- advertisement -

Who can bolus/test BG at your child's school?

Discussion in 'School and Daycare' started by Lorraine, Jun 6, 2007.

  1. Lorraine

    Lorraine Approved members

    Joined:
    Feb 17, 2007
    Messages:
    309
    Hi there.

    I am preparing for my son's school year starting in August and am wondering what other people's experiences are. I have heard over and over that the school nurse is the main person responsible for a D child's care at school. I am wondering how this works for you all. My son is currently pumping. He will be attending preschool at a parochial school who has a nurse provided by the public school system. He will be there 3 days a week and will have lunch there.

    Specifically,

    Does your child go to the nurse for each bolus for lunch and each snack?

    Who is typically the back up person when the nurse is absent? Does the teacher have any responsibility for bolusing?

    If there is an impromtu snack, who estimates the carb count? Every time my older son comes home from school and tells me about the special snacks he has that I had no idea about, I wonder how kids with D handle this.

    Sending in lunch, I expect to be providing carb counts. My son typically eats whatever is provided to him. But what happens if your child does not eat their whole lunch for which they have been bolused?

    Checking blood sugar - is this done only by the nurse? And since we have been pumping, checking his sugar 2 hours after he eats has been an instrumental part of his dosing management. Is this something that is accomodated?

    I realize I have some legwork to do to get a proper 504 plan (or something similar for a parochial school) in place and to set up a meeting to set expectations and such. I am also looking for the practical advice that only fellow parents can provide. I'd like to understand what people find to be reasonable as far as expectations so that I am prepared at the initial meeting. This school currently has three other D children, so I expect that there will be clear procedures in place. But again, I want to be sure that if I don't agree with their approach, I will at least have a sense if I am being reasonable.

    Thanks for any and all thoughts.
     
  2. jules12

    jules12 Approved members

    Joined:
    May 26, 2007
    Messages:
    2,333
    School - First Grade

    Our school nurse is the main person. We also have a health room assistant who helps with his BG readings. The nurse splits time between two schools. We are fortunate that the health room assistant is working toward being certified or something like that to be able to help with my ds insulin needs. We do not have a 504 in place. I will push for that if needed but so far the school has been very helpful with just an IEP. Our doctor also wrote on the "orders" for the school and "child may administer his own insulin." This has gone a long way in helping when the nurse is at another school. She has a check list to go through with my ds to prove he can bolus with Mom or the Nurse on the phone determining the carbs. We time morning breakfast so that he can stop by the nurses office to check his bg. He then goes to see the nurse before lunch and she helps him bolus with his pump - he does all the button pushing he the nurse observes. He brings his lunch and also buys the school lunch. We decide what is for lunch the night before. I tell him that if he doesn't feel as hungry to let the nurse know before he bolus or if for some reason he doesn't eat all his food because he is full to go and tell the nurse. This has only happened once and he did just that - they found a small snack that equalled the carbs he didn't eat. We have also had the cafeteria subsitute a food he was suppose to eat with something else and I was so proud of him because he went and told his teacher and the cafe manager went and found him the banana he was suppose to eat. They have never substituted again with emailing me or the nurse. I type out the food and carb count for everything he is going to eat and send it to school each day.

    When we have special snacks in school, the nurse has called me to help determine if 1) it is OK to have the snack (which is always is) and 2) to determine how much insulin or how many carbs is the snack). I know we are still knew to this but I have not limited snacks at school for special occasions that someone else bring in. My ds is different and I cannot control that but I can let him eat the same thing as everyone else every once in a while.

    I know other schools are not as friendly or helpful but this method has worked for me. If I met any resistance at all, I would push for a 504 - we have just been very fortunate and have recieved excellent care. I talk to the nurse or the clerk at least once a day.
     
  3. selketine

    selketine Approved members

    Joined:
    Jan 4, 2006
    Messages:
    6,057
    I would talk to the school some more and ask them the questions you've asked to the list about what they are currently doing for their diabetic kids.

    In many daycare/preschool situations all they will do is test bgl and not give insulin. It sounds like this school is really doing alright with having the nurse and so forth.

    Is this a private religious school? I'm confused by the fact that they are provided a public school nurse - so the nurse is actually paid by the public school?

    The laws are somewhat different for preschools and whether or not they are run by the public school system or a private preschool. I guess the issue there is whether they are obligated to evaluate for a 504 if they are a private school. If they receive any federal money then I think they are obligated to do 504 plans if requested....at least to evaluate the child.

    I posted this on another thread because Jules had mentioned she had an "IEP" for her child. I'm thinking she meant an "IHP" or health plan but I didn't want you to get confused by the terms!

    Is it an IEP (individualized educational plan) or a health plan? Many schools use an acronymn that sounds like "IEP" for their health plan (IHP, etc). If you aren't sure then go back and look at the documents. An IEP is usually developed for students who are having difficulties at school that cause a need for special education. If you have an IEP then the types of things covered in a 504 would also be included in the IEP. You should ask for a reconvening of the IEP team to add the diabetes accomodations.

