Back to School Year #13

My daughter went back to school this month- for the 13th time if we include the preschool years. It's still never easy.

Back to school is a challenge for most kids. There are difficult teachers, tough social situations, and strict schedules to keep.  But for my kid and many like her, fall's biggest stumbling block is diabetes.

The back-to-school diabetes problems are ever-present, but not always the same. Some years there's a new nurse who we have to meet and coordinate with. Some years there's a new activity which coincides with the start of school, adding another diabetes thing to think about. Some years the time of lunch has changed (like the 'year of brunch,' linked for you here though I'm going to choose not to reread and relive the horror). Some years gym proves to be a seemingly insurmountable obstacle (like last year, when at some points it was simultaneously terrifying and ridiculous). Some years there's a teacher who just doesn't quite get it. Or one who's extra nervous. This year we've added a daily walk to school, just a couple of blocks but most of it straight uphill.

There's one back-to-school diabetes challenge that's constant from year to year: the overall change in the daily schedule. August is lazy- featuring vacation, the backyard, books, friends and the pool. For the past couple of years August has also included sleeping late at least a few days a week, and alternate sedentary stretches of binge-watching Netflix and power-finishing summer homework. Going from a slow, sedentary start to 6:30 a.m. breakfast followed by a brisk walk to school would be a jolt to anyone's system. Adding diabetes requires an annual investment in juice boxes and a lot of dosage tweaking.

By the fourth day of school this year we'd already changed the breakfast bolus ratio and several basal rates. Twice.  And she was still eating glucose tabs every day half an hour before lunch. We've gotten that to the point where she's usually just barely 80 at lunchtime but then shooting way up into the high 200's late in the day- except when she has marching band in which case she's staying steady and then tanking overnight. We will not discuss what the weekend numbers look like with an ever-changing band/homework/fun/sleep schedule.

Every year kids face challenges going back to school, diabetes-related or otherwise. They come home and tell their parents, who provide any number of phrases to soothe them: This too shall pass. What doesn't kill you makes you stronger. Life's too short to worry about that. Just do your best. And so we'll continue to apply these same pithy phrases to our approach to managing the back-to-school diabetes adjustment. We'll do our best, making tweaks every couple of days, trying not to worry, knowing that we will get through this, stronger in the end, as we always do.

The Nervous Nurse

I glanced at the caller ID on my phone, which read  'SCHOOL.' It was my daughter on the line from the nurse's office.

"I was told to call you.  My blood sugar is 77.  I was 60 when I got here 15 minutes ago. I had a juice then and couple of glucose tabs just now. Lunch is in 20 minutes. It's Mrs. X.  She's not sure if I should go back to class. I'm worried about missing the final review and study-guide handout for tomorrow's math quiz."

"Mrs. X is the nervous substitute nurse, right?"

"Yup."

"Put her on. I'll tell her to let you go back to class."

Encounters with nervous nurses are, at best, like the one above. But they have also been known to go like this:

OMG YOU"RE 47!  SIT IN THIS CHAIR AND DON'T MOVE UNTIL YOU'VE CONSUMED ALL OF THE JUICE IN THIS OFFICE. I'M CALLING YOUR MOTHER RIGHT NOW.

Or, WHAT DO YOU MEAN YOU DON'T CHECK KETONES EVERY TIME YOU'RE OVER 200? THAT'S A VERY HIGH BLOOD SUGAR. DO YOU KNOW HOW DANGEROUS THAT IS?

Or, I CAN'T LET YOU {PLAY GYM/TAKE THE TEST/WALK HOME FROM SCHOOL} THIS AFTERNOON. YOU WERE 62 AT 9 A.M. YOU'LL GO LOW AGAIN!

Our full-time nurse for the duration of fourth grade was a nervous nurse.

We spent hours over the course of that school year talking her down from the ledge. With each phone call we explained again that every blip on the blood sugar graph was not a full-blown medical emergency.

We indoctrinated her, slowly but surely, into the idea of addressing diabetes concerns in the moment and then letting that moment pass and continuing on with the regularly-scheduled programming.

It was a delicate dance of acknowledging her concerns while inserting a dose of reality. We were unable to completely reprogram her but she became less panicky as the year progressed.

Substitute nurses are trickier- they definitely don't know my daughter as well, and they often have less experience with children with diabetes in general. I do hear we're making progress with one we've known since early elementary school. Generally, though, we resort to phone calls like the one above, on a case-by-case basis.

I absolutely understand the concerns. A nurse's job is to focus on the medical concern of the moment, with a 'safety-first' mentality. Which begets worry. Which I understand.  I know worry. I worry a lot about diabetes. So does my kid. But after 14 years, we've learned when to worry and when not to. We have learned when the time to worry has passed. We have learned how to incorporate life with a chronic illness into life lived fully. So sometimes we need to talk a nervous nurse down from the ledge.