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Assisted self management for an (almost) 9-year-old?

Discussion in 'Parents of Children with Type 1' started by njswede, Jun 17, 2016.

  1. njswede

    njswede Approved members

    Feb 9, 2015
    Hi there!

    It's been a while! Things are generally going pretty well over here and the summer fun has just started.

    Noah is showing a growing interest in self-managing his diabetes. We've already let him go to a few parties without us coming with him. We live in a very small town, so the parties are rarely more than 5 minutes away from us and with him on the Dex, we felt like it's reasonably safe. He typically texts us what he's planning to eat, we text him back a carb count and he lets the pump do the math, texts us the dose and we sign off on it. So far, it's been very smooth.

    The relationship with the school nurse has been... well... OK. Not great and he feels it takes a lot of time out of his school day to run back and forth to her for boluses. He starts 4th grade next year, and we're toying with the idea of letting him self-manage and self-administer with a sign-off over text from us or the nurse. There's another kid about the same age in our area who's been doing it successfully for two years now.

    Our endo is very much against this idea and doesn't think anyone younger than 10-11 should self-manage, even if it's under supervision. Noah has matured a lot over the last year and has turned into an intelligent and responsible kid. My wife and I think we may be ready for some assisted/supervised self management.

    What's you experience?
  2. jenm999

    jenm999 Approved members

    Apr 30, 2014
    We have an 8 almost 9 y.o. boy too, entering 4th grade in September. The nurse is adamant that he not dose without her, and because she is *so good* with his care we have decided not to push it. Since her office is right next to the cafeteria, we have all agreed to have him see her on the way to lunch and pack no carb snacks so he doesn't have to leave class except for extreme highs/lows. But at home he boluses by himself for anything with a label, and is getting very good at guessing carbs when at a restaurant or party.
  3. Snowflake

    Snowflake Approved members

    Dec 1, 2013
    My kid is a few years younger, so I have no direct experience to offer. But I do hope that my dd is on the same path to partial/assisted self management by mid-to-late elementary school. Our dd is a budding Type A personality -- highly independent and responsible for a 6-yr-old, and a bit of a control freak. She really does not like being the only kid whose parents stick around at drop-off parties, and whose family passes on soccer carpools, etc. So I think as soon as she has a better grasp of math, she's going to try to wrest the PDM away from us.

    T1 management in the nurse's office sacrifices a lot of classroom time, and by fourth grade the kids are learning some pretty meaty stuff. Plus, we're fortunate enough to live in the year 2016, with unlimited text messages and Dexcom Share, both of which should give you and the nurse a lot of ability to supervise his decisions even if you're not physically present.

    I think it's awesome that your son wants to self-manage, and it seems like this is a good age to start ingraining habits in him. Good luck!
  4. Brhodes

    Brhodes Approved members

    Nov 6, 2014

    My son just turned 10 and will be entering 5th grade. He'll be in the same boat this year. It was pretty obvious he was ready for it about halfway through last school year. He's way more knowledgeable than the nurse and is probably less likely to make a mistake than she is. As long as you have a way to contact him I think you'll be fine.
  5. rgcainmd

    rgcainmd Approved members

    Feb 6, 2014
    Just be sure you have it completely and accurately spelled out in his medical orders from your endo and in his 504 plan. Big problems may arise if you don't do this!
  6. Cheetah-cub

    Cheetah-cub Approved members

    Feb 18, 2014
    My daughter was diagnosed in the middle of 5th grade. She went to the office at lunch time to give shot, later bolus via a pump throughout the 5th grade year.

    Right at the start of 6th, my daughter (who was, and still is very independent with T1D management) decided that she rather NOT go to the office to administer insulin anymore. She wanted to go straight to cafeteria with friends, and to check BG, bolus for insulin on her own there.

    Because she did show independence early on, our doctor was supportive, wrote out a doctor's note to that effect for school. Our school nurse (whom we love) went along too. We got no push back from our endo or school.

    My daughter did very well on her own. She does have celiac, so I packed a lunch for her, and wrote out the carbs information item by item for her, so that apart was easy. She does not even call or text me at lunch time.

    I think it is doable for some kids to manage independently. But you do need the support from the endo and school.
  7. njswede

    njswede Approved members

    Feb 9, 2015
    Thanks! The timing couldn't be more perfect, though. We can give him some more freedom to self-manage over the summer and see how it goes. If it works out, we have some data to bring to the endo and convince him to write the appropriate orders.

    He just got back from a "late-over" playdate with some friends and he self-managed through pizza and ice cream with perfect numbers. So far, so good! So proud of him!
  8. Sarah Maddie's Mom

    Sarah Maddie's Mom Approved members

    Sep 23, 2007
    Mine started self-managing in 3rd grand with endo's enthusiastic approval. There was an aide in the classroom who kept on eye on dosing and became practically an honorary D mom but she was there 75% for another child with behavioral issues - she was not requested for my kid. It was just that first year, from then on she managed things on her own knowing that the nurse was in the building should she need her.

