504 accomidation to cover CGM monitoring when not covered under District Policy/ Diabetes management

So, here is another one.

Currently my just DX kiddo prior to "clinical DX criterion" is going to the clinic to have her CGM viewed. If below 75 or above 300 to a finger poke to check blood glucose. She has basal going on the Ping and I bolus for breakfast based upon her wakeup. We are not bolusing at school because she will drop down on her own even with eating. Now her numbers have been higher the last couple of weeks of school but we have been in a wait and see mode. I have increased her morning bolus and basal during the day and decrease her snack carbs.

But now I am running into issues with, there is no District policy governing CGM DATA just BG test results.

With no policy covering CGM data, I might have to look into a 504 accommodation to get done what I want done. Check the CGM and then Decide if a BG check is needed? I am honestly confused right now with it being so personal and close to home, where is the line between the heath office and diabetes care and the 504 accommodations in an educational setting? My mind is occupied by o many other family circumstances' right now to be able to think straight.

Any help/insight is needed, thanks.

 

I'm a little confused by your last two threads.

As far as I know our school has no "district policy" on anything that would be covered in a medical management plan. WE dictate medical thresholds and treatment, so be it ketones or when to bolus or not, that would be a plan set by me and our endo and communicated to the school via the nurse.

If you want your kid checked at XYZ number(s) then can't you just include that in your MMP? Or I'm I needling more coffee?

 

I'll give the same response as in the other post. There is no district policy. We along with our team, dictate what is to be covered on our emergency medical plan. We dictate thresholds,BG testing times/places and course of action. The only thing the district has to do with all this is to FOLLOW our plan and make sure they are upholding their end of the bargain.

 

My Districts policy, see section 5.9 on page 4.

Before I worked for my Districts Student Health Services I did not know about these policies that all our school nurses are trained on, which is how they create a school Health Care Plan based upon a Dr's orders.

 

That policy gives me hives.

We would just tell the nurse what we want her to do. 504 plans are for the accommodations. I guess we just have an informal medical management plan with the nurse.

 

Oh good Lord! Who wrote this? Was there any guidance from a pediatric endo?
What about puberty? Every kid with diabetes who needs an extra correction due to hormones needs to go home?

I love this one:


EMS will be called for a student who is symptomatic AND has a high blood glucose level AND large urine ketones/blood ketones above 1.5.
Do they mean having a seizure?

Reading stuff like this makes me feel so lucky that we don't have to put up with some of the stuff other families do. We have a great team of nurses from elem through high, they all work together and they all know what works and what doesn't. Luckily, we have no district policy!

 

Holy Moly that's insane! What works for one student doesn't necessarily work for another. If ever there was a time for a 504, it is NOW.

 

My favorite is the paragraph that essentially says that if the doctor's orders aren't in compliance with the district's policy, the district won't follow them. Whoo boy.

 

We have had a great run until this year, our school nurse retired and now the school nurse assigned currently is having issues with what I am asking for so they have brought in another nurse to help. Someone got in trouble I think because now they want to follow policy to a "t" when our last school nurse saw the nonsence in sending a T1D home for a 0.6 ketones and a BG of 300 and no symptoms, give a correction and check later to make sure that did the trick. She also saw the benfit of using the CGM to monitor glucose levels between regular checks.

I think the biggest issue is this new nurse has never had a child so young, she may have Diabetes care under her belt but she is only 6 not a middle or high schooler and that is anissue for her.

 

That's really messed up. Your school staff obviously has too much time on their hands and too little matter between the ears.

Hope you can devise a workaround.

 

Wow. Just wow.

That is crazy. And it tries to shove every diabetic into one little box as if there is no variation between kids. Some of that is ridiculous!

Our school staff likes to refer to 'district policy' a lot and I now see what it probably looks like all written out. Yikes. We went with the 504 and have plans in place that say what the expectation is for my kids' care and it has nothing to do with their policies. It's what WE need that we are legally allowed to claim and it is what is followed, not their policies. I think of 'district policies' as their default - it's what they do if someone comes into the school system and doesn't create an individualized plan.

I suggest that you start the 504 process and put together the plan YOU want them to follow.

Good luck!

 

Dexom has template 405 plans

Go to the school nurse tutorial here http://dexcom.com/sites/dexcom.com/files/education/nurse/story.html and click on "Resources" in the upper right corner.

 

I think this is a big issue too... the age. I don't think most nurses are used to seeing kids as young as ours like you said so they're not used to having to do absolutely everything for them, whereas they were in MS or HS, they'd be doing most if not all their care themselves. It'd be nice if all these kids could follow orders to a T but we all know every day has different circumstances for little kids with D.

 

well the only Nurse we have ever had that just retired was WONDERFUL with my girls. My oldest started in 1/2 day kinder ( now a 4th grader) and just this last year supported me thru DX and the start of insulin with my youngest in full day kinder. We were friends and confidants and I truly felt like she listened and questioned my thoughts and concerns and would work with me.

This is such a a change that I am heart broken. I am worried that the atmosphere is not happy go luck and matter of fact and than my girls will be picking up on it and feel burdensome.

I have had a 504 meeting and have the accommodations to sign off on. BUT, I did not know about these issues until after the 504 meeting so I feel torn. I will sign the accommodations that I want now and then call another 504 meeting to add on if the Nurses want to balk at my requests.