Who Does Carb Counting At School

[Dan]

I have an 8 year old who has had T1 since he was 22 months. Our school is great and they do everything to accommodate us. My wife always places stickies with amount of carbs that Joshua needs to be bolused for during snacks and lunch. The issue is that Joshua will not eat all of his food on most days which has lead to lows.

Have any of you had this issue and how did you resolve?

[Sarah Maddie's Mom]

Who gives the insulin? If it's a nurse, and it's prebolused then maybe they need to talk more about what looks good and how hungry your son if feeling that day. Some kids go to the nurse, bolus for 1/2, eat, come back with all the leftovers and they see if any additional insulin is needed.

Eight is sort of a tough age - not quite mature enough to say, " I'll eat this but not that" ahead of time but there may be oher things going on other than just appetite. Maybe there's a game or some other social thing that he's rushing to get to? Is recess tied to lunch? Could he be sharing his lunch? Maybe parts of his lunch are no longer "cool" or some kid mentioned that only weirdos eat bananas

Good luck.

[Dan]

The nurse currently asks how much he will eat and adjusts for 1/2 or 3/4 the bolus. That is part of the problem he needs to go to the nurse to get checked/bolused then go to lunch. By the time he gets back to the lunch room he only has 20 min to eat and my son is a social butterfly.

This year I want him to check himself in the classroom and bolus himself a preset amount which I would make 1/2. Then have him eat and then go to the nurse to see if he needed additional insulin. This would mean that she would need to do the carb counting. We have a great relationship with both nurses and they call us every day at least 2-3 times looking for direction.

Do any of you have your kids check and bolus themselves at this age?

I also want him to treat his own lows in the classroom. I want to minimize him leaving the class room.

[jules12]

That is a tough one but here is what we did for school:

1. We always prebolused (note: during this time he was hyper sensitive to insulin and carbs so we couldn't regulate very well without doing this) YDMV

2. Lunch included only foods he liked and would eat - no broccoli or other food items he doesn't like to eat - I made sure he had those at home.

3. Had to eat all his lunch or if not, had to let nurse know and they would substitute the carbs for something else (like juice) -- this only happened a couple of times

4. Discussed it with the nurse and when he purchased school lunches, they only put the food on his tray that he had already approved to eat - therefore if it wasn't written down on his carb count sheet - it didn't get put on his plate.

5. He could always go to the nurse and add some more food (extra snacks were kept in the nurses office) if he was really hungry - this didn't happen very much either.

6. The lunch room monitor kept an eye on him to see that he wasn't throwing away food or not eating it all.

My son left early for the nurses office so he could get to the lunch line with his friends. Usually during this time, the class was going to the bathroom and washing hands. He didn't bolus and/or treat himself until 5th grade. The nurse never did any carb counting except for unexpected snacks. I would send the carbs for lunch every day on a slip of paper -- during that first year when he was 7-8, I would also email the list to the nurse in case he lost it.

I just wanted to add that even though I wanted my son to have more time in the classroom, he just didn't want to deal with everyone watching him, etc. By 5th grade, he was asking to do it. I really worried about the time out of the classroom but now looking back, it really didn't hurt him. He made good grades and I always discussed with his teachers to watch to be sure he didn't miss a concept. If she thought he needed extra work, we would go over it at home.

[joy orz]

Originally Posted by jules12

That is a tough one but here is what we did for school:

1. We always prebolused

2. Lunch included only foods he liked and would eat - no broccoli or other food items he doesn't like to eat - I made sure he had those at home.

3. Had to eat all his lunch or if not, had to let nurse know and they would substitute the carbs for something else (like juice) -- this only happened a couple of times

4. Discussed it with the nurse and when he purchased bought lunches, they only put the food on his tray that he had already approved to eat - therefore if it wasn't written down on his carb count sheet - it didn't get put on his plate.

5. He could always go to the nurse and add some more food (extra snacks were kept in the nurses office) if he was really hungry - this didn't happen very much either.

6. The lunch room monitor kept an eye on him to see that he wasn't throwing away food or not eating it all.

This is very similar to what we do. Ava gets a lowish carb lunch of a small sandwich and if she says she wants it that morning, an apple sauce. We also pack plenty of non carb fillers like cheese, pickles and veggies if she still has an appetite. She knows she HAS to eat the sandwich (or go to the nurse for a juice) and if she's still hungry she can eat the rest of the stuff. Sometimes she eats it all, sometimes, she has the leftover stuff as an after school snack.

[hawkeyegirl]

My son is 8 and will be in 3rd grade this fall. Here's what we will do:

1. While the rest of the class is putting their stuff away getting ready to line up for lunch, he slips out to the nurse. He checks BG in there, and she doses him for around 25g of carbs, plus any necessary correction.

2. He joins his class in the lunchroom, or as they're coming down the hall.

3. He goes to the nurse after lunch, and she doses him the remaining carbs. If he only ate 3/4 of his sandwich, she guesstimates how many carbs that was.

4. He goes out to recess. The nurse has a door that opens out onto the playground, so he can leave directly from her office.

