“1. Current blood sugar? 2. Overnight hypo? 3. Active insulin? 4. Stressed or ill? 5. Weather today? 6. Breakfast now? 7. Walk or drive? 8. All supplies packed? Eight high-stakes calls, all made before I even sit up in bed. By 8:45 a.m., my pupils see a calm, organised teacher; they never see the mental paddling underneath. This is the swan effect of diabetes.”
Sarah, a 62-year-old primary school teacher diagnosed with type 1 diabetes 25 years ago, navigates a world where professional responsibility clashes with the unpredictability of hypos. We interviewed Sarah to understand the emotional, cognitive, and practical burdens she faces managing T1D alongside her career as a teacher.
EIGHT DECISIONS BEFORE GETTING OUT OF BED
For many people with type 1, the workday starts long before the alarm actually “starts” the day. Before feet touch the floor, there is already a rapid‑fire internal checklist to go through.
Each of these questions matters because every variable – stress, illness, temperature, food, activity – can push blood sugar up or down. There is no “neutral” morning; every day starts with risk management. By the time most people are choosing what to wear, someone with type 1 may already have made eight or nine medically significant decisions, any one of which could set them up for a smooth day or a rollercoaster of highs and lows.
LIFE AS A TEACHER: ACTING 'FINE' WHILE PADDLING UNDERNEATH
Now layer that invisible workload onto a job like primary school teaching. The teacher is the steady adult in the room, responsible for thirty children’s learning and safety. Lessons must start on time, classes have to be supervised every minute, and energy is supposed to be high and consistent. There is very little space in the timetable for sitting down quietly to treat a hypo or to wait out the brain fog that can follow.
“It's really difficult because I look out at my 30 children who I am responsible for and yet, sometimes I don't feel in control of myself. It's almost like I'm acting and I have to pretend that everything's fine.”
Once the day begins, this is where the swan effect is at its most visible – or rather, invisible. On the surface, the teacher smiles, moves through the lesson plan and answers questions. Underneath, a constant internal monologue is running: Have I taken enough glucose? Will this push me high later? Can I get through the next 20 minutes without needing more? Why can’t I remember that child’s name? Am I slurring my words? Can they tell something is wrong?
When low blood sugar hits in the classroom, the clash between responsibility and physical reality can feel brutal. They might feel shaky, confused and overwhelmingly sleepy, yet still must care for their students. They cannot simply say “everyone read quietly for half an hour while I recover” – especially with younger children – so they act. They sit down instead of walking around, lean more heavily on routines, try to keep their voice calm and steady, and buy themselves pockets of time to treat the low without alarming the class.
Luckily, Sarah's students and colleagues are understanding. Her class now alerts her when alarms sound ("Mrs L, you need your sweets!"), and they've even held lessons comparing glucose levels with a T1D student—turning vulnerability into connection.
Yet the cognitive symptoms of hypoglycaemia – confusion, word‑finding difficulty, memory lapses – can be especially cruel in a job built on communication and authority. Forgetting a pupil’s name or losing track of where you are in the lesson isn’t just frustrating; it can feel like a public crack in the professional mask. So the person with type 1 often works twice as hard to appear “normal”: over‑preparing lessons, building in visual prompts, creating backup activities the class can do independently, and rehearsing simple explanations if an alarm goes off.
“I think the brain fog for me is one of the worst things about having a hypo. I might forget children’s names or lose track of where I am in a lesson and what I should be teaching. And that can go on for most of the day. It's very frustrating because you would think once you have treated your hypo you should be okay 10 minutes later, but it just doesn't work that way.”
THE EMOTIONAL WEIGHT OF LOOKING 'EFFORTLESS'
From the outside, colleagues and parents may see only the calm part of the swan. They notice that the teacher “manages so well” or “never lets diabetes get in the way.” What they do not see is the exhaustion of constant vigilance: checking levels between lessons, treating small dips before they become bigger crashes, adjusting insulin for PE, playground duty, school productions or parents’ evenings, and then reviewing what went wrong later that night.
“You want people to be able to rely on you, for example to do the lighting at a school production. And then suddenly you have a hypo and need to take some time out. It's horrible because you feel you are letting people down, and I hate that more than anything.”
That discrepancy can create a strange, lonely pressure. On one hand, there is pride in being competent and reliable. On the other, there is a sense that needing help – to cover a class for ten minutes during a bad hypo, or to keep an eye out during a play rehearsal – may alter people’s perceptions. Many people with type 1 are “strong” personalities who are used to coping; admitting that, in certain moments, they are helpless and need someone else to step in can feel deeply uncomfortable.
MAKING THE HIDDEN WORK MORE VISIBLE
The swan effect will probably always be part of life with type 1 diabetes, but it does not have to be borne in silence. Small cultural shifts can make a big difference in places like schools:
- Leadership that explicitly invites staff to share health needs and builds simple backup plans for lessons.
- Basic education for colleagues about what hypos look like and what kind of practical help might be needed.
- Normalising things like glucose alarms, snacks in meetings or sitting down in class for a few minutes without making it a drama.
For the person with type 1, giving trusted colleagues a glimpse “under the waterline” can reduce isolation. Explaining that there are eight or nine decisions before breakfast, that some days start with a “diabetes hangover” from night‑time hypos, and that teaching through a low is like acting through thick fog, helps others understand why some days feel harder than they look.
If this story resonates, you don’t have to keep paddling in silence. Share this article with one colleague you trust as a way to start the conversation, and explore tools that make treating lows faster and more predictable during the school day. The more people understand what’s under the surface, the less alone you have to be.