    I think it really puts D kids at a serious academic (and social) disadvantage to be running off to the nurse for every bolus and check. If you feel your child is ready then your child is ready :)
  9. Beach bum

    Beach bum Approved members

    Nov 17, 2005
    My daughter started self managing in 4th. She would test, call the nurse and if needs tell her correction. If it was a number she was concerned about, she would walk down to confer. It was great prep for 5th grade, which in our town was middle school.
  10. dpr

    dpr Approved members

    Dec 17, 2013
    My daughter started 100% self treating about half way through 3rd grade and just finished 4th grade. It's worked out extremely well for us. If you child is willing and able, go for it. I've had as much bad advice as good from endo's and nurse's so I don't let them dictate anything to me. It's all about when and what our kids are ready for. Make sure the phone is in your 504 and that they have access to it at all times for D treatment. If you use the 504 instead of the medical treatment plan it bypasses the endo and nurse, which is 2 less people to have to deal with and I'm all for making things as simple as possible. Or at least at our school the endo and nurse aren't involved with our 504 at all. I also tell the teacher and staff that if they think my daughter is screwing around with her phone to let me know asap and I'll handle it immediately. So far that hasn't been an issue but I'm sure it will be sooner or later..
  11. msschiel

    msschiel Approved members

    Oct 21, 2013
    My son was in 4th when diagnosed and all diabetics always go to the nurses office before lunch and before going home to test. He always gave himself his shots, so the nurse just over sees. After we started pumping, she just double checks his numbers and off he goes. He carries his regular Dexcom receiver during school, not his phone. If it alarms he checks it and does what he needs to do. He will be going into 7th grade in the fall, so same school. There are several different nurses in the school at any given time and most of them do pretty well. Not sure how things go in the high school, so we will find that out next year. It is great that your son is willing and ready to self treat!
  12. SHirsch999

    SHirsch999 New Member

    Mar 2, 2016
    Hi. I know this is a bit late to the discussion but I figured I would add what we do. My daughter is 11 now and entering 6th grade, but we have been doing this for the past 2 years, only the last year with a pump. We do pretty much what you do in regards to her testing in her classroom, texting us the result and inputting it into her pump, putting in the carb count on her own and giving the insulin on her own according to what the pump recommends. Since being on the pump she hasn't seen the nurse even once for her diabetes management. The school board and nurse were reluctant to allow us to do things this way at first, but she is a very responsible and mature kid. We were also lucky in that the school principal was also a T1D so he was very much an advocate for us and changing the school district's protocols for how these students are managed.

    As for your endo, self-management depends on the individual child and has to do with more than just age. Also, this really isn't self management - she is in contact with us before actually giving the insulin. She doesn't make decisions on her own. She tells us what she wants to do and then we all decide if it is appropriate.
  13. glko

    glko Approved members

    Aug 12, 2010
    Another reason to push for testing and bolusing in the classroom - our son pre-boluses 15-20 minutes before lunch. Yes, the nurses office is on the way to the lunchroom, but we found that with the super high carb school lunches (topic for another day!) the only way to minimize the post lunch spike is by pre-bolusing. If he had to go to the nurses office to do that he would basically miss the last half of the class before lunch.
  14. Lakeman

    Lakeman Approved members

    Nov 10, 2010
    I wonder if you might get others on board if you just changed the words you use. Instead of "assisted self-management" suppose you said he would "do what he could with supervision"?

    I agree with others that if more of the care takes place in the classroom (or wherever he needs it) that promotes independence which I assume is a long term goal. Doing the care in the nurses office is for the convenience of the nurse. I don't think it is wrong to do things for the nurses convenience but it would not be my driving factor. We have it written into our 504 that cares take place wherever needed but the nurse and my daughter decide between the two of them where they want to do things.
  15. Schpoodle's Dad

    Schpoodle's Dad Approved members

    Nov 6, 2007
    The decision on when to self-manage depends on each child and should be based on that, not a guideline from the Endo that says 10-11. Some kids are going to be ready much earlier and others aren't going to be ready at 11.

    In my opinion, once they start to express an interest in looking after themselves, they should be encouraged to do so (with an appropriate safety net of course).

    We were lucky with our daughter in that she wanted to be independent and look after herself. We are on MDI and she was looking after her own shots at school when she was in the second grade. We gave her a card that said how much insulin for each BG reading and she looked after herself. The teacher just verified that she was giving herself a shot. We don't have school nurses in most schools in Canada so it was a necessity.

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