D-Mom Blog

The sweet life with a diabetic child

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Kids First, Diabetes Second Book: Talking To Other Students

Summary: This is the second of three monthly excerpts about taking type 1 diabetes to school. Last month I shared some tips to help navigate the school day with diabetes and next month I’ll talk school parties. There is an entire chapter in Kids First, Diabetes Second about diabetes management at school including information on 504 plans and developing a working relationship with teachers.

Kids First Diabetes Second Book Students

Talking To Other Students

There are two camps when it comes to educating classmates about diabetes. Some parents want to educate all of their child’s classmates about diabetes. For younger grades you can easily educate children by having a short show-and-tell, including reading an age-appropriate book about diabetes. Tell children in simple terms what diabetes is (that your child’s pancreas does not work and she can’t make her own insulin), and that they won’t catch it, which might be a common fear of young children. Show them your child’s blood glucose meter and supply bag, and explain that they may see your child checking blood sugar or even getting an injection, but this shouldn’t worry them. Tell them that your child might have to eat extra snacks, like on the way to PE, or that she may have to have juice if her blood sugar is low. Instruct them that if they ever notice your child acting differently, or if they can’t wake her up, to let a grown-up know.

The other camp doesn’t want to bring even more attention to their child, thus making the other children think he or she is different right out of the starting gate. We chose this approach for several reasons. While we made sure that teachers and staff were educated and trained, we decided not to do formal teaching to the children. Instead, we took a “wait and see” approach. We found that children asked Q, the teacher, and the nurse questions as they had them, and that Q was confident enough in herself to respond. On many occasions when I was at the school, children would ask me specific questions like how Q got diabetes, why she has to check her finger, and why she had to get shots.

In kindergarten, Q took it upon herself to do a show-and-tell. She displayed her medical ID bracelet, told the kids about checking her blood sugar and getting insulin, and fielded questions. I was proud of her for taking the initiative when she was ready to educate her peers. I wish I had been a fly on the wall that day!

Kids First Diabetes Second Book

Learn More

If you’d like to learn more about the book, you can read more on the Kids First, Diabetes Second book page. It’s available widely in print and as an eBook from book sellers such as Barnes & Noble, Amazon.com, and IndieBound. And if you do read it and find it to be a valuable resource, I would greatly appreciate if you could write a review on any of the online retail sites. Thanks!

Disclosure: This post contains affiliate links to booksellers.

Please remember that I never give medical advice. Ask your endocrinologist or pediatrician for advice about your own child. Make your own informed decisions for your own child.

 

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Managing Type 1 Diabetes at School

Here are over a dozen articles about managing type 1 diabetes at school including information about 504 plans, working with school staff, school nurses, school lunches, medications and supplies, standardized testing, and more.

School With Diabetes

I know I say this every August, but where did the summer go? Seems like I was just lugging home all her diabetes supplies and making an End of the School Year Checklist. Last year we had uncharted territory as Q began middle school. With that came different logistics because she changed classes all day long, had PE every day (and they sometimes go off school grounds for PE), participated in before and after-school activities, and even rode the city bus.

I’m in the process of filling out the fourteen-page diabetes care plan (yes, I said fourteen!) that the district requires and getting all her medical paperwork in order. We made a few minor changes to her 504 plan last year, and I think we are all set on that front.

Not to mention that our school supply shopping list includes things like glucagon, juice boxes, and a back up of supplies to be kept in the nurse’s office.

You’ll find lots of information here on D-Mom Blog about sending kids with diabetes to school: posts about school nurses and diabetes at school and school lunches.

And I want to reassure parents sending their little d-kid to preschool or kindergarten for the first time this fall that your kiddo is going to be just fine — you might shed a few tears that first day — but your kid is going to be alright.

If you are interested in more information than what’s here on the blog, there is an entire chapter in Kids First, Diabetes Second devoted to school. And, of course, the ADA (Safe at School) and JDRF (School Advisory Toolkit) have resources as well.

504 Plans and Testing

Diabetes at School 504 Plan504 Plans

If you read only one post about diabetes at school, read this one. I include a list of the many things you might want to add to your child’s 504 plan and why. And if you are unsure if your child needs a 504 or if your school has said that a care plan is the same thing (it’s not!), I urge you to get a 504 started for your child. Right now. Before you have issues. It’s your child’s right, and because of their diagnosis with type 1 diabetes, he/she cannot be denied a 504. (And even private schools must adhere to the law if they receive even a dime of annual federal funding.)

