issue
about diabetes in society - and it's clear that people either understand
this or just don't get it.

No.. I am saying that this is entirely about the wider issue of diabetes in
society. The more opportunities (through the odd minor adjustment- NOT
special treatment) that diabetics have to progress through the academic
system and excel, the more they will be represented throughout a broader
spectrum of professions and be recognised as being able to do any job or
career for which they are capable. It is the concept of enabling them and
providing them with every opportunity to succeed AND also control their
diabetes.. not by letting silly pettiness, that they shouldn't have got 5
minutes here or there to test their blood cloud the bigger picture.

7. Sorry but I just don't buy that a diabetic's life will be ruined forever
because they had a minor hypo or slightly raised BG during an exam. Or
because they weren't allowed to have extra time to test their BG. We
have to cope with such things in everyday life as diabetics. If such an
incident is going to prevent an 18 year old becoming a doctor, then I
don't think they're cut out for it in the first place. In the worst case
where you have major problems during exams, there's nothing to stop you
resitting an exam.

well,, you were obviously lucky and did get the grades (but at what cost to
your health?) or maybe when you sat your exams the requirements were less
stringent,..but for someone who may have lost a few marks and then did not
get on their chosen course or were rejected from entry to their chosen
profession, I beg to differ that it does not change their life. I have seen
kids devastated by such rejection. A whole load of top employers will only
consider first time passes.

It's nothing to do with being cut out for it! Perspective entrants to
medical school (and other demanding courses) MUST get first time passes,
MUST get straight A's and cannot resit..most top universities do not accept
resits..unless there are serious mitigating circumstances..such as death in
the close family. My son was fortunate enough to achieve top marks, but some
of his friends missed their grades by just 2 or 3 marks and can no longer
get into medical school! His close friend had a sickness bug during one
paper, having spent the previous night at the hospital and he was not
allowed to resit. His offer to study medicine at Bristol was rescinded,
despite his life-long ambition. With one place for each 30 applicants, they
don't need many excuses. For many exams resits are just not an option..or if
so. will delay or prevent career progression. Your argument has been based
on what it says to employers. well what does it say if you have to explain
that you had to resit an exam or spend an extra year in the 6th form because
you had a hypo?.. (surely 15 minutes time out and a first time pass is by
far the favourable option?)

Given over a set of exams ( which spans a few weeks), it is unlikely not to
have at least one hypo or high reading, preventing optimum performance, why
would you want to risk someone's career and their health by not having a
stop the clock arrangement to test during the exam? I'm sorry but it comes
across as being pig-headed. Do you not take time out at work to test your
own blood or only do this out of working hours I wonder?


8. I - and plenty of others on here - have been through
all this. I wish I'd had a pump when I was doing exams - I was still on
one injection a day throughout the whole of school and MDI throughout
university, my control was awful. I was registered blind halfway through
doing my PhD, but I still finished it in 3 years. My point is not that
I'm amazing - there are lots of people who have similar experiences to
me - the point is that I just got on with it and didn't allow my health
issues to be an excuse for not doing well.

I think this says .. "I didn't have those opportunities..so why should
others" "I had it hard, my control was awful, so shouldn't everyone else's
be."? Shouldn't you be saying instead. "my health suffered because I didn't
have such provisions.. I'm glad this generation have it better"? I think
that such an attitude helps no one and belongs in the 20th century. You
should celebrate that today's students do not have to risk their health to
prove their worth! I'll take eyesight over stiff upper lip any day of the
week.

We all should be striving to ensure that diabetics (whether in school or the
work place)  do not have to compromise their health in order to achieve. You
know the reality; for tight control and a good HbA1c, you need to frequently
test and keep BGs low, therefore the odd hypo is inevitable. Exam times are
stressful and will have adverse effects on blood glucose levels, so these
times do need and should be given greater care and attention.. (perhaps back
then on your once-a-day regimen, you didn't notice the impact..but you admit
your was control awful), but tight control should be encouraged at all
times.  Today's school children are exposed to exams from age seven
continuously until they complete their degrees (that's without post-graduate
study).. a span of 14 years or more..with at least 2 months a year being
high stress. Sarah will sit 12 exams next month alone .. and that's just at
age 14!  Most children /students will have to run high to prevent hypos
unless they know that provisions (and time allowances) are there to deal
with them. Knowing they can have a small time out to regularly test and see
to their diabetes allows them to look after their health as well as giving
them equal opportunities.


