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How to work in a morning snack during school?

Discussion in 'Parents of Children with Type 1' started by ashtensmom, Apr 15, 2012.

  1. ashtensmom

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    Our DD has been on the pump for 5 months. Since starting the pump, she has not had a morning snack during school days, because we were nervous of her having to remember to bolus for the snack. (I go to the school during lunch and confirm her lunch boluses everyday).

    She asked today if she can start having morning recess snacks again and I am here to ask for your suggestions on how to work this in other than having her bolus for the snack, because I have read some creative ways to "cover" the mid-morning carbs without bolusing.

    So, she eats her breakfast at 7:15 am and morning recess (snack time) is 10:00 am. Should I give her a lower I:C ratio (more insulin) at breakfast, or should I increase her "basal" to cover the mid-morning snack. Or, should I just have her bolus during the eating (keep in mind she only has 15 mins) so for an 8 year old she will not be able to check BG, bolus and change shoes, put on jacket, eat and play in this short period of time.

    I am really nervous about this as I don't want to chance a low. Does anyone have a child with this similar schedule that can give me some ideas how to do this?
     
  2. Amy C.

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    1. Send food that is low in carbohydrates
    2. Have her leave class early to be tested and bolused so she is back in the room at the beginning of snack.
    .
     
  3. caspi

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    If everyone else is having a mid morning snack, I would absolutely let her have one. Normally, whenever my son eats, he boluses for it. But given your daughter's time constraints, I probably would try to figure out a way to work around the bolus, depending on what time her lunch was. You could also always go for something with no carbs in it, like a sugar free jello or cheese stick.
     
  4. cdninct

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    I think part of the issue is there is no one at school who does the bolusing for her?

    Sadly, I don't think there is a great answer.

    Starting with low carb snacks seems reasonable so that no matter what you do, there will be less room for serious BG fluctuations.

    Is there somebody (teacher, secretary, EA...) who would be wiling to help her out--double-checking numbers, for example? Would they allow her to check her BG before recess so she could at least get the process started?

    We thought we were going to have this issue with DS, and we decided that raising his basal to peak at snack time would be the best bet (as long as snack will be reliably consistent). Luckily, it never came down to that, so we didn't put our plan into action. When is the last time you see her in the morning? Could you do a square-wave bolus at that time to cover it? Any of these arrangements would probably require a whole lot of weekend time trials to see what effect the timing will have on BG.

    Finally, how confident are you in your DD's ability to bolus herself? I ask only because you seem to be considering it. I don't think as a general policy that 8 year olds are ready to handle that responsibility with nobody watching over them, but I suppose each child is different--I think for me that it would still come down to whether there is somebody at school who could at least oversee what she was doing.

    It makes me really frustrated that you have to go in to confirm numbers. I really want to come back home to the Great White North, but one of the things that makes me nervous is the lack of guarantees for DS's diabetes care.

    At any rate, it's a tough one...good luck!
     
    Last edited: Apr 16, 2012
  5. Beach bum

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    Who does her checking for lunch? Is there any way that that person can help her for snack too?

    I would give her free foods, such as SF jello, cheese sticks, carrots and celery with a dab of cream cheese of pb. I know, all kind of boring and not what the other kids are eating, but it would allow for a worry free situation.

    Being that she's eating snack at 10, what time is lunch? I'd probably want something really low carb anyway in order to have a fairly accurate lunch time number.
     
  6. StacyMM

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    This is exactly what I would do.
     
  7. ashtensmom

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    I am the one checking her for lunch, or at least I am the one watching over her do it. I will not be able to do this very much longer either because of work. Since we are in Canada, it is different here then the US. We have no school nurse, and dd just stops what she is doing at 12:00 and pulls out her checker while sitting at her desk and checks bg, then boluses. All the while the teacher is teaching. She then has lunch at her desk at 12:10. I think that I trust dd confirming her own bolus then asking the teacher to stop in the midst of teaching and confirming her bolus since she has no experience whatsoever.

    Getting back to mid morning snack, ugh! Just was corrected by teacher and it's at 10:20 to 10:35, so with lunch being 12:10, there is no 2 hour gap to having accurate lunch numbers. I am really leaning toward a cheese stick for snack or sugar free jello. One good thing is that 3 out of 5 days gym class is in the morning (different times each day, however) so if she has a few carbs after or before gym, it's not so bad. Her numbers have been high at lunch lately so this also throws a kink into figuring this out.

    Also, the combo (amnimas) sounds interesting... How would this work, would you bolus the extra carbs that will be eaten at snack and stretch out the delivery to end when snack occurs? So if she is eating 10 carbs at 10:20 I would do a 4 hour extended bolus for about 80/20 (I also bolus 1/2 hour early for breakfast because of the spike, so I bolus at 6:45 and she eats at 7:15). I would definitely have to test this on a weekend... Also this scares the @&*%^ out of me too.
     