Read 504 Plans (Must read! Lists lots of things to consider adding to your 504, plus links to great resources.)

Standardized Tests

Oh boy. Don’t even get me started on my feelings about standardized tests including the newly instituted PARCC. Because of the way things went down for us in fifth grade, I actually ended up opting Q out of the second round of testing. I personally feel classroom time is better spent. She did go ahead and take the PARCC each year in middle school, and I told her that she shouldn’t feel any pressure to perform.

All opinions aside, you can help set your child up for testing success by making sure that everyone is on the same page and by including “important tests” as an item addressed on the 504. And please note that this doesn’t just apply to tests like the PARCC. It also applies to any important test that the school will use as a placement or assessment and even applies to the SAT and ACT.

Read Standardized Tests

Working With School Staff

Hello TeacherHello New Teacher, My Kid Has Diabetes

This is a sample email to notify new teachers at the beginning of the school year about your child’s type 1 diabetes and highlight important aspects of the 504 plan.

This includes downloadable PDFs about Glucagon and “10 Things Teachers Should Know About Diabetes.”

Read Hello New Teacher, My Kid Has Diabetes

Building RelationshipsBuilding A Working Relationship With School

We always had a pretty good relationship with Q’s grade school, but things broke down a little in fifth grade when we ran into a few issues that I felt could have been avoided or addressed better. I was glad to have a fresh start in middle school.

The following is a guest post by Scott Benner of Arden’s Day, which is so good that I also included it in my book Kids First, Diabetes Second.

Read Building A Working Relationship With School

Training School StaffTraining School Staff

Read Training School Staff

Following ProtocolsFollowing Protocols At School

We have to put trust in the nurses and staff that take care of our children to make sure that they are kept safe each and every day. Mistakes happen…sometimes with serious consequences. I offer a list of suggestions on how you can help to minimize the potential for mistakes.

Read Following Protocols At School

Maybe not alwaysMaybe Not Always

Just because Q is pretty self-sufficient in her diabetes care, I don’t want school staff to become complacent.

Read Maybe Not Always

Supplies & Medications

Low BG Classroom KitsLow Blood Sugar Classroom Kits

In past years we’ve had these kits stashed in a few different locations at school. In middle school, Q was all over the place and often going from the third floor to the first and back again, so I created one of these boxes for each classroom (minus the BG meter).

Read Low Blood Sugar Classroom Kits

Glucagon TipsGlucagon Tips

Without even realizing it, Q went from needing a half dose of glucagon to a full dose. Restocking for back-to-school is a good time to make sure that you are using the right dosage.

Read my tips on glucagon at school including how to train nurses and staff members using expired glucagon kits and an app that can help you keep track of expiration dates.

Read Glucagon Tips

Last Day ChecklistEnd Of The School Year Checklist

I know this post is about what I did at the end of last year, but in addition to being about wrapping up each school year, it’s also a chance to reflect and look forward on what to do differently the next year.

Read End of the School Year Checklist

Tips For D-Kids

Kids First Diabetes Second Book StudentsTalking To Other Students

There are two camps when it comes to educating classmates about diabetes.

Some parents want to educate all of their child’s classmates about diabetes. For younger grades, you can easily educate children by having a short show-and-tell, including reading an age-appropriate book about diabetes.

The other camp doesn’t want to bring even more attention to their child, thus making the other children think he or she is different right out of the starting gate.

Read Talking to Other Students

Kids First Diabetes Second Book schoolTips For Navigating The School Day

Here are some things that you can put in place so that diabetes management goes a bit more smoothly during the school day including lunchtime, substitute teachers, lockdowns and severe weather, taking the bus, and field trips.

While some of this changed for us as Q became more independent, much of it stayed the same during middle school.

Read Tips For Navigating The School Day

Food And Celebrations

Lunch StrategiesMaking School Lunch Run More Smoothly

Read Making School Lunch Run More Smoothly

Cupcake StashCupcake Stash

Whether it’s because you are dealing with a food allergy, celiac, or need carb counted treats at school, here’s my tip on making sure you have something safe or appropriate for your child. Because we all know that somehow there is a celebration almost every single week! (Seriously, can we stop all this crappy junk food at school?!)

