Exam guidance for CYP with type 1 diabetes : University College London Hospitals NHS Foundation Trust

Although parents and children might not consider diabetes as a disability, they are still covered under equality laws (falling under the Equality Act 2010). Every school has to make reasonable adjustments to help any child make sure that diabetes does not get in the way of students being able to do their best in exams.

Diabetes is usually an invisible condition and the effects that blood glucose levels outside of the target range (3.6mmols/L - 6.9mmols/L) have on cognitive and physical function are often not appreciated or are underestimated.

Low blood glucose levels, or hypoglycaemia, (less than 3.6mmols/L) will affect the ability to concentrate and can cause confusion and disorientation. Although the child or young person will usually feel better approximately 15 minutes after treating the hypoglycaemia, there is evidence that it can take one to two hours following normalisation of blood glucose levels before they are able to achieve a maximum level of performance.

Furthermore, there is evidence that high blood glucose levels, or hyperglycaemia, adversely affect the ability to concentrate. High blood glucose levels are associated with poorer test results and slower performance. High blood glucose levels also increase the need to pass urine and lead to dehydration, where the young person may need more frequent toilet breaks and easy access to water.

Exams are a stressful time for most people and unfortunately, stress is a common cause for rising and/or fluctuating blood glucose levels in people with type 1 diabetes. Therefore, at a time when it is especially important to optimise blood glucose control, it is particularly difficult to do so.

Help for students with type 1 diabetes

Diabetes UK have designed a tool to help students with type 1 diabetes, their families and schools plan and prepare for successful exams; https://www.diabetes.org.uk/resources-s3/2018-11/1201C_Type%201%20diabetes%20and%20exams_DIGITAL.pdf. This tool is most relevant to secondary school exams but can be used for exams in primary school too. At the end of the tool, a printable card is included that can be given to the invigilator on the day of the exam.

Hybrid Closed loop pumps and mobile phones used as medical devices

When wearing a continuous glucose monitoring (CGM) system, the high and low alerts can be put on vibrate, so as not to disturb others. Only the urgent low alarm, which requires immediate attention cannot be muted. Appropriate low alerts can be set to help make treatment decisions, which should help prevent an urgent low alarm level being reached.

It is becoming increasingly common for students to need direct sight of their mobile phone to manage their diabetes. The school or college must process an online application for access to a mobile phone for medical purposes. The school will need formal evidence that you have diabetes (a clinic letter can be used for this) and supporting school-based evidence. The request needs to include the details of the mobile phone arrangement that you need, including where you want it to be placed. If you are using the phone as a display device for your continuous glucose monitoring, you may want the phone on your desk. The CGM app uses Bluetooth to connect to your transmitter, so the phone will work as a receiver without Wi-Fi. If using the phone in ‘Airplane mode’ the Bluetooth will need to be enabled to allow Bluetooth connectivity.

There is a new arrangement from this academic year (Sept 2023) where if deemed vital, a parent can send medically related prompts, via text to the student. In this instance, the invigilator would hold the candidate’s mobile phone, check the text message received and then show the student the medical prompt. Once in possession of their mobile phone the student would be individually supervised by the invigilator to ensure that he/she would not access the internet, any files/folders or any other form of electronic communication. If the mobile phone is being used as a CGM display device or used to allow a follow function, it will need to be within six meters of the transmitter.

What should you do?

The most important thing when thinking about exams is to plan ahead. To make sure that diabetes does not give you a substantial disadvantage during exams, talk to your school. You will need to arrange a meeting with your school to talk about what you’ll need well before the exams begin. Some access arrangements will need approval from the Joint Council for Qualifications (JCQ), so the school will need time to apply for these on your behalf.