Keeping Blood levels between optimal levels is probably most difficult around exams. The range of emotions that accompany preparation takes its toll on all of us, but it’s extra challenging for Type 1’s.
Exams bring about inevitable stress. This can have both hyper and hypo effects on blood glucose levels. In the build up to an exam, I find that if I’m under pressure to get something finished within a limited time frame, my levels will rise. However, if I’m extremely nervous prior to an exam, the stress of thinking about it will decrease my bloods. A perfect example is my reading before my physiology exam on Monday last (a module which has the third highest fail rate in UL). I worked myself into a tizzy before the exam, convincing myself that there wasn’t a hope that I would pass, making myself very nervous. This cause my bloods to drop to 3, 40 minutes before it was due to start. Far from ideal as it takes 20-25 minutes for that hypo feeling to disappear and for my bloods to normalise.
I also find it very important to try and keep and routine, eating at the same time every day, for those of us on long lasting insulin, it’s important to try and take that at the same time everyday to avoid fluctuations with blood glucose levels. The biggest thing I struggle with around exams is snacking. It’s nice to have something to nibble on while dragging yourself through study, but in our case it’s impossible to find something with zero carbs. There’s always the cheese option, but I’m not really going to whip out a block of mature cheddar cheese and eat it away while I study. I have yet to find a reliable and tasty zero carb snack that I can eat, so the best advice I can give on this is to bring something tasty with you and eat it when it’s meal time, and adjust insulin doses accordingly. It’s not a great second option, and it’s not really a snack, more of a treat but it will have to do until a tasty alternative is found. I made the mistake around my Christmas exams to snack and just take more insulin when I was eating to bring my levels back to normal ranges again. This was not my best decision as I found myself to be quite slow and lethargic because my blood levels were high, not something I will do again. Hindsight is 20/20, but mistakes have to be made to grow and learn. If I had a euro for every time a made a mistake with diabetes, I would not be sitting exams, instead I’d be sitting on a beach in New Zealand, not that I’ve thought about it…
Sleep is also a key component to keeping blood levels within optimal ranges, getting a good nights sleep benefits us all, type 1 or not. I’m a notoriously bad sleeper, I rarely go a night without waking up, it’s the way I’ve always been but it’s particularly frustrating around exams. However, if I’m lucky enough to get a decent night sleep, I find that when I wake, I’ll get up rather than lounging around in bed, this really improves my BG levels in the morning. Hormones will push levels up in the morning and I notice this if I don’t get up and eat when I wake. This means higher BG levels which leads to increased lethargy. Also, I feel this is a good time to give my housemate/personal alarm clock Cliodhna a shoutout (this message was written under duress), I make her wake me up at 7 every morning to ensure I get a seat in the library, so thanks Cli!
I recently applied for the disability service in UL for the sole purpose of getting extra exam help. It’s not that I’ll always need it, but it’s better to be safe than sorry. It means that I’m in a separate room to the rest of my course, which has its advantages and disadvantages, but the main benefit is that I can take “comfort breaks” meaning that I can step out at any stage and treat hypos or test my blood levels without losing exam time. The exam is paused when I step out, and the timer restarts when I sit back in my seat. This is extremely handy, as hypos can cause severe lack of concentration, which is far from ideal when trying to complete an exam. It also means that I ca bring food and drinks in with me. This is definitely something I would suggest people look into within their own institutions, as it is a very useful resource to have.
Exams come and go, but diabetes doesn’t, well not for the moment anyway! It’s important not leave the standard of care for yourself slip.