Read Cupcake Stash

Kids First Diabetes Second Book School PartiesAnd Then There Are The Parties

Read And Then There Are The Parties

And Many More…

Those were just a selection of the posts here on D-Mom Blog about diabetes at school. You can click these links to look for specific topics:

Additional Resources

ADA Read the Safe at School: Safety and Fairness for Children with Diabetes information and learn about your legal rights for your child at school.

JDRF You can request a School Advisory Toolkit and can also ask that a mentor contact you.

Children With Diabetes Sample 504 plans by age that you can download.

Please remember that I never give medical advice. Ask your endocrinologist or pediatrician for advice about your own child. Make your own informed decisions for your own child.

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Kids First, Diabetes Second Book: Tips For Navigating The School Day

Summary: This is the first of three monthly excerpts about taking type 1 diabetes to school. In the coming months I’ll discuss talking to other kids about diabetes and the dreaded school party. There is an entire chapter in Kids First, Diabetes Second about diabetes management at school including information on 504 plans and developing a working relationship with teachers.

Here are some things that you can put in place so that diabetes management goes a bit more smoothly during the school day. While some of this has changed for us a little as Q becomes more independent, much of it has stayed the same as she entered middle school.

Now that Q has more activities in middle school, both at school and away from the school, we have relied on her texting me to let me know about blood sugars, etc.

Kids First Diabetes Second Book school

Tips For Navigating The School Day

Lunch Time

  • Kids have a very short period of time to eat their lunch. Children with diabetes should be allowed to go to the front of the line to get their meal or milk.
  • Ask if your school district publishes their menu and nutritional data on their website.
  • If you need a substitution, ask for it. We ask that Q be given fresh fruit instead of juice when it’s served because juice can spike her blood sugar. The school district might require a letter from your doctor.
  • Ask that the nurse not hover over your child, as socialization with peers is an important aspect of school.
  • Ask that injections or insulin by pump be given promptly so that your child doesn’t miss recess, which is also important for socialization and daily physical activity.

Substitute Teachers

  • Lesson plans should clearly identify that your child has diabetes and specify who is trained in your child’s diabetes management.
  • Include a simple one-to-two page instruction sheet including symptoms and treatments for low blood sugar. This instruction sheet should have a photograph of your child so a substitute teacher can identify her.
  • The daily schedule should include times that diabetes-related activities ought to occur, including scheduled blood sugar checks and snacks.
  • Remind the substitute teacher that the child has free access to water and the bathroom, and may need to see the nurse or other staff throughout the day.

Lockdowns and Severe Weather

  • Lockdowns and severe weather are hopefully uncommon, but you need to develop a plan.
  • Place an extra supply kit in the room where your child is likely to be during a lockdown or when students take cover for severe weather.
  • Stock the supply kit with a blood glucose meter and test strips, fast-acting sugar for treating low blood sugar, glucagon, and snacks and water in case they are there for a long time. The kit should include a simple one-to two page instruction sheet including symptoms and treatments for low blood sugar and your phone number.
  • Develop an exit strategy. Is there a window or another way for emergency workers to get to your child in case of a severe hypoglycemic event?
  • Decide on a form of communication between the teacher and emergency workers or administration. Does the teacher have a cell phone, is there an intercom system, or can they be given walkie-talkies?

Taking the Bus

  • Ask if your child can be the last one picked up in the morning and the first one dropped off after school. This will shorten the amount of time your child spends on the bus.
  • Have your child’s blood sugar tested at the end of the school day before she or he gets on the bus. Work out a plan to treat low blood sugar on the bus. It may include having the child eat a snack, notifying the bus driver or monitor, and/or calling you.
  • Is there a bus monitor? The monitor and the bus driver should be trained, just like school staff, to identify and treat low blood sugar.
  • Have your child ride with a sibling or a buddy who can let the bus driver or monitor know if your child is having a low blood sugar, and can also make sure that your child gets home safely each day when dropped off at the bus stop.

Fieldtrips

  • A trained person, besides the teacher, should accompany your child on fieldtrips. This can be the nurse, if available.
  • The teacher may be too busy keeping track of the other students. A designated person, such as the nurse or yourself, can make sure blood sugar is checked and snacks are given at the scheduled times, and can treat low blood sugar.
  • If the nurse is not available, consider volunteering as a chaperone.
  • Don’t forget the diabetes supply bag. List it as a student on the roster so that it is accounted for before leaving school grounds and is not left behind.

