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How do you incorporate dexcom info into school plan

Discussion in 'Parents of Children with Type 1' started by kail, Aug 31, 2015.

  1. kail

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    DD is starting kindergarten next week and I am meeting with the school tomorrow to help train and discuss the treatment plan. She was in preschool the first year of diagnosis but that was at a public school and she had a pretty strong honeymoon so it was all pretty straightforward with one test before lunch and dosing her .5 units each time for 30g meal that I sent. She never had to be checked off schedule and never had hypoglycemia when tested.

    Now she is starting K at a private school with no nurse and limited experience with diabetes. We have had DD home and with dexcom we have gotten used to being able to vary our treatment considerably. For example if she is slowly trending down with a straight or diagonal arrow we might give her 1-2 of the larger smarties which are .8g each and that will bump her up 15-30 points. Obviously if she is coming down fast then we treat more aggressively although rarely the 15 gram juice boxes she used to do when first diagnosed. Not to mention that sometimes we use dextabs or smarties and other times juice but they do not seem equivalent. I'd guess a 4 gram dextab seems more equivalent to 2 ounces of juice which is about 7.5 grams. If she has a low we will vary our dose based on how long since taking insulin and exercise and what she ate etc etc and then dose more if not enough. We try to head off the significant low with small doses of quick carbs when we see her trending down.

    I don't want to make things too complicated for the school or overwhelm them but I would like to use the trends from dexcom. How do people manage this with a younger child especially so the teacher or office aid is the one handling it all (plus calls to us of course). Do you give the school guidelines that take into account the trend such as .5 dextab if arrow straight or diagnonal, one dextab for straight down arrow, 2 for double arrows down etc.
    I feel so helpless when I think about giving these decisions to school teachers and aids. We will try to be available by phone and DH is about 15 minutes away but it is nervewracking.
     
    Last edited: Aug 31, 2015
  2. Theo's dad Joe

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    This makes sense because dextabs are 100% glucose (4 grams) while juice and smarties and candy are all 50% glucose and 50% fructose (the fructose doesn't go into the bloodstream right away, but into the liver without insulin and into some gut cells also without insulin where some gets turned into blood sugar and some gets turned into triglycerides in the liver).

    I am working on a system for the school in terms of half or whole dextabs or sweet tarts or skittles. In my case, my son is 50 pounds and I think I will go with about 2 dextabs in the 60s and 3 in the 50s (it hasn't happened yet).

    Also if he comes to lunch in the 70-80 range I have a problem because he will hit the 60s on dex around the time he finishes lunch (with food on the way) and I don't want them to treat him with juice with a full lunch in his stomach when he's flat at 68 so I am probably going to give him 2 sweet tarts or skittles if he is in the 80s and 4 if he is in the 70s when he gets his shot so he doesn't drop while he is finishing lunch and get an alarm. At home I would not really worry about it but I don't want him to ignore alarms at school at his age (9) and I don't want the school to ignore them, and I don't want him to have to get a fingerstick 20 minutes after lunch every day when he should be at recess.
     
  3. MomofSweetOne

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    THREAD HIJACK WARNING!! To Joe, have you yet experienced glucose tabs working SLOWER than either honey or fruit juice? We have, repeatedly, in the nights. I'm assuming it's because her stomach is trying to rest and not digest, but glucose tabs take significantly more time than other things to bring her up in the wee hours. She prefers juice, and I prefer honey (for some reason, she's not wild about honey that gets into her hair:wink:) And add to that, she has a four juice box limit or she begins to puke them up, complicating things even more. So, even fast carbs are a YDMV and it's good to get lots of low treatment ideas, but there are not fast, solid rules even in this.
     
  4. Theo's dad Joe

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    I have only treated one low with dextabs, and I did overtreat because the first 2 didn't show any effect at 15 minutes, but I ended up getting about 10 points per gram after about 90 minutes and that is a lot more than he gets from juice or candy. I have only treated 2 lows in 7 months so far, and one was the first 69 I saw on week 2 and the second was a 64 that I treated with 3 dex tabs and they put him up to 170.

    But I am saying that I did see far more points per gram from the tabs but slower than I expected and I thought it might be because the tabs are acidified which slows absorption and also they are solid, so there is a tendancy for the stomach to pull in water first when the concentration is high. Oh, I also treated a 55 at the pool with glucose liquid and it was fast. I can look through my records. Its not the speed anyway, its just that 15 grams of carbs from honey or juice is going to be half fructose which does not go into the bloodstream, but the juice or honey may very well absorb faster. We get about 5 points per gram from juice and 10 from dextabs but later down the line.
     
  5. MomofSweetOne

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    OK, I understand where you're coming from. I hadn't analyzed how much different types of low treatment bring her up. When it's an in-the-wee-hours-of-the-night low, all I care about is seeing results as fast as possible, especially when we were dealing with the furiously fast drops of teen girls that required in excess of 100g at times. We actually only recently started buying the glucose tabs. She doesn't like them, but they were convenient for her to fly with and looked medically so food wouldn't be an issue.

    You'll reach a day where precise measurements of carbs for treatments don't matter as much. It becomes mostly automatic to grab a certain amount. With the lows you've described, we actually will use fruit or vegies like peas or carrots since they're not true lows. Food rather than sugar, please! But, the night I caught a 32 recently with her sound asleep with the sensor in start up, I didn't bother to measure. I grabbed the honey bottle and squeezed her a mouthful. I was rather impressed with the Dexcom graph my pour job created.:wink: But at that moment, my goal was to get her brain out of starvation as fast as possible and I wouldn't have minded an overshot.

    AND NOW TO RETURN TO THE ORIGINAL THREAD (Which I'm no help with since my kiddo was dx at 11 - my hats off to those of you who manage little ones!)
     
    Last edited: Sep 1, 2015
  6. Sarah Maddie's Mom

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    Dragged up this old thread thinking it might help. http://forums.childrenwithdiabetes....60-A-tool-for-managing-D-at-school&highlight=

    No mater how you communicate with school staff, I agree, you're going to have to simplify things, at least at first. Honestly, in 12 years in school with D we've only had one assisting adult (that includes the nurses who were all great) who really understood D like a D mom would. Most outsiders can't comprehend IoB+ Food on Board + fat %+ exercise + recent trend + duration + etc etc. And truth be told? I don't blame them :)

    Good luck. Hope you come up with something that feels reasonable!
     
  7. dpr

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    Last edited: Sep 2, 2015
  8. Sarah Maddie's Mom

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