Amused and yet mildly irritated

[Charlotte'sMom]

So this is a light-hearted vent. I LOVE the school nurse, the nurse's aide, the teacher and principal. Everyone has been fantastic so far. However, as the nurse and I have gone over the IHP that the doctor needs to sign we're disagreeing on one little point. According to her supervisor, the health care plan must include something along the lines of "parents can make I:C adjustment up to ____ grams of carbohydrates. Any more than that and the directions must come from the physician." I get that they are just covering their butts, but our endo has NEVER put a limit on how much I can adjust ratios, and I think it's silly that the school is trying to insist that the dr put that limit on me.

I know there are some parents who probably don't have the experience to make significant changes, but I feel totally comfortable doing so. So, in the forms that I filled out and sent to the doctor for him to sign (because his website says he wants parents to fill the forms out) I only said "parents can make changes as needed." I just couldn't bring myself to write in some arbitrary number just to make the nurse happy. I know she's going to be irritated by that. But oh well. I figure if the dr signs off on it, I'm good to go!

The funny thing is, there are no snacks during 1/2 day kindergarten so they will use the I:C ratios almost NEVER! And since the ratios are plugged into the pump, they wouldn't notice the change unless they compared it to the original paperwork anyway. I just think it's silly that she insisted on it in the first place.

[timsma]

I agree. That is ridiculous. I'd maybe just put in that spot the word 'unlimited' and see how they like that. For our IHP plans all these years (k-12th grade) the form came from the endo office, not the school. And on those forms, there was never any limits of any kind either. Maybe your endo has such a form as well?
I'm glad everything else is going along nicely for you!

[Charlotte'sMom]

The dr's office have their own generic forms too. I ended up just typing out my own, leaving out the stuff from the generic forms that didn't apply to DD.

I checked our endo's forms online. Theirs say "Parents are allowed to change mealtime doses as directed by the physician, and can notify the health office by phone or in writing when changes are made. There is no requirement to have updated orders from the physician for each dose adjustment. If the school health office has any questions or concerns about reported dose changes, please contact the ordering physician."

(Bolding is part of the dr's form!) Since the endo knows full well that I make plenty of changes to DD's pump settings in between quarterly visits, I take this as permission. I should have included this in the health plan I typed out since she asked for note from the doctor whenever he did make changes. Next time...

[DsMom]

I would be a little more than mildly irritated about that. You are an experienced manager of your child's D...what right do they have to tell you what you can and can't do with the I:C rates? My son's school nurses have no idea when and by how much I change rates unless I give them the heads up to look for something new in his BGs.

You are taking it well...better than I would. Glad everything else is going so well!!

[Diana]

Our school has this on their forms also. I just put in a huge range. The school nurse totally knows what I am doing, but the form gets filled out and everyone is happy. The endo actually signs the form blank so I can fill it out however I want (our school nurse happens to know this also, but I didn't tell her for a while)

So, for example, I put on there that I am allowed to change carb ratios by 50 (so from 1:10 to 1:60), ISF by 300, target by 200.

Our nurse got on board when I told her that if she called the doctor for dosing advice (which she would never really do), the first thing the doctor was going to have to do would be to call me to find out what settings we were using.

In any case, there is no way the school nurse even knows what our pump settings are at any given point, so I find it all a bit useless. I change them all the time and she is none the wiser. When my son was your daughter's age, he operated the pump and the nurse just double checked he input the numbers correctly. She didn't even know where to find the settings, so it was all sort of a moot point and not worth fighting about.

[mmgirls]

just have them but in you can chnge by 20 carbs. That should be more than enough room to never become an issue.

(and trust me they don't notice changes that easily.)

we have the same thing is on our form.