Q: My son was given a detention at school for acting out in class. Checking his meter, I can see that his numbers had been all over the place that day, and he was heading low when the incident (talking back to the teacher) occurred. For 13 years old, he’s pretty good with blood sugar checks and food. I don't want him to feel like he’s being unfairly punished. Should I call the school to request the detention be canceled?
A: The issue you raise is a challenging one, for both parents and schools. Determining whether misbehavior is related directly to a child’s blood sugar level or is just a case of acting out may seem very confusing, especially since you don’t want your son to feel punished for having type 1 diabetes. As a general rule of thumb, I recommend parents add to their child’s educational plan that blood sugar be checked whenever there is an out-of-character episode of inappropriate behavior at school. If the child’s blood sugar is normal -- or close to normal -- at the time, then the behavior is not likely related to diabetes, and the school’s usual discipline plan should be followed.
If a child’s numbers do show up as out of range, however, it’s important to take into consideration what kind of influence this can have on behavior. If a child with diabetes experiences low blood sugar, typical symptoms include looking pale, feeling shaky or tremulous, headache or a clammy sweat. If the low persists, other symptoms can develop, such as lethargy, confusion, and disorientation. Some children may also display unusual combativeness (i.e., acting out) as a sign they’re low.
Whenever any symptom points to a low, a child’s blood sugar needs to be checked and treated as needed. If the child’s inappropriate behavior appears to be the result of some of those symptoms mentioned above, and a low sugar is documented, then it makes sense that the student not be held to the usual discipline policy on that occasion.
However, if the child is not is not experiencing any other low blood sugar symptoms, and blood sugar levels were in range when checked, it’s unlikely that the misbehavior was caused by low blood sugar. In your son’s case, you may want to look more closely at his numbers and any symptoms of low blood sugar he may have experienced that day to help you make a decision about how to best proceed.
High blood sugars and their effects on behavior can be a trickier subject to address. Persistently high sugars can cause fatigue and/or lack of concentration. If a child is feeling poorly due to persistent highs, it can result in a child being more likely to act out, due to fatigue. Parents of all children, whether or not they have diabetes, have no doubt experienced the crankiness that can come when a child becomes overtired.
When a high blood sugar is detected, it needs to be treated. But should this excuse negative behaviors? As difficult as it may be, learning the lesson that one must deal with the consequences of one’s actions is vital to success in school and in life overall. I don’t think it’s helpful for a child’s sense of behavioral self-control if we tolerate or excuse misbehaviors just because of fatigue -- whether that child has diabetes or is fatigued due to some other reason, such as lack of sleep.
Ultimately, it’s up to you and your child’s school to come to an agreement about consequences for inappropriate behavior and acting out. However, one of the best ways to support your child in making positive behavior choices, whether he’s at school or home, is making sure he has all the tools necessary to keep his diabetes managed. If you notice that your son is experiencing frequent highs or lows, talk to your diabetes care team about management plan changes that may need to be made. If behavior problems persist despite your best efforts, it’s also worth making time for your child to check in with your team’s social worker or family therapist to dig a little deeper beneath the surface.
--David Nickels, M.D., is the director of pediatric endocrinology at East Tennessee Children’s Hospital in Knoxville.
How Other Parents Deal
“We had a very unfortunate incident happen a few years ago when our son developed a low just before lunch. He was already in the cafeteria, but refused to get in the lunch line because he needed to sit down. The cafeteria monitor -- who didn’t know he had diabetes -- reprimanded him and told him to get in line with the other kids. Luckily, one of my son’s teachers saw what was going on and recognized that he was low. She quickly got him some juice. My son was fine a few minutes later, but this incident was a real eye-opener for me that all staff should be aware of my son’s type 1 and our ironclad policy that his health and safety come first before anything else.”
--Rebecca L., Melrose, Mass., mom of 12-year-old Oliver
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