We make sure that he leaves the classroom a bit early to go to the nurse so that he does not miss any lunchtime. Like your son, he enjoys the socialization at lunch, and they also do not have much time to eat. I don't want him having to choke down his lunch fast, so he leaves class a bit early. He does not miss anything.

I also do not want him to HAVE to eat any part of his lunch. I feel like that can set up unhealthy food habits, and I personally would feel resentful if someone told me that I HAD to eat anything. He eats what he's hungry for, and we dose for that. It's why we only prebolus for some of his lunch. Yes, it means two trips to the nurse, but the second trip is super fast and doesn't bother him at all.

He COULD check and bolus himself in the classroom before lunch, but I'd rather he go to the nurse at this age. I don't feel like it's necessary for him to be that independent in his care at this point, and I'd prefer that he still have an adult supervise his boluses. And if he was very low or very high, he'd still have to go to the nurse, and it seems easier to me to have him just go there in the first place at this point.

[Tigerlilly's mom]

Originally Posted by hawkeyegirl

My son is 8 and will be in 3rd grade this fall. :

1. While the rest of the class is putting their stuff away getting ready to line up for lunch, he slips out to the nurse. He checks BG in there,

2. He joins his class in the lunchroom, or as they're coming down the hall.

3. He goes to the nurse after lunch, and she doses him the remaining carbs. If he only ate 3/4 of his sandwich, she guesstimates how many carbs that was.

4. He goes out to recess. T
We make sure that he leaves the classroom a bit early to go to the nurse so that he does not miss any lunchtime. Like your son, he enjoys the socialization at lunch, and they also do not have much time to eat. I don't want him having to choke down his lunch fast, so he leaves class a bit early. He does not miss anything.

I also do not want him to HAVE to eat any part of his lunch. I feel like that can set up unhealthy food habits, and I personally would feel resentful if someone told me that I HAD to eat anything. He eats what he's hungry for, and we dose for that. It's why we only prebolus for some of his lunch. Yes, it means two trips to the nurse, but the second trip is super fast and doesn't bother him at all.

He COULD check and bolus himself in the classroom before lunch, but I'd rather he go to the nurse at this age. I don't feel like it's necessary for him to be that independent in his care at this point, and I'd prefer that he still have an adult supervise his boluses. And if he was very low or very high, he'd still have to go to the nurse, and it seems easier to me to have him just go there in the first place at this point.

This ^^^^^^....my son always left before the rest of the class and unless there was some kind of "issue" a low that he needed to stay with the nurse for, would make it to the lunchroom right in time to join his class

[mom24grlz]

The way we do it isn't really ideal, but it's what works for us. 9 times out of 10 Ashleigh packs her lunch. I write down the carbs for everything on her lunch bag. So example I'd write Sandwich=20 carbs, Chips=15 carbs, drink=8 carbs. You get the idea. Then she boluses for each individual thing after she eats them. Obviously this is easier done on the pump. So if she doesn't want to eat her chips or her sandwich she won't bolus for that particular item. Before this we were running into the same problem, where she'd prebolus for everything, but end up feeling to full to eat it all.

[Sarah Maddie's Mom]

Originally Posted by Dan

The nurse currently asks how much he will eat and adjusts for 1/2 or 3/4 the bolus. That is part of the problem he needs to go to the nurse to get checked/bolused then go to lunch. By the time he gets back to the lunch room he only has 20 min to eat and my son is a social butterfly.

This year I want him to check himself in the classroom and bolus himself a preset amount which I would make 1/2. Then have him eat and then go to the nurse to see if he needed additional insulin. This would mean that she would need to do the carb counting. We have a great relationship with both nurses and they call us every day at least 2-3 times looking for direction.

Do any of you have your kids check and bolus themselves at this age?

I also want him to treat his own lows in the classroom. I want to minimize him leaving the class room.

Our daughter started doing her testing, treating and bolusing in the classroom in 3rd grade. She did see the nurse for lunch bg and to bolus ( if I'm remembering correctly) just for lunch, largely because it was on the way and she too was a social butterfly and could easily "forget" to test and bolus. She would bolus for the carb count of what she thought she wanted to eat - I packed in a paper bag and itemized the carbs on the bag. Generally speaking the bolus would be right - if something happened to prevent her from eating it all she'd stop into the nurse on her way back up after lunch/recess to trouble shoot the situation.

[MamaC]

Lest anyone reading this feel bad about their own school lunch regimen, I will share a dirty little secret:

My son was dx'ed in 7th grade, at 13. He went to the clinic to test before lunch, went to lunch and came back after eating to dose for what he ate. Of course, middle school socializing did not involve recess, more the table talk. He left a few minutes early to check, and got back a few minutes late after dosing...but it was in his 504 that time missed due to D was not to be held against him.

He's notorious for eating either more or less than he expects to, so dosing after was the way to go. Optimal? No. Best practice? No. Happier child? Yes.

Oh - and he did have a couple of run-ins with the cafeteria lady food police..."You can't have that cookie..." and "All he eats is junk..." Shut that down RIGHT QUICK.

Just in case we're not the only ones NOT prebolusing