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dexcom at school

Discussion in 'Parents of Children with Type 1' started by kail, Aug 13, 2016.

  1. kail

    kail Approved members

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    Its funny (or sad) that as I was researching posts before starting a new post, I ran across my own post from a year ago with many of my current questions.

    My daughter is now about to start 1st grade. Last year she went to a small private school and it went fairly well with diabetes management. They had no nurse or prior knowledge but were willing to learn. Most of her care fell to her teacher and the office manager. The teacher was amazing and wore a small purse we provided with DD's dexcom receiver showing through a clear pocket and her iphone tucked inside another pocket. She not only responded to alarms but obviously checked it frequently and she texted us for advice through the day. If she noticed DD trending down she would give a few smarties and then text us for further advice for example and then send DD to office for meter test if she continued to go down or was actually low on dexcom. If she was extra high at snacktime (which always fell into her post breakfast spike) she might text about delaying her snack for a little while. It was a small campus and she was never out of range of her dexcom. We did go at lunch to test and dose her insulin but that was largely by choice as I think they would have done it if we had spent the time teaching them.

    Fast forward to 1st grade and DD is switching to a public school. I am having difficulty imaging how this is supposed to work in a school with a large campus and many students in the classroom.

    My first concern is who is supposed to hold on to the dexcom/phone and monitor it for alarms or other trends. I suppose it is possible that the teacher will be willing to wear the purse with the dexcom and attend to its alarms at least but I can see many problems with this. Specifically the teacher may not be willing to wear it or even keep it on her desk or may not pay attention to it (and how could I blame him/her with all of their other responsibilities and large class). Even if they are willing I imagine there are times that the class goes somewhere and the teacher does not stay with them such as going to the library or their computer, art or dance class and certainly the teacher will not be at recess or lunch. So am I suppose to buy a belt or something so that my 5 year old can keep the receiver and phone with her all the time? Or have the teacher give the purse to her during the times she will be on her own (recess/lunch). But then am I expecting my 5 year old to be the one to notify an adult if her dexcom alarms??? She is quite responsible but I am not very comfortable with this idea.

    Number 2 concern is how to handle the alarm or down trend on dexcom. I saw an old post about a chart that varied how many tabs to give depending on number and dexcom trend. I like that idea although it is hard to put in into a chart since we do it by feel right now depending on all the typical variables. I guess I can muddle through this part of it and maybe give a tab in class without testing if she is trending down or borderline low but give a tab then walk her to nurse if she is alarming low and then follow some type of chart like that with the "nurse" who is a health clerk without much skill in diabetes.

    I know I will need a 504 and I have seen many posts about the issues about walking escorted by adult to the nurse and being allowed to carry phone, test anywhere etc. and I am ok working all of that out. My biggest concern is who is responsible for the actual receiver (and phone) and monitors the alarms (and trends if possible).
     
  2. quiltinmom

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    I think there's not a "right" answer about who should carry her phone, although it needs to be close to her, so if she is responsible enough with it (put it in a belt?) she could carry it. If there is a full time nurse, he/she can monitor her via share, and come to her if there's a problem. With funding cuts etc sometimes they share a nurse between several schools, so you need to find out about your school. If there is no full time nurse maybe her teacher or a classroom aide or office staff member who could help monitor via share.

    It's tough to have to figure out what to do especially with a new school, but you'll figure it out. He best thing is to have an open conversation with school staff and be workable. Your plans can change as you go along, if you don't get it right at first.

    Good luck!
     
  3. rgcainmd

    rgcainmd Approved members

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    September is just around the corner, so if you haven't already, you should be writing your 504 Plan and making sure doctor's orders are current. Good luck!
     
  4. mikegl31

    mikegl31 Approved members

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    As was already stated, you should get into school and talk to someone face to face about the 504. My son just finished 1st grade, in a public school, and we met with the nurse about 2 weeks before school started (She doesn't create the 504, but we went over doctor's orders, and talked about how we did things/how my son reacts to various situations. He had about 20 students in his class (including another T1). Our school had no problems with anything that we wanted - Dex, food in the classroom, drinks, absences, etc.. At the end of last year, we discussed allowing my son to connect to the school wifi so that we don't have to use data for the Share.

    I think I might be lucky, but the nurse at my son's school is awesome. My son keeps the Dex/Iphone on him at all times - in his pants pocket - we went out and purchased new pants that had those pockets on the side of the legs by the thighs (cargo pants). Those pockets were bigger and not as tight as the ones up by the hips. The nurse downloaded the Share app, so she gets his data on her phone. For any lows, she went to the classroom to treat/test. Highs, depending on how high, we just ignored until the next meal - school was difficult with that, because he ate breakfast around 7:30am, snack at 10am, lunch at 12:15pm, and then dismissal at 3pm. There wasn't really much time in there to correct, because insulin was always on board. She would only address if the BG got really out of control and was rising into the 300s. For the first few months, she texted me a few times a day with, "What would you do here?" As the year moved along, I trusted her to make her own decisions. Of course, I could see his numbers as well, so if I saw something with the numbers - like too high, or a quickly dropping low, I would give her a call just to check in. His teacher had a walkie-talkie in her room, which communicated directly with the nurse, so if there was ever any issue/if he said he felt low, etc., the teacher would just radio the nurse.