My daughter was 18 months old ( May 6th 1998) when she was diagnosed, we
came out of the hospital with lancets as thick as her finger tips and
syringes longer than her hands. I was told to rotate injection sites when
her exposed tummy (not covered in nappy rash from thrush) was less than an
inch in diameter. I could not find one doctor in the UK at the time who had
ever treated a diabetic baby! I hard to learn the hard way.  No books on
babies, no internet, no support at all. she didn't have teeth, so couldn't
eat glucose tablets, she couldn't walk..so suggestions she "run around" to
get her blood sugars down were useless, she couldn't talk to tell me she
felt low or high. so I had to watch her like a hawk and often found her
unconscious on the floor. When she was asleep, I'd pinch her to make sure
she was alive and conscious. As a toddler I couldn't let her run around
without fear of hypos or eat sweets and cakes at other kid's birthday
parties (if she got invited). Thank God that babies and kids these days can
be on pumps, continuous monitors, fast testing kits, new insulins and
technology progression so they can have some degree of normality.  Equally
thank God there are improvements and that most people have a better
understanding of the trials and tribulations of being diabetic and with it
the acceptance that under certain circumstances, some adjustments are
warranted. I had to get on with it with her.. you had to get on with
it..(but at the price of your eyesight and awful control), does that mean
that so should everyone else?

I certainly wouldn't judge or begrudge anyone who is diabetic who is able to
level the playing field, remove just a little of the disadvantage they do
have to make their lives simpler or healthier. This is not..as you say about
health issues being an excuse for not doing well, it's about equal
opportunities and preventing discrimination due to genuine disability. It's
about stopping diabetics from being treated unfairly or having to risk their
health by running high. just to prove they can do things the same as someone
who isn't diabetic.. Have you ever thought that perhaps in this approach you
are just cutting your nose to spite your face? Just maybe. each accumulated
hour that a student's control is better (over the course of their exam
lives) will contribute to a longer life expectancy for the future, a lower
HbA1c, better quality of life..(through health and career/earning potential)
and with it less loading on life insurance premiums and the like?

I will continue to argue that diabetics should be given every opportunity to
succeed in life and whatever reasonable help or adjustment to do so. That
they should not be discriminated against or prevented from doing anything
that it is reasonable to do. I have spent 13 years caring for my daughter's
diabetes and fighting for her to have a top education, best healthcare and
every opportunity in life. I have taught her that with good diabetic control
there is nothing should cannot do. Her average HbA1c is 6.8% over 13 years.
That's partly from me staying up all night to test her blood to ensure she
starts each day with a good BG. She rarely gets a full night's sleep and
will still sit exams or goes into school however tired. This week alone she
has had 3 hospital appointments and has had to catch up the work she missed.
No life isn't easy and I (nor she) certainly won't let her use her health as
an excuse for not doing well..but nor will I allow it or anyone else to
prevent her from excelling either. I hope that she will keep her eyesight,
kidney function and limbs way into old age.. she is only 14 now and has a
lifetime ahead of her. I hope that I live to see a cure and even better
methods of glycaemic control and that everyone including those that had to
do it the hard way will not begrudge our future generations from having
opportunities just because they didn't.


Karen


Mum to Sarah aged 14, dxd at 18 months..also hypothyroid, with Vitiligo,
alopecia, scleroderma, PCOS ..to name but a few. Pumping 7 years, now on
Animas2020 and
Dexcom7plus CGMS and David (not diabetic) age 19, First Year Medical
student. Both about to sit exams next month.
.
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