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Correction doses at school

Discussion in 'Parents of Children with Type 1' started by susanlindstrom16, Sep 7, 2016.

  1. susanlindstrom16

    susanlindstrom16 Approved members

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    I'm wondering what everyone does about correction doses at school (that are not related to a meal so no carbs) at the end of the day. Just received a text that my daughter's BG is 295 but she did not get a correction because the threshold is 300. Looking through the way our diabetes management plan is, 300 is the threshold for hyperglycemia, where they would call me, check for ketones, etc. But my understanding was that corrections can be given whenever we are over our target (120), and that the ezBG calculator on the pump is used and so if there is any iob that will be taken into account.

    She had lunch at 12pm so if she's still 295 at 3pm without eating anything else she needs more insulin. How do you guys have that worded in your plans? Do they get corrections at the end of the day at school if they are high, but not officially hyperglycemic? This is sure to happen again so i need to figure this out. She goes to an aftercare program located at the school. Thanks for any insights!
     
  2. mikegl31

    mikegl31 Approved members

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    I would expect my son's nurse to correct a 295 3 hours after lunch. I am not sure exactly what his plan says, but I think it says anything over 180 gets a correction - especially if he is wearing a pump. The nurse really just follows the lead of the pump. If the pump says to correct, she does. She is also getting good at making adjustments for activity like gym or recess. She called me at 2:50 today and said that his blood sugar was 179 and the pump was suggesting .5 units. Since he was going to after care, where he runs around a lot, and there is no nurse, she likes to run things by me. We decided to give him .25 units. I would suggest talking to the nurse just so everyone can get on the same page.
     
  3. dpr

    dpr Approved members

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    I would want a correction. Talk to the nurse. Since you text and have a pump, it's probably an easy fix. Some where around 7-8 we got our daughter an IPod that connected to the schools wifi so we text directly. If you think your ready for an iPhone a Dexcom with the Share app will let you watch everything all day long and be able to text you daughter direct. And a Dexcom makes everything about d management easier and better.
     
  4. rgcainmd

    rgcainmd Approved members

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    My daughter has absolutely no involvement with the school nurse. :D:):D. We use Dexcom Share; my iPhone and/or Apple Watch alerts me whenever she's above 140 or under 65, and I text her instructions on what to do. About 75% of the time she's already addressed the issue herself. So much easier this way, and more time is spent in the classroom.
     
  5. Snowflake

    Snowflake Approved members

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    I think it partly depends on how she's cared for in after-care and what the activity level is.

    Our daughter doesn't do after-care, but we do sometimes sign her up for short "enrichment" courses -- a couple of days a week of 60-90 minute after-school programs in particular subjects like foreign language, arts, etc. The enrichment teachers aren't trained in diabetes, and all they know is to call us if dd says she's low or beeps low. On those days, dd goes to the nurse's office for a poke right before the final bell. The health aide texts us a number, and if she's high, we request that she give half the recommended bolus. If she's 120 or under, the health aide gives her a snack with the full bolus. The goal of all of this is to get our daughter safely through the enrichment class.

    I think you should definitely push the nurse to correct highs at the end of the school day, but, depending on who's caring for her in aftercare and how much activity is involved, you might want to temper how aggressive she is with the high treatment.
     
  6. susanlindstrom16

    susanlindstrom16 Approved members

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    Thanks! this is definitely true. The aftercare activity varies a lot, but it almost always involves playground time and running around like maniacs. So i think that's a good idea to do a half correction, depending on how high the number is. I thought about having her just do the check at aftercare when she got there but I think she likes stopping in at the nurses office for privacy. I talked to the nurse today and I guess what it comes down to is that our plan states to give insulin at meal and snacktimes but does not specifically say to give insulin at any other time. So i guess we will have to have the doctor write that in.

    She was also saying that in the typical language of the plan for hyperglycemia that its 2 checks that are above 250 3 hours apart and that you don't give insulin at the first check, just water. To me that makes no sense, I can see 2 checks at that level that are not brought down by insulin. But I also think that she is dealing with a lot this first week of school, so i think we will just have the doctor edit the plan if that's what it takes.
     
  7. mmgirls

    mmgirls Approved members

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    we do a correction dose daily at 9am, we find mornings the hardest and the most unpredictable even with the same foods and routines. I test and give a breakfast bolus by 6:15 when I am waking up my girls, at 9AM my youngest is getting tested in class and getting a correction bolus to a targeted 100, she has the option to eat a zero carb snack at that time.

    If she is having a daily check at the end of the day maybe do a 0 carb snack and change the target to a higher number? like for my oldest she has PE at the end of the day so the checks after lunch but before PE is targeted to 125 instead of 100 and she will do a correction only when I get her. when I figit with basals I change it up to 140.

    Something that the nurse needs to know is that the pump will not stack insulin and I find the Animas pumps to be the most conservative compared to Medtronic.
     
  8. Jejessica

    Jejessica Approved members

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    Do you have a copy of the care plan as well? Ask your doc to send you one, just to be 100% sure. My son had had the same school nurse since diagnosed until this year, so it was a little scary entering junior high. I wanted to be sure we were on the same page, so when I had the dr office send the care plan, I asked them to send it to me too so I know the exact wording and steps. And then if you see that she's wrong, try not to say "hey you're reading that wrong," but maybe, "the way i understand this is...." Just my two peanuts. :)
     
  9. Jejessica

    Jejessica Approved members

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    BTW, we correct anything over 150, as long as it's at least two hours before/after lunch, which is when the checks are scheduled for anyway.
     

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