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I need some advice. Please

Discussion in 'Parents of Children with Type 1' started by mapoe4, Nov 4, 2013.

  1. mapoe4

    mapoe4 Approved members

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    I am still waiting on the doctor to call back. I called the office at 9am.

    It has been a while since I have posted here. I know I can count on the advice I get from here.

    I am trying to figure out the sliding scale for Billy. I am scared that I am going to do it wrong.

    Billy gets 3u Lantus in the morning. He now needs Humalog for carbs. He gets 1/2u per 30 carbs. (He got Dx'd very early thanks to Trial Net so at this time he is on a very small insulin regimine)
    I did the 1800 rule so I came up with is 1u will drop BG 360.
    5u insulin daily.

    For the sliding scale I have figured out:

    1/2u- BG 250-400 (or should I change this to 300-400)
    1u 401-500
    1-1/2u 501-600

    I also have to fight with the school again because they won't give Billy injections. Been 5yrs fighting them with John now since I don't have Billy on the pump yet I get to fight even more. He won't do it himself yet and is still scared when he has to get the Humalog. He doesn't mind the Lantus anymore.
     
  2. missmakaliasmomma

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    Do your kids go to a public school? I was under the impression that they had to give injections if it's in the 504.. do you have a 504? My daughter started kindergarten this year and was first using her pump. We went back to injections during the 1st or second week of school. We had no issues, EXCEPT the school thought she needed her nurse less because she is now on shots?? I explained to them that because you have to round with shots, she needs a nurse more.
     
  3. Sarah Maddie's Mom

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    Hi Bobbi,

    Sorry to hear that you are still having problems with the school system. :( Did the endo get back to you? My memory of using a sliding scale is so faint that I don't dare advise you. On the school front can you get back in contact with the ADA folks who helped when your older son was being denied care?
     
  4. Mish

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    Is there a specific reason for doing a sliding scale vs just figuring it out based on carbs eaten and correction for high blood sugar?
     
  5. mapoe4

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    School board here says only RN can give injections. Yes John has a 504 and Billy and IEP.
    I am still fighting them with John. And now Billy.

    I need the sliding scale for the durrable medical management plan for school.
    If it isn't written just right by the doctor they won't do anything.

    I am waiting for an email back from the doc. I had to send Billys readings to her but she said that she probably couldn't get to it any sooner than sometime tomorrow as they are short staffed.
     
  6. Mish

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    Unless he's eating exactly the same number of grams of carb at every meal (which is when a sliding scale works) I would think it would be easier to just say 1 unit for every 60 g of carbs and 1u for every 360 over target. If you have to write the math out for them :

    grams of food / 60 = total meal insulin
    (Blood sugar - target blood sugar) / 360 = correction insulin
     
  7. mapoe4

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    Yes everything has to be specific detail for them. if it isn't and I try to tell them something the school board will tell me that isn't what the doctors orders say.
    It's not the school nurse it is the school board.
    Also, when I need to change any of this, as I will, I have to have the doctor fax in new orders. She has to fill out a whole new Durrable Medical Management Plan every time.
     
  8. sincity2003

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    Please, please, please contact the ADA about your school district. I'm also in Florida and am having huge issues with the school board and school nurse. The ADA is very interested in Florida schools right now because there is a huge problem with school districts not giving/not following 504 plans for Type 1 children.
     
  9. Beach bum

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    It amazes me that they are still wanting to do this dance with you?again. I'm sorry that once again you are having to battle with the school system. I'd touch base with the ADA to go on record of the run around you are getting?again.

    Hang in there, you've got all of us in your corner!
     
  10. wilf

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    I think I understand what you're wanting to do. :)

    Some questions - does he get roughly the same number of carbs for lunch each day? If so how many? Does he eat all of his lunch?

    A sliding scale will only work if the number of carbs in the lunch is same each day, and if he can be counted on to eat his lunch.

    Let us know the answers to those questions and we can put something together for you. :cwds:
     
  11. missmakaliasmomma

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    That's true. I do believe only an RN can deliver medicine. An LPN would have to be supervised so it's pointless for a school to have one IMO. I guess I shouldn't be assuming every school district is the same, I really though all school nurses were RNs.

    You don't need the sliding scale for the medical management plan. There's a formula on my daughter's which is actual BG - target BG divided by her ISF which is currently 170. So if she's say 180 before lunch, the nurse would do:

    180-120= 60... 60/170 so that's .35 units. Then she adds her I:C ratio (1:21) so if she's getting 21g of carbs she'd technically need 1.35 units of insulin.
     
  12. missmakaliasmomma

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    My doctor has them prefilled I think and just changes as necessary. I don't see why they'd have to do a whole new plan.

    I'm in NY (didn't catch where you are) and here there's a new law that parents can't tell the nurse what to do, even if the endo says you can in the orders. It has to be very specific for my daughter as well. The first couple weeks of school, we needed about 4 new orders faxed. Now, it's been pretty mellow.
     
  13. wilf

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    Billy's not using a pump.

    And I think Bobbi is looking for something very easy for the school to use, likely on the assumption that the easier it is the less likely they are to fight against it..
     
  14. Christopher

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    No, it is not always true. It depends on the location of the school and the way the orders are set up.
     
  15. sincity2003

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    Here in Florida, either an RN or a "trained diabetes person" can deliver insulin. My son's school has both and we much prefer to deal with the TDP than the RN. Also, there is no state law about the medical management plan; however, many schools in our state are now making up the rules as they go about what they can/can't do. For instance, the RN at my DS' school didn't like his DMMP, so she called the endo's office behind my back to have it changed (which was a thread here). If she had just spoken to me, we could have resolved it.
    We ended up sending in a note from the endo's office that my husband and I have final say on all his D care and what we say overrides his DMMP. Our RN doesn't like it, but by Florida law, there's nothing she can do about it.
     
  16. mapoe4

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    I have a lawyer thru the ADA and a lawsuit with the OFFICE OF CIVIL RIGHTS. Part of the lawsuit is already finalized in my favor but the school board for Sarasota County is still having problems with the whole thing. Everytime they try something new we have to go back thru the OCR. The school boards policy states only an RN can administer/draw up insulin. The school nurse outside of school is an LPN. She can give injections but the school won't classify her as an LPN only a clinic aid.

    I have had problems with the other RN trying to change what my other son has for lunch and trying to prevent lows. She isn't there this anymore and I have only spoken t the new one a few times at the begining of the year.The school nurse and the TDP in the office I don't have any problems with.
     
  17. Christopher

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    Then how do they/would they handle a child with a pump?
     
  18. missmakaliasmomma

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    My daughter isn't on her pump anymore either. they have to round down, or round up. rounding has to be in the orders as well though.
     
  19. missmakaliasmomma

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    For some reason, I think some of these "school people" don't consider bolusing as actually administering insulin because they are not physically drawing it up in a syringe? While I know it's stupid, I have a feeling that's part of their thinking. Less possibility of an error when the pump does all the calculating for you as well.
     
  20. hawkeyegirl

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    It's been a while, but I think I remember in Bobbi's case, they made John push the buttons himself. Her school district appears to be comprised almost completely of total as$holes.
     

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