Kids First Diabetes Second Book

Learn More

If you’d like to learn more about the book, you can read more on the Kids First, Diabetes Second book page. It’s available widely in print and as an eBook from book sellers such as Barnes & Noble, Amazon.com, and IndieBound. And if you do read it and find it to be a valuable resource, I would greatly appreciate if you could write a review on any of the online retail sites. Thanks!

Disclosure: This post contains affiliate links to booksellers.

Please remember that I never give medical advice. Ask your endocrinologist or pediatrician for advice about your own child. Make your own informed decisions for your own child.

 

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Kids First, Diabetes Second Book: Sharing the Diagnosis

Summary: Tips on sharing the type 1 diabetes diagnosis with other children, family, and caregivers.

Sharing the T1D Diagnosis

Sharing the Diagnosis

It’s natural for friends and family to want to call or stop by in those first weeks after the diagnosis. They only want to help, but you may be too busy trying to figure out how you’re going to keep your child healthy to deal with a flurry of visitors. It’s okay to ask friends to hold off on visits until you get a handle on things. When you’re ready, here are some good ways to share the news and teach people about diabetes:

Young Children

  • Read one of the various age-appropriate children’s books to your child’s class.
  • Show the children what’s in the “kit” you (or your child) carry so they don’t think it’s so mysterious.
  • Make a collage showing your child measuring a meal, getting their blood sugar checked, receiving an injection, etc., to show to the class.
  • Some children think needles are scary. Explain that it’s a small needle, not like the vaccinations they get, and that they shouldn’t be nervous if they see your child getting an injection.
  • Tell them that they will not catch diabetes from your child. Explain simply that her pancreas stopped working and she can’t make her own insulin. She has to check her blood sugar and get injections to stay healthy.

Friends and Family

  • Invite several people over at once so that you don’t have to give the same talk multiple times.
  • If they are not caregivers of your child, you can teach them the basics, such as the signs of low blood sugar and how to treat it. Let them know that they don’t have to make special accommodations, such as stocking up on sugar-free products, and that your child can still be included in celebrations, including eating cake.
  • If your child is self-conscious about her diabetes, you may choose to do this without her present.

Caregivers

  • Share books covering the basics of diabetes care, such as Diabetes Care for Babies, Toddlers, and Preschoolers or A First Book For Understanding Diabetes. You want to educate caregivers without overwhelming them with too much information.
  • Go over the signs and symptoms of low blood sugar, including treatment using the “rule of 15s” (see chapter 4), how and when to use glucagon, signs and symptoms of high blood sugar, and when to check for ketones.
  • Give an introduction to counting carbs and giving insulin if this will be one of their duties when caring for your child.
  • Hand out a simple one-to-two-page instruction sheet that includes all the important information at a glance.
  • Reassure them that they can do this, too, and that you are only a phone call away if they have questions.

Kids First Diabetes Second Book

Learn More

If you’d like to learn more about the book, you can read more on the Kids First, Diabetes Second book page. It’s available widely in print and as an eBook from book sellers such as Barnes & Noble, Amazon.com, and IndieBound. And if you do read it and find it to be a valuable resource, I would greatly appreciate if you could write a review on any of the online retail sites. Thanks!

Disclosure: This post contains affiliate links.

Please remember that I never give medical advice. Ask your endocrinologist or pediatrician for advice about your own child. Make your own informed decisions for your own child.

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Kids First, Diabetes Second Book: Training School Staff

Training School Staff

When I wrote the school chapter of the book Kids First, Diabetes Second, I think Q was in second or third grade. She has definitely become more independent in her care since then, but I still do the same training and make sure that her 504 plan is followed. In the book I have a list of supplies to stock at school, information about 504 plans, as well as quite a few tips you might find useful to navigate diabetes at school. The section “Training School Staff” is part of the chapter called “School Days.”

Training School Staff

When Q started kindergarten, we contacted the assistant principal during the summer to set up teacher training, and we have continued to do so every new school year. I like to call a meeting every year in the day or two before school starts to train all of the teachers who oversee her throughout the school day. This includes the classroom, art, music, and PE teachers, as well as the librarian, the assistant principal, and the nurse. For some of these staff members, it is a refresher course; but for the classroom teacher, it is always brand new.