    We developed a good relationship right from the start - I don't know if we got lucky, or if other schools are like this as well. I would start by trying to meet the nurse before school starts, and see how that goes.

    Unfortunately, in my sons school, the nurse that he had is only the nurse for grades K-1. He will be working with a new nurse when he starts second grade this year. We will be meeting her in 2 weeks. His old nurse will still be in the building, and I know she will be looking out for Austin, so I am not too concerned.

    Good luck!
     
  5. jenm999

    jenm999 Approved members

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    If you use Dexcom you can look into Nightscout which will allow you to see his numbers on a desktop. My son's nurse keeps tabs on him this way and will call down to his classroom for a tab if he's trending low (I'm the one who made the chart and it's worked very well for us - 15g is often way too much for a mild low). It's important to ascertain ahead of time if you have good cellular/wifi signal in your child's classroom - we do not so have provided a wifi router for his classroom. And many nurses/teachers prefer not or cannot use their cell phones at school.

    My son carries on his person his PDM, his Dex phone (which is written into his 504 as a medical device, and has had the browser, camera etc. disabled), and tabs. In this bag: https://smile.amazon.com/Manhattan-...=1471193250&sr=8-6&keywords=manhattan+portage (yes, it's expensive but you show me a boys' bag that does not look like a purse!). There is an exhaustive kit at the nurse's office with meter, glucagon, snacks, extra pods etc. When we go out with him we carry the whole shebang. He also likes cargo pants.

    Seconding that a 504 is essential - not just for the document which the school is legally obligated to follow, but for the communication around it. Getting everyone on the same page is critical.
     
  6. kail

    kail Approved members

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    Thanks everyone. School starts in about 10 days but the health office was closed until tomorrow. I plan to go in the following day but needed my thoughts in order first. I will of course talk to the health clerk and the teacher (once they are able to tell me who she is with) and do our 504 but I am realizing that most likely she will have to carry her own purse. Her purse is cute and pretty small but I still hate that she will have to drag it around to play and also monitor her own alarms. My DD attending preschool at this school when she was first diagnosed so I am familiar with the health clerk and at least one of the nurses. The nurse is fine but not at school except when she comes to give insulin at lunch. I don't have tons of confidence in the health clerk partly from my own interactions but also from others that have type 1 kids at this school. I guess that no one would be watching her closely if we didn't have dexcom but it is still a big change from the kind of supervision that she has now or had last year in kindergarten.

    That is a great bag Jenm. I agree it probably is hard to find a boys bag that doesn't look like a purse. Makes me so sad though that our kids have to drag around a bag like this while they are supposed to be running around and hanging upside down on monkey bars. But then what doesn't suck about diabetes.
     
  7. SarahKelly

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    So, not just what we've done with my son but what several other parents have done at the school he attends - one the nurse has downloaded the nightscout for parents that utilize that. She has also been willing to add the dexcom share app on here phone for parents that want that. I know my son wears his pump in a "Too Sweet Boutique", but in Kinder and First he wore tank tops with pockets in the back that I had sewn on for his pump and receiver. Another boy at the school uses the spi-belts and can cram both his i-phone and receiver in there. When my son is using his dexcom we keep it in his classroom and just know he'll miss a bit of data when he goes out for his recesses (20 min each) and when he goes to his specialist classes (35 min) but he checks the number on it before leaving for those times. I would stress open communication and asking what the teacher is willing to do, too. You might be happily surprised to find that many teachers will try to do just as you ask as long as it isn't the part that is making decisions, but rather helping with monitoring and following along a guideline. I hope all goes well and she can just hand upside down on monkey bars without worrying about everything :)
     
  8. kail

    kail Approved members

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    Well my preliminary phone conversations with the school (health clerk and district nurses) is that their usual way to manage the CGM in a younger child is that the parent monitors it from home/work and calls the school health clerk with instructions on anything she needs to do (go check child/treat etc). Sigh. (And I'm sure the health clerk will just be sitting in the office at my beck and call) They do seem more than happy to poke test my child as many times as I want. They are planning to check a preschooler hourly at the start of school until she is settled in the routine. The health clerk seemed frankly appalled that I didn't plan to have DD checked by meter before snack and PE. So now I do sort of feel like I need to start training DD on how to manage her trends and self treat to ward off lows. Maybe give her the chart instead of the nurse :(

    I know it will be ok somehow. My daughter is pretty good and always runs to dexie at home if she hears it alarm. She has some idea of what needs to happen.

    On the other hand, she is only 5 and when she is low especially I can not expect her to make good decisions always. Yesterday I (stupidly) left her at gymnastics while I did a super quick errand. I left her with a bunch of instructions to my kids, the teachers and supervisors, her kit, lots of candy, her 9 year old sister and her iphone but realized 5 mins away that I had dex!. I was back in 15 min and she had drifted to 60 but seemed fine and we treated it. Later on I heard from my older daughter that DD had been lying down during gymnastics class while I was gone and when my older daughter suggested that they should check her number, DD said no and that she was just tired. The teacher suggested it to but DD say no, she was fine. Ugh. my fault though. But a good reminder to me that DD does not have the ability to manage her diabetes alone at school.
     

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