    This link explains the IEP: http://www.diabetes.org/advocacy-and...chool/idea.jsp

    This link compares the IEP to a 504: http://www.dshs.state.tx.us/schoolhealth/exhibit2.PDF

    This document briefly notes what type of info is in a health plan vs. what is in a 504: http://www.diabetes.org/advocacy-and.../schoollaw.jsp

    This is also helpful about 504 plans: http://www.diabetes.org/uedocuments/504-2-pager.pdf

    My guess is that if you likely have a health plan in place and not an IEP or 504. It is wonderful that your school has been great with your child and you're happy with it. The 504 ideally - for your case - could be used to actually put in writing what the school is doing so that if there is any dispute down the road then it is clear what the school's responsibilities are. What happens if the nurse leaves and you don't like the new one? A teacher refuses to let your child go to the bathroom or test herself in class- or treat a low, or sends her to the nurse alone when she isn't feeling right? What if your child does poorly on a test and you find out her bgl was 500 - or 50? What if the nurse goes out for a few days and no one is there who can give glucagon or insulin? What if you can't go on her field trip - who will go to check her bgl, give insulin and give emergency treatment?

    These are some of the issues that can be discussed with your school and put into the 504 plan. It sounds like your school is doing the right thing so far. I would look over the info on 504 plans and what is generally included. If you call 1-800-DIABETES and ask for their school discrimination packet they send it out for free. If you do not have a 504 in place then the things I mentioned above - the school can choose to do or not for the most part. If they do NOT do it - then you have little recourse. Only the 504 or IEP (not a health plan) legally obligates the school district to provide services and accomodations for your child and protections and a means of appeal and resolution if something goes wrong.

    In other words, would you buy a house without signing any papers? Take out a car loan? Would you trust that they would handle your money correctly and what you agreed on would be enforced down the road even without documentation if something goes wrong? I feel the 504 is similar - we sign all sorts of agreements with others on important issues and it is not an adversarial process. We all understand our obligations and it is spelled out on paper for future reference. If one of us reneges on that - then we have the framework for resolving the dispute.
    ___________
    _______
     
  4. jules12

    jules12 Approved members

    Joined:
    May 26, 2007
    Messages:
    2,333
    Agree on 504

    I agree that we need to get a 504 plan in place. With one month left in public school, I was overwhelmed just getting into diabetes, let alone what all had to be done at school. The nurse was awesome and took the ball and setup all the steps - I was still in a daze.

    I have talked with others and am collecting information for the 504. You are right it is a IHP - sorry for the mixup in terminology - we have an IEP for my daughter for speech - too many initials!

    I believe I will end up having a 504 with an IHP so that the IHP can be more flexible regarding the dosing, etc. and can be changed without all the formality. I know I am new so please listen to those who have been around a long time. I just wanted people to know that there are public schools out there who are willing to work with you. Our nurse met with the teacher as well as all the extra teachers (pe, music, art, principals) and even the bus driver. She even got minimed to come out and do a training demostration! On play day, she was right there testing him every hour (he drops low with exercise and we had him disconnect for water events). I just love her!
     
  5. Lorraine

    Lorraine Approved members

    Joined:
    Feb 17, 2007
    Messages:
    309
    Caleb will be attending a preschool which, starting next year, will be absorbed by the parachial school it has for years been partnered with. Yes the nurse is provided by the public school system. I was surprised to learn that, but felt it would indeed help my position since government funding and 504 go hand-in-hand.

    I have gotten a sense of what the school currently does for the other 3 T1s in the school. However, because of his age, I want to be very very clear on how his care should be handled. The nurse seems very competent with D, however perhaps a little too much as she seems hesitant to get down in the details at this point. It's still early however. I plan to take the summer to get my ducks in a row. I was looking for some practical experiences related to the questions I had and was hoping for some more specific examples. But I'm confident that I will be able to fairly spell out his needs in an efficient manner to ensure they can be handled.

    If anyone has some practical tips, I'd love to hear what you all do. He will be going into public school for K, so the parties will change and I'm still curious to know who bolus' and how special treats and the like are handled by others.

    Thanks!
     
  6. selketine

    selketine Approved members

    Joined:
    Jan 4, 2006
    Messages:
    6,057
    Jules - I think you are doing great! I think you would have much more practical info and be able to answer Lorriane's ?'s better than myself. I should have said that William is just starting kindergarten in the Fall so I'm in the process of figuring out all those issues myself (where William will be tested, etc.) I realize that whole acronym thing is easy to confuse!

    Lorriane - We are going to ask that volunteers be trained in diabetes mgmt (be able to test him and give glucagon) so that there is always back-up at the school. I would ideally like his teacher to know how to test him and be exposed to what is involved in his care if there ever was a lock down situation so she wouldn't be clueless.