During the training session we go over key aspects of her 504 plan, especially the items that pertain to her daily school life, like access to water and the bathroom, checking blood sugar as needed, snacking at scheduled times, and checking blood sugar before important tests. I stress that her supply kit is listed as a separate child on the class roster, so that it is taken (and brought back) on field trips, and any time she leaves the immediate school grounds, such as during a fire drill.

I go over an instruction sheet I create for teachers line-by-line. It includes: the symptoms of low blood sugar; Q’s usual symptoms and the language she uses to describe them; the rule of 15s; low blood sugar treatments; when to use glucagon and to call 911 if it’s needed; and the symptoms of high blood sugar, along with protocol for checking and treating. I point out the three phone numbers they can call to reach my husband or myself, and encourage them to call with any questions. This sheet also includes a photo of Q so she can be easily identified, and it is placed in the lesson plan any time there is a substitute teacher. I put the instruction sheets in plastic page protectors and give one to each teacher, the nurse, and assistant principal.

I then show them the classroom kit, and we decide where each of the kits will be kept. We keep one in the classroom, usually on a shelf near the door, and one in the music room in the supply cabinet because that’s where she would likely take shelter during severe weather or a lock down situation. I go through the entire contents of the classroom kit because teachers might not be familiar with each of the items.

Although Q tests her own blood sugar, I show staff how to load a lancet, lance a finger, and apply blood to the test strip in the meter. If she were unable to think clearly or were shaky, someone might have to test her blood sugar for her. When I demonstrate, I’m always surprised at how much it hurts!

The training session culminates in a demonstration of the glucagon kit. I explain that, while the need for glucagon is not common, it is very important that if she is unconscious or having a seizure, the glucagon must be given immediately and 911 called. Not doing so can result in brain damage or death. This always scares teachers. I assure them it’s like an insurance plan: you need to be prepared just in case, though you may never need it.

I think glucagon makes people nervous for three reasons. First, they are nervous because it’s used in an emergency situation for the child, and they are afraid they won’t remember what to do under pressure. Second, they are afraid that if they do it wrong they will do more harm than good. And third, that needle is really huge!

When training school staff, I try to be as calm and reassuring as possible. I show them what the plastic case looks like and where they can find one in an emergency (in Q’s d-supply bag, in the classroom kits, in the main office). I show them exactly how to use the kit and remind them to have someone call 911. After horrifying the teachers with the glucagon instruction, I assure them, once again, that they will get the hang of things even if they are feeling overwhelmed with the depth of information, and I tell them not to hesitate to reach out to the nurse, or assistant principal, or me with any questions.

After the regular staff leave, I stay a bit longer for more in-depth training with diabetes personnel listed on Q’s 504 plan, which include the school nurse and assistant principal. With these staff I go into more detail about checking ketones and blood sugar, making sure she gets insulin for the food she actually eats at lunchtime, and how to use her insulin pump.

Kids First Diabetes Second Book

Learn More

If you’d like to learn more about the book, you can read more on the Kids First, Diabetes Second book page. It’s available widely in print and as an eBook from book sellers such as Barnes & Noble, Amazon.com, and IndieBound. And if you do read it and find it to be a valuable resource, I would greatly appreciate if you could write a review on any of the online retail sites. Thanks!

Disclosure: This post contains affiliate links to booksellers.

Further Reading…

More posts about glucagon

Back to School with Diabetes: Lots of information and links!

I have an entire chapter about school in my book Kids First, Diabetes Second.

Read more posts about Diabetes at School.

Please remember that I never give medical advice. Ask your endocrinologist or pediatrician for advice about your own child. Make your own informed decisions for your own child.

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Diabetes at School: Making School Lunch Run More Smoothly

Summary: School lunch with type 1 diabetes can run more smoothly if plans are in place for getting medical care (BG check and insulin), having enough time to eat, and getting recess like everyone else.

Lunch Strategies

A recent news story (which I won’t link to because I feel this child needs her privacy) got me thinking about ways to make lunch at school run a bit more smoothly for our kids with diabetes. I think what’s important is making sure all staff are on the same page from the classroom teacher to the school nurse (or whoever does the lunchtime BG check and insulin) to the cafeteria workers.