  8. Connor's Mom

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    Our situation is similar. Breakfast is 6:30, recess snack is at 10:30 and lunch is 12:20. He checks his BG after recess and boluses in the nurse's office if he has a snack with carbs. If it's a beef stick or sugar free jello he checks in class and eats it there. By the time he checks for lunch it is usually 12:30 before he is eating so, I use the lunch number as accurate. If there is insulin on board, the nurse will call me and let me know before she adds a corrective dose if he is out of range. That way we don't stack and end up low after afternoon recess.
     
  9. cdninct

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    Oh, I don't know; I was just thinking on my feet and throwing out answers! If I was doing it (and, to be clear, I really don't think I would), I think I would bolus for snack separately rather than including it with breakfast, then I would do nothing up front and everything spaced out over...hmm, if there are 3 hours between bolus and snack, part of me would say do it over less than 3 hours because otherwise the end of that dose would be chasing the carbs, but the other part says that if you do it over less time, like 2 hours, more insulin will be given up front, which could drop her low before snack time.

    This is by no means an ideal scenario and, upon reflection, I'm thinking that playing with her basal rate is probably a much safer way to go since you can adjust when it will peak. You just have to be sure that the carbs will be consumed when they need to be (really, it's the pump equivalent to being on NPH!).

    At any rate I certainly think that the most risky way of doing things would be to play with her I:C ratio at breakfast--that seems like it would be asking for lows.

    It sounds like you are going to have to have her take full responsibility for her own boluses at lunch time soon (or maybe she might be able to confirm with you via phone call or text message?), so maybe you will just have to stay no-low carb at snack time until you do your big overhaul.

    Sorry--this stinks for you and her, and it really frustrates me. I hope that somebody else comes up with a better plan for you!

    ETA: I know that prebolusing is a great thing, and I'm sure it makes a difference to your daughter's levels, but if it would make it easier for somebody (like the teacher) to take a look at what she is doing at 12:00 after the lesson is over, perhaps it is worthwhile to put aside lunchtime prebolusing for a while?
     
  10. ashtensmom

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    Pumping equilavent to NPH...what an excellent analogy! And now that I have read it, I am thinking I would be crazy to go that route! I am favoring low or 0 carb snack.
     
  11. suz

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    My son is almost 8. At lunch time he enters all the info into the pump and the nurse just double-checks before he his "OK". This is new for him, and so far it's going good. Not sure I'd trust him to do it by himself tho....

    He has breakfast at 7am. Lunch at 12. His class snack is at 9.30. I have his I:C set so that he can have a low car snack (6-8g) uncovered, and he'll still be in range at lunch. I know this works out OK for him as we check his Dex log for the day and there are no major fluctuations.

    Twice a week he has PE straight after snack, on those days I don't mind giving him a few extra carbs to hold him over.

    Things I give him include:
    Carbmaster yogurts: 4g
    Cutie satsumas: 7g
    Freeze dried fruit: 7-9g
    Trailmix: peanuts, pumpkin seeds, small amount dried fruit and choc chips: 5-9g (I mix this up myself so can literally add just 1-2 choc chips to keep him happy!)
    small jerky sticks: 1g each
    Sugar-free cookies: 2 for 5g

    I also find those individually-packaged treat size Goldfish and other cracker-type things - usually the Holidays such as Halloween, Valentine's etc.. are a good time to pick these up.
     
  12. emm142

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    If I were doing this, I'd probably go for raising the basal rate at the time of the snack. I assume that for Animas you can raise the basal in half hour increments? If so, I'd do something like this:

    7.15AM - Breakfast
    7.15AM-10AM - Normal basal rate
    10AM-10.30AM - Normal basal rate plus however much is required to cover the carbs
    10.30AM onwards - Normal basal rate

    That way her basal insulin will cover the carbs and she should be in normal range by lunchtime. The only slight issue is that she would HAVE to eat her snack or a low would happen, but she might be happier with that than with no snack at all. And perhaps whoever would help her with a low in the school day could also check that she has eaten her snack?
     
  13. Butterfly Betty

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    Sophie has a similar schedule as your little one. She eats breakfast around 7 am, and has the option of a midmoring snack around 10am. She checks her bg and bolus on her own. Then she has lunch around 11:30. Her numbers have been much better with the morning snack. I would suggest a low carb snack or carb free if you can, but if she wants something more, I would bolus for it.
     
  14. cdninct

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    I wasn't sure if you would find the analogy comforting or appalling, but I figured it would shed some light on the subject one way or the other!
     
  15. danielsmom

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    Daniel eats his free snack 15g's everyday...with no problems...he only needs shot for lunch....
     

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