    William won't be able to eat an impromptu snack because he is also highly allergic to peanuts. I plan to leave some snacks at school if this happens - with the carb count on them. I think if he could eat the impromptu snack I would ask them to call me for help on bolusing. I would request that notice be sent to parents NOT to bring impromptu snacks and to work with the teacher on when to do a bday party, etc. so I can know ahead of time. But I know it won't always take for some people!

    If he doesn't eat all of his lunch then I think we have to have some back-up food. Maybe something like crackers or yogurt, etc. I don't think just giving juice to make up those carbs - unless it is only a bit - would work well. I guess I would ask them to call me on that too until we can see how it works. I don't plan to have them pre-dose ALL of the insulin (he pumps) before lunch - although we do that at home - when he first starts school. I think I need to see how well he will eat lunch at school. I expect this has to be worked out during the first few months.

    If your nurse cannot do the 2 hour test then....what the heck is she good for! I would think this is a reasonable request! I expect William will need to test about 3-4 times at school every day depending on how it goes. I'll probably ask to have him tested more when he starts and less as it goes on.
     
  7. kiwikid

    kiwikid Approved members

    Joined:
    Dec 29, 2005
    Messages:
    3,011
    Sending in lunch, I expect to be providing carb counts. My son typically eats whatever is provided to him. But what happens if your child does not eat their whole lunch for which they have been bolused?

    This was my biggest worry at school, Rachel can be so fussy. Rachels careplan is written like this.

    Monitoring of Food Intake
    All food intake needs to be closely monitored and directly supervised. Jane will provide a lunch box of food. She will make a record of all the food items along with their carbohydrate content. The school will monitor and record all items eaten. (and ensure that it is not swapped, given or thrown away (and said to be eaten)). Rachel does not need to eat everything in her lunchbox, but it is essential that the school team calculate the carbohydrate intake and the total carbohydrate content be entered into the pump, and insulin doses according to the carbohydrate content be delivered.

    Rachel is at school from 9am until 3pm, the way the school day unfolds makes it easy for Rachel to be tested. She is tested at 9am when I drop her off, 10.40am for morning snack, 12.40 for lunch and then when I pick her up at 3pm.

    Rachel is NOT prebolused because I don't trust that she will eat everything she says she wants, but I make sure that she is bolused straight away when she says shes had enough.

    We've had few problems with impromptu snacks, but I hate her missing out when the other kids are having something so I have provivded a carb book to the school and they will ring me if they want to check.
     
  8. jules12

    jules12 Approved members

    Joined:
    May 26, 2007
    Messages:
    2,333
    Box in Classroom

    I did make a box of snacks in the classroom which has 0 carbs - like beef jerkey, sf jello, cyrstal light bottles, etc. That way, if the class has a party for being good or something and even though I know in advance - sometimes I forget about those things - then my d kid has something to snack on - I also have quarters in the box so that if everyone is having a snack - he can go to the teacher's lounge and buy a diet soda (it makes him feel very special)!!! The teacher also appreciated having these. I also provided a box of ziploc bags so that if a snack or candy was passed out, it could be sent home for my ds. Candy is one thing we try to incorporate with meals only in small amounts - not just as a snack. So we talked about it and he brings it home.

    My ds also keeps a sports water bottle on his desk so that he can drink anytime he needs too.

    Our goal is self-management. I know it is scary, especially for Kindergarten, etc. I was suprised at how much my 1st grader and now 2nd grader this fall can actually do himself. He amazes me everyday.

    We are also working on portion identification for certain foods he eats with the school lunch. He told me one day his friend received 10 chicken nuggets instead of 5 - this quickly turned into a discussion of what would you do if you got 10!! At the end of the school year, we worked on cutting in line when he was low so he could eat right away. He almost always buys milk to go with his lunch.

    It is very scary but I know I cannot be there all the time. DS also wants to go to friends houses to play - two moms have approached me and are willing to learn but I have waited to be sure my he can do things like check his bg by himself, bolus for snacks, etc. We aren't perfect yet but these are the goals. It's a lot to ask of a seven year old but I believe any D kid is not typical - they take on more responsibility and grow up a little faster than the rest!

    One more thing, I wasn't sure how I felt about this at first but it did stop all the kids from asking questions - they to ask them all out right up front and it turned out to be a good thing. The nurse came into the classroom and read the book - taking diabetes to school. My ds answered the questions he felt comfortable talking about and the nurse helped with the rest. It really helped the kids to understand why he got an extra snack or why he was always going to the nurse, or drinking at his desk, etc. They also talked about how they could be a good friend if my ds started acting tired, sleepy, etc. on the playground and how they could get a teacher. Each kid is different and some may not like the extra attention but it worked for my ds.
     

Share This Page

- advertisement -

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
    Dismiss Notice