# T1 support in school for missed lessons



## KLSingleton (May 9, 2022)

Hi everyone,

Just looking for a bit of guidance from anyone who has/had a teen with T1 doing GCSE’s and missing regular classes.

For a bit of background, daughter was diagnosed 4 years ago and generally manages very well. She is in year 10 at school and until recently we’ve had no issues. The problem we’re finding (this year in particular) is that when she goes through rough patches with her levels- often hormone related- she can miss frequent classes, e.g 4/5 a week, which in her gcse years, and in certain subjects could mean she misses almost an entire topic and we’re struggling to find an ongoing solution to help her catch up.

The school have told us it’s their responsibility; which it is, and the teachers need to help her catch up, which they do, but in reality it’s just not happening so wondered if anyone has experienced something similar and had any suggestions to get round it?

She’s very conscientious, normally enjoys school (I know!!) and works so hard so she wants to do the work and gets upset if she’s missed a few, turns up to the next one and has no idea what the teacher is taking about and then struggles to follow what’s happening/catch up.

One of the things we’ve asked that they have implemented is if she’s missed a few and they’re having a test/similar that instead of her doing that the teacher spends the time with her to go over the subject while the rest of the class does the test and they are now doing that which is a help.

However, we’ve also asked that the teachers send her a copy of the PowerPoint slides and a copy of a students notes from the class from any classes she misses so that she can go over them in her own time (and then follow up with a teacher if she has any questions) as she was finding she was having to teach herself parts of subjects she’d missed, with not knowing until she did a test if she’d got it right or wrong- obviously not something. We’d want to happen with her actual exams!!

All the teachers agreed to this but we’re finding that some are great and do so this, others aren’t and she has to them email them to chase it up.

I raised this with the school and suggested that (to make it easier and save my daughter the extra work)


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## Lily123 (May 9, 2022)

Hi @KLSingleton, I’m not quite in Year 10 (year 9) but may be able to help.

What keeps happening with your daughters numbers (mine go high but everyone’s different) 

Does your daughters school use Google Classroom?


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## KLSingleton (May 9, 2022)

Normally the issue is when she gets her period and she levels just go haywire- anywhere from 2-22 and back again several times a day for the whole week. We’ve just started her on the pill to stop her periods to try and settle that down so that will hopefully help, but there are also other times when she might just have a cold etc when they’ll be quite up and down. 

Part of her ICHP though is that if she had either a hypo or hyper then she comes out of class and goes to their student support room until it’s back in range so that can potentially happen every day or at least a few times a week.

She’s often therefore within school grounds, just not in the class lesson, although sometimes of course she is actually at home if she’s having a really bad day with her levels.

Not that I know of, the school certainly haven’t mentioned it if they do. Is that something you use?


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## Lily123 (May 9, 2022)

2-22 is quite a range unfortunately. Could she not take her book with her to carry on with the work?

My school uses Google Classroom and we all use laptops - either our own or borrowed from school - and the teacher posts the work on their and then even if someone is ill at home but the feel up to trying to do the work they can


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## rebrascora (May 9, 2022)

Hi. Afraid I can't help with the teaching issue and catching up, but I was thinking more about preventative steps, so that she might miss less classes.... I just wondered which basal insulin your daughter was using and if she might be better off with a more flexible basal like Levemir if she is currently on a longer acting one. The advantage of this is that the basal dose can be increased or decreased for time of the month or illness to provide much more adjustment for hormones, illness or activity. I love my Levemir for enabling me to make adjustment for my body and lifestyle. Or perhaps your daughter is on a pump and doesn't have basal insulin?
I assume your daughter does have Freestyle Libre and if so, you would hope that that is helping her to head off some of the hypos. If she doesn't have Libre then ask her team about getting it pronto.


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## KLSingleton (May 9, 2022)

Yes bless her, her periods really cause havoc so hopefully the pill will delete that down.

One of the things I was going to ask for is for the slides that (presumably) the teacher has prepared before the lessons are sent to her in advance so that if she has to leave the class she has them, with her book, to carry on the class if she’s feeling well enough to, and then get a copy of a students notes after just to consolidate it so can ask them if they can do that through google classroom.

Do the teachers just automatically put it on there for everyone or do you have to ask for it? Part of the problem is the teachers are not remembering to give her the slides/notes as it’s not routine; which is why I thought it would be helpful for me to email to chase if needed, so will ask school about this again


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## KLSingleton (May 9, 2022)

rebrascora said:


> Hi. Afraid I can't help with the teaching issue and catching up, but I was thinking more about preventative steps, so that she might miss less classes.... I just wondered which basal insulin your daughter was using and if she might be better off with a more flexible basal like Levemir if she is currently on a longer acting one. The advantage of this is that the basal dose can be increased or decreased for time of the month or illness to provide much more adjustment for hormones, illness or activity. I love my Levemir for enabling me to make adjustment for my body and lifestyle. Or perhaps your daughter is on a pump and doesn't have basal insulin?
> I assume your daughter does have Freestyle Libre and if so, you would hope that that is helping her to head off some of the hypos. If she doesn't have Libre then ask her team about getting it pronto.


She has a Libre and that’s definitely helpful, and she’s on Degludec for her basal- we can adjust that up or down but it normally takes a day or two to take effect and the main problem is when it’s her period, it’s so up and down even by the hour that it’s almost impossible to make adjustments to cater for it, but that’s why she’s just started the pill to stop her periods so that should hopefully start reducing the amount she’s missing


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## trophywench (May 9, 2022)

Well if she used a pump, she'd already have a different basal pattern to use for periods.  D Clinics do know what happens to girls on a monthly basis!  @KLSingleton - what has her clinic suggested she could try?