The reality is that at some schools the nurse may have to attend to several children with diabetes as well as dispersing medication to many kids. Implementing every single of one my suggestions may not be possible at every single school for each child. But perhaps one or two of these suggestions could help lunchtime run a little more smoothly for your child.

I think there are three key issues that need addressing regarding lunch at school with diabetes:

1. Getting proper medical care (BG check and insulin),
2. Having sufficient time to eat since insulin is based on the number of carbs consumed (particularly important if a child gets her insulin before eating), and
3. Heading to recess with the other children on time because lunch is also about socialization and getting energy out as much as it is about the actual eating (and we don’t want our kids missing out on recess because of diabetes).

In my opinion, it’s good to add some of these accommodations to the 504 plan, while others can be a verbal understanding between you and the school nurse and/or lunch staff and school administration.

(Read: Diabetes at School: 504 Plan)

Location and Timing of Pre-Lunch Blood Sugar Check

I hear a lot of parents say that their child must make a long trek to the office or nurse’s office for the pre-lunch blood sugar check. It’s my philosophy for all aspect of diabetes management in the school that the care come to my daughter as much as possible because it reduces the amount of time spent away from classroom instruction.

Our school nurse comes to my daughter’s classroom a few minutes before lunch begins to check her blood sugar and pre-bolus. My daughter will either walk with the class to the lunchroom or she and the nurse will go ahead and start walking down.

I personally do not feel that a younger child should be missing any part of the lunch period for blood sugar monitoring, especially if it requires them going to the office.

Lunch Line

I noticed when my daughter was in kindergarten that often the lunch line was very long. Whether she just needed to grab a carton of milk or if she was purchasing hot lunch, she just wouldn’t have much time to sit down and eat if she spent a chunk of time in line. Because her insulin was based on the amount of food she ate, I wanted to make sure that she had the most amount of time possible.

We had an accommodation added to her 504 plan that she is allowed to go to the front of the lunch line for either milk or hot lunch. The lunchroom staff were all informed. In the beginning there were a few kids (particularly older kids who didn’t know my daughter) who chided “Hey, you cut in line!” But the assistant principal, nurse, or cashier would matter-of-factly inform them that she was allowed to go to the front. (No medical explanation is needed.)

On days that the line is short, she’ll just wait in line. But if it stretches to the back, then she goes toward the front of the line.

If she is just having milk, often the nurse grabs it for her.

Counting Carbs and Bolus

Because we never know how much my daughter will eat, we give a blood sugar correction and partial pre-bolus before lunch. We have a lunch slip that we tuck into her meter pouch each morning as we make lunch. It includes a spot for her blood sugar, a list of the foods and their carb counts, and a spot for the amount of insulin given.

While my daughter is eating, the nurse tallies up the number of carbs. When she is almost done, the nurse double checks to see if she ate everything and adjusts the carb count if necessary. She then gives the remaining bolus. Early on I made it clear that I wanted this happening before the kids were dismissed for recess as much as possible. (That’s one thing about the PDM being remote. As soon as it beeps that the insulin is being delivered, my daughter can take off.)

Recess

I don’t know about your school, but at ours there is no morning recess and the kids have little unstructured time. It’s so important for ALL kids to get recess each day. Recess is important not only for the physical activity, but also because it is a time of social interaction with peers. I do not want diabetes management taking any time away from recess.

Who is Left Holding the Bag

Because I want my daughter to have freedom to hang from monkey bars and run around, she does not carry her diabetes supply bag to lunch. Rather the nurse carries it to lunch, holds it during recess, and returns it to the designated spot in the classroom after lunch. Sure my daughter could carry it, but why make her if she doesn’t have to?

These are just a few strategies we use to make sure that lunchtime at the elementary school level runs more smoothly, that my daughter has enough time to eat, and that she doesn’t miss recess because of diabetes care.

Diabetes At SchoolFurther Reading…

Back to School with Diabetes: Lots of information and links!

I have an entire chapter about school in my book Kids First, Diabetes Second.

Read more posts about Diabetes at School.

Please remember that I never give medical advice. Ask your endocrinologist or pediatrician for advice about your own child. Make your own informed decisions for your own child.

 

Diabetes Awareness Month: Day 29

“Though you want your child to eventually self-manage their diabetes, take back over care if it becomes too much for them or they need a break. They have their entire life with diabetes ahead of them.”