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Parent notes vs. doctor notes for 504

Discussion in 'Parents of Children with Type 1' started by Jejessica, Nov 21, 2014.

  1. Jejessica

    Jejessica Approved members

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    The reason his ketones seem like a mystery is because they don't always happen. He can go several days waking up around 105-120, then suddenly he's high. He doesn't always wake up high. Often, but not always, it's not consistent. Like I said earlier, I'm going to start a meal log to see if I can find a trigger.

    His I:C ratio is 1:30 when he's at school (lunch), and 1:15 when he's at home (breakfast/dinner). his endo did that to combat his afternoon lows, cuz he was dipping for a while. I don't really know what you mean by run the numbers? I'm guessing I need help with that.

    The endo office only does adjustments on Wednesdays, so I'll definitely call this wednesday n push for an increase in his basal. I did have a pretty extensive talk with the assistant principal and explained what all is happening and we came up with a plan for his high days. He will go to school and they will dose him every two hours and he will have an alternative plan for PE.
     
  2. Beach bum

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    Do you do middle of the night testing? I'm wondering if he's going high during the night (causing the build up of ketones), but then coming down to a semi-in range number. It's hard, but I would suggest checking at around 2am for the next few nights to see if that could be contributing to the problem...
    Running the numbers means tracking all BG's at home and school, writing down how many carbs were eaten, how much insulin was given for both food and corrections. Logging is a big help in trying to get to the root of problems, a lot of times seeing it on paper, or a spread sheet on your computer makes much more sense than just looking at it on the meter.

    Hang in there, you will figure it out! CWD parents are a great pool of knowledge and will offer up whatever help they can.
     
  3. mom24grlz

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    We have it written in Ashleigh's 504
    " there will be no penalty by the district for any diabetes related absences. These days will be marked as excused absences due to diabetes, as long as a doctor's note is provided"

    so i don't think the school is unreasonable in asking for a doctor's note. In our district a student is only allowed 10 parent excuses, after that you need a doctor's note
     
  4. GChick

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    Half of the solution is finding the right dose and the other half may be finding the correct split.

    I started out Lantus in the night and could not go through the night without bottoming out. Dropped the dose to ridiculous levels and woke up good... but then was high for half the day.

    Moved shot to morning, which helped tremendously as when I needed to treat the real "action" time for the lantus for me was ~around~ lunchtime then... but things were still off. If I had to wait 15 extra minutes for lunch I'd be bottoming out too, so while "ok" was still inconvenient. Still, this worked pretty well for a while until I started to notice that I had started to be consistently high by bedtime... but if dose was increased then would have problems with lows earlier in the day.

    After some more trial and error I found the split that worked for me (and I think rarely does a 50% morning/50% night split work). For me, I needed 10units at night and 7 in the morning and it seemed to work out pretty well (or as well as things could be, given that nothing is predictable with this disease).

    When you feel more comfortable with things maybe you can try a range of adjustments to see what works... but