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## Lily123 (May 9, 2022)

KLSingleton said:


> Yes bless her, her periods really cause havoc so hopefully the pill will delete that down.
> 
> One of the things I was going to ask for is for the slides that (presumably) the teacher has prepared before the lessons are sent to her in advance so that if she has to leave the class she has them, with her book, to carry on the class if she’s feeling well enough to, and then get a copy of a students notes after just to consolidate it so can ask them if they can do that through google classroom.
> 
> Do the teachers just automatically put it on there for everyone or do you have to ask for it? Part of the problem is the teachers are not remembering to give her the slides/notes as it’s not routine; which is why I thought it would be helpful for me to email to chase if needed, so will ask school about this again


There’s always the chance that her school doesn’t use google classroom- although they would probably be in the minority. Hopefully the pill will help stop the crazy numbers for your daughter

The slides are posted on classroom either  before the lesson or at the start of the lesson - helpful if we have cover teachers so we don’t fall behind


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## rebrascora (May 9, 2022)

Degludec (Tresiba) is one of the ultralong acting basals and takes several days to see the effects of change so it is likely causing problems with such variable basal needs whereas split dose Levemir will give you pretty much real time adjustment on a day and nighttime basis, but obviously a pump would be the ideal solution to tackle such variation as it can be set for hour by hour.


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## KLSingleton (May 9, 2022)

trophywench said:


> Well if she used a pump, she'd already have a different basal pattern to use for periods.  D Clinics do know what happens to girls on a monthly basis!  @KLSingleton - what has her clinic suggested she could try?


A pump has been suggested but she doesn’t want one.
In fairness her clinic is very good, and we’re in very frequent contact making changes to try and settle it down, but for the last few months her periods have made her levels so erratic it’s very difficult to regulate, they vary dramatically each day of her period, never mind month to month, so even if we find something that works that month it won’t work the next month, that’s why we’re trying the pill to hopefully settle that down.
But still want to try and find a solution with the school to have something more fixed in place for how to catch her up when she kisses classes because even if we do get on top of the issues being caused by her period, she will still inevitably have periods of time if she’s unwell etc when she misses classes


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## KLSingleton (May 9, 2022)

Lily123 said:


> There’s always the chance that her school doesn’t use google classroom- although they would probably be in the minority. Hopefully the pill will help stop the crazy numbers for your daughter
> 
> The slides are posted on classroom either  before the lesson or at the start of the lesson - helpful if we have cover teachers so we don’t fall behind


Well I’ll certainly ask as I think that would definitely help her carry on/catch up on lessons if she’s having to leave them. Thank you


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## KLSingleton (May 9, 2022)

rebrascora said:


> Degludec (Tresiba) is one of the ultralong acting basals and takes several days to see the effects of change so it is likely causing problems with such variable basal needs whereas split dose Levemir will give you pretty much real time adjustment on a day and nighttime basis, but obviously a pump would be the ideal solution to tackle such variation as it can be set for hour by hour.


Ok thank you, not heard of that one but certainly worth speaking to her team about it to see if that can help


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## trophywench (May 10, 2022)

I started on Levemir in the mid 1990s - and only changed from it in the late noughties when I was offered a pump. It's been around for 30-ish years by now, and the T1 NICE Guideline used to suggest Levemir as the first choice for the newly diagnosed.  It has been noticeable in recent years that more T2's seem to be prescribed it but very often once a day - which is no use at all for a T1, as it was always intended to be twice a day.  Furthermore some clinics tell folk to make the doses 12 hours apart and/or the same amount for each.  In use though - those 2 things are baloney!  Don't have to be 12 hours apart, don't have to be same amount. In the finish - but I did have to test test test and experiment* - I used 14u in a morning and 4u at approx 9.30pm at night, whereas I'd first started off 'when I got up' and 'just before I went to bed' with approx. similar amounts.

*but - that is the life's work with T1!


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## rebrascora (May 10, 2022)

Same here with Levemir. Currently 20 units in the morning and none at night but can be anywhere from 0 to 7units for my night time dose depending upon a number of factors. I was on 2 units the night before last and had 2 minor nocturnal hypos so cut it down to 0 last night. May need some tonight but I will have a good idea by bedtime. I take mine 6.30-7.30am most mornings but usually 11pm ish at night unless my levels start showing a pattern of drifting upwards earlier in the evening and then I will bring it forward. I just love how flexible it is to adjust both timing and doses to fit what my body needs and how you see the result of changes straight away.


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## trophywench (May 10, 2022)

rebrascora said:


> Same here with Levemir. Currently 20 units in the morning and none at night but can be anywhere from 0 to 7units for my night time dose depending upon a number of factors. I was on 2 units the night before last and had 2 minor nocturnal hypos so cut it down to 0 last night. May need some tonight but I will have a good idea by bedtime. I take mine 6.30-7.30am most mornings but usually 11pm ish at night unless my levels start showing a pattern of drifting upwards earlier in the evening and then I will bring it forward. I just love how flexible it is to adjust both timing and doses to fit what my body needs and how you see the result of changes straight away.


Exactly!


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## Thebearcametoo (May 11, 2022)

The pill worked really well for my kid at reducing the wild swings of hormones and attendant issues with diabetes management so hopefully that will solve some of the problems. Even if the periods don’t stop it will lead to fewer major swings hopefully. As has been said a pump of a different basal are other options that may help too. Do you use different bolus rates during periods? We have a setting in the meter like for illness to do the maths for us to adjust the bolus that covers hormonal variation (we tended to see highs with PMS then lows with periods but some people find the opposite). The school should be doing more in following through with making sure all teachers give her the missed work.


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