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questions about school lunch

Discussion in 'Parents of Children with Type 1' started by coconne3, Mar 11, 2009.

  1. coconne3

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    Hi all, For those of you who have 1st graders in school eating either a lunch from home or from the cafeteria, I have a couple questions...
    1)because they are younger and can't really assess how much of something they have eaten, who's responsibility is this at school? I can write the carbs down on homemade lunch but someone would assess how much she ate. The teachers are not in the caf but there are lunch monitors.

    2)the kids have 20min to eat and 20 min to play (doesn't seem like much time to me but...) anyways do you have the staff give insulin before lunch or do you wait and have them lose some playtime to return to the nurses office to get their med...

    3)if she does choose to eat hot lunch, how do I plan for serving size and carbs? the menu comes out monthly.

    Just looking for ideas...I'm a planner and even though the new school year is months away I'm already thinking and worrying :)
     
  2. zell828

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    It's good to always think ahead ;)

    My SD is now in 3rd grade, but I will still answer.

    1) The school nurse or an aide usually watches what my daughter eats at lunch time and will give her carbs (usually juice) to make up what she doesn't eat.

    2) We pre-bolus and always have. My SD goes to the office first and the nurse helps her bolus, then she goes to lunch.

    3) The school gave us a menu with the nutrition numbers and that is how we figure carb grams. I assume what their grams say is the serving size they give for each child.
     
    Last edited: Mar 11, 2009
  3. *Shannon

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    My daughter was dx while in first grade. I sent her lunch everyday, and she ate all of it everyday. She is a very good eatr, thoguh. I can count on her always finishing her lunch. If your daughter may not finish, I'm not sure who would be responsible for estimating how much she ate. Perhaps who ever is administering her insulin. Have them look at the lunch before she eats, and then after... then give the injection.

    2) Janie stops by the clinic onthe way to lunch and boluses through her pump. In your case, I might have her bolus after lunch just to make sure she doesn't get too much.

    3) Our school district has all menu items w/ nutritional info available for download. They rotate through certain menus so you can always find out how much carbs are in whatever meal is coming up. Saying this... Janie takes her lunch everyday, so I don't worry about it. Before dx she only ate hot lunch maybe twice a month.

    Hope this helps!
     
  4. Amy C.

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    My son has learned since he was four that he must eat all his lunch. I worked with him so he would have a lunch he liked and would eat.

    If you wait until after recess to give the shot, the food will have a head start on the insulin. It is best practice to prebolus and see if the exercise is too much for the insulin.

    All you can do is guess on the hot lunch, unless you go in and look at the proportions served. Ask your daughter what she will eat out of the lunch and communicate this with the nurse giving the shot.
     
  5. Beach bum

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    )because they are younger and can't really assess how much of something they have eaten, who's responsibility is this at school? I can write the carbs down on homemade lunch but someone would assess how much she ate. The teachers are not in the caf but there are lunch monitors.

    Abby goes in to check her bg at the nurses office on the way to lunch. The nurse looks at her lunch and my sheet that I send in. On the way back from lunch, she stops in to have the nurse see how much is eaten and to be bolused. Has worked well for the past two years.

    2)the kids have 20min to eat and 20 min to play (doesn't seem like much time to me but...) anyways do you have the staff give insulin before lunch or do you wait and have them lose some playtime to return to the nurses office to get their med...
    We do immediately after lunch/before recess. Abby doesn't always finish her meal, so to prebolus for us is very tricky.

    3)if she does choose to eat hot lunch, how do I plan for serving size and carbs? the menu comes out monthly.
    We participate in Nutrikids(menus, payme
    nt online) and they publish the carb count. I have friends at other schools who talk with the lunch dept and get an idea of serving sizes and carbs and then give the sheet to the nurse.

    I don't blame you for planning in advance, makes things go much more smoothly when the time comes!
     
  6. selketine

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    William is in 1st grade and eats the school lunch most days. He is an adventurous eater!

    Our school system provides the carb counts for the lunches and they have been fairly accurate so we use that.

    He goes to the nurse, checks his bg and she walks with him to the cafeteria and sees what he puts on his tray. After he eats he walks back to the nurse's office with his tray and she assesses the carbs eaten and boluses him. He is a very dependable eater and I pre-bolus lunch at home but at school he can get distracted by talking or whatever - I just prefer to not have to feed the insulin. I've found he does not spike so much after lunch (compared to breakfast) - the pre-bolus is not essential.

    It makes a difference if your school has a nurse or health room tech or has nothing. EITHER WAY if it is a public school they are responsible for providing someone to help with the carb count and lunch bolus. Private school it is trickier.
     
  7. hawkeyegirl

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    Here's what we plan to do: (my son will be in all day Kindergarten in the fall)

    Jack will go to the nurse's office before lunch. She will check BG and prebolus him 15-20 carbs. He will go eat. He will swing back by the nurse's office after he eats and she will see what he actually ate and dose him for the rest of the carbs. In the HIGHLY unlikely event that he does not eat the 15-20 carbs he was prebolused, she will make it up with milk or juice.

    I can't imagine that he'll ever want to eat the school lunch - he's pretty picky. So I'll provide carb counts in his lunchbox.
     
  8. Mouchakkaa

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    My daughter goes to the nurses office to have her blood sugar taken and she is given a pre-bolus of 20 carb count. When she is finished eating she brings her lunch box back to the nurses office and the nurse determines how much she ate and calculates the amount of carb from the numbers I have provided. She will take off the 20 carb count and give a bolus for the rest. My daughter is a VERY picky eater and never eats her entire lunch so we can not give the full bolus up front. I know that she will eat at least 20 carbs so we get that working in her system so that she does not go up to high from lunch. It is sometimes 30 minutes from the time she starts to eat lunch to when she makes it back to the nurses office and that is to long to wait for a bolus.
     
  9. ecs1516

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    We prebolus 20 like some of the other people said. My boys have the Cozmo and I have the custom 'Lunch' bolus set up to get the 20 carbs. I saves time they just hit meal bolus then lunch and it gives them 20, they do have to add the correction factor. This is what we do for homeschool.
     
  10. Jboudo01

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    We've done it both ways. Initially, when she started the pump this year (she is 5), we had school nurse pre-bolus for 1/2 of lunch carbs and remainder after lunch. Once we were comfortable with how much she would eat, we began pre-bolusing all of lunch. She participates in preparing her lunch so we're sure she will eat it. Also, she didn't like missing recess time to go back to the nurse - sometimes she had to wait. She knows that she has to eat everything though - we explained the importance of it. The people assigned to the cafeteria duty those days also knows that she has to eat it all and allow her time to finish. She knows that if she can't finish, she also needs to tell her teacher when she returns to class. She has always eaten everything. We had a couple of occasions where she at 3/4 of her sandwich, but we just continued to stress that she eats everything. We had to follow up with school on checking on that too. Fortunately, they check her 2 hrs after lunch and they ask again about what she ate for lunch. We don't allow her to eat school lunch. The menu items may change without notice and she can be pretty picky. School district food department can provide carb counts though.
     
  11. tbcarrick

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    my son is 12,but i work in a cafeteria.i dont know where you are from,
    but most schools are wellness now.that means they are to serve certain
    amounts of food,and offer 3 types of fruit and vegetables.for my school (k-6),we have 4oz. of fruit,meat, and veg.the kids only have to have 3 components,but can take all three plus milk. if you have a "head" cafeteria lady you could always ask her for the exact amount,then you could help her decide in the morning what she wants.basically all our food is the same as store.we use tyson,schmit bread, mussleman, and stuff like that.good luck
     
  12. twicker1

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    In kindergarten, you would have thought that the district had never had anyone ask for any nutritional info before! It took us almost two months to get it from them. Turns out it was just the person in charge of food services. Since then, the new guy gives the whole nutitional info packet to whichever school nurse requests it, each month.

    Our routine is like some on here. Brandon goes to the nurse before lunch for BG check, goes and gets whatever he chooses, eats, and brings the tray back to the nurse. She calls me every day and tells me what he has eaten, and then I figure out what to give him. She CAN do it, but there is just a part of me that can't give in to letting her do it unless I just can't be reached by phone.

    In kinder, with all the problems getting the menu, and the fact that Brandon DID like to take his lunch, I just made his lunch every day.
     
  13. JenniferM

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    We have our DS test at nurse at lunch time (he is in 3rd grade). He preboluses for 40 carbs. We know that he will eat at least 40 carbs. The milk itself is 35 so it is a pretty safe bet.

    He eats. When he is done eating. He calls us and we have the lunch menu and total carbs. We then give him the rest of his bolus.

    Jennifer
     
  14. Big Hair Momma

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    Our DS is a 1st grader this year. Our school has recess first. So our schedule is Caleb goes to the health tech before lunch recess. She checks his BG. After he eats lunch, he takes his sack lunch and all his trash back to her. She boluses for the carbs I have listed on the front of the brown bag. We have the agreement that he's to eat everything I pack. If he wants to eat hot lunch, I go to school at lunch and actually look at the tray. We agree on what he's going to eat, I bolus him for the carbs, which I get from Nutrition Services, and leave him to eat.

    HTH!
     
  15. wvchinacat

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    Had to write something down here too. . .message too short it said! :D
     
  16. ethical_erin

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    Each school is different-My stories

    Hi there! I used to be the Child Nutrition Supervisor for a district of 5000 students at 10 serving sites. What we did was I did CHO counts for all school menus (breakfasts and lunches) for the month then sent them to the nurses to distribute to their diabetic students/parents. This worked well. Students would bring their trays to the nurse so she could clinically assess how much was eaten like in a hospital and then the students would dose from there after eating. The blood sugar test was done before the meal, though, and of course if there was a low or high it was addressed pre-meal. The school where I'm working now is great. There are currently 2 type 1s and each is treated differently because of needs, ability, and parental requests. One does all the pre-meal w/ nurse then walks to cafeteria w/ her to assess the meal. The other student (3 grades older) tells the nurse what he will be eating from the menu (or home) and then doses. It works well for both of them. Yes, rapid acting works best when given 10-15 minutes before meal, but better I think to be accurately dosing it. The beauty is that there are multiple options that can be worked out for it to work successfully!
    Erin Aylor, MS/RD, MEd
     
  17. Mary Lou

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    I think it is a good thing to think ahead.

    When you have your 504 meeting, (or sooner), find out what your school is capable of providing already. When Brian was dx'd, there were already CWD at the school, and the cafeteria published carb counts for us.

    We have, since then, switched cafe services, and they didn't initially have carb counts. It took a couple of months, but now they are great at both providing carb counts and SERVING THE PORTION THEY ARE SUPPOSED TO....a-hem. It's been my experience that what is supposed to be served isn't always. Now, I send and email to the lunch manager whenever Brian is eating hot lunch, and they'll weigh or measure out his tray and have it ready for him.

    The nurse pre-boluses for 20 carbs. He brings his tray to the nurse after and they calculate the consumed carbs. I know it's a bit of a hassle, but in this day and age of over-weight children and adults, and the added possibility of "insulin weight" I do not believe children, any children, should be made to eat their entire lunch if they dont' want to, especially with the less than healthy hot lunches out there. (just my 2 cents :rolleyes:)

    Good luck!
     
  18. wilf

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    Are you pumping, and if not then what sort of insulin regimen are you on?
     
  19. coconne3

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    Thanks for all the examples, suggestions and great replies. I know we will be ok. Yes she is on the pump
     
  20. GaPeach

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    You have had wonderful suggestions and examples from fellow CWD members.

    I digress a bit here...

    Just wanted to add that my DD is in 5th grade. When she was dx in 3rd grade, we were homeschooling. A lot of time at each meal was spent having her measure weigh and calculate her carbs. She has become very good at "eyeballing" and carb counting over the 2 years. Empowering her to do her own carb counts has given her many freedoms for sleepovers, playdates, special activities after-school, church activities and most importantly a non-D summer camp.

    Beginning in the 4th grade, she went to public school. It has been a great journey. The really cool part is how involved her classmates have become. She brings a classmate with her to the clinic. Together they talk about what she ate, look up the carb counts in a master book that the nurse keeps on the desk. Melissa has her classmate do the necessary math to compute carbs based on the serving size and what was actually eaten. (The nurse listens in and confirms the count and dosage.)

    The neat part is that the non-D classmate that she chooses to accompany her that day gets a lesson on what is involved. Hopefully, they are "getting it" about Diabetes. BUT also they begin to understand serving sizes and carbs and perhaps get a message that will help them avoid the epidemic of over-eating and obesity that is plaging our society today.
     
    Last edited: Mar 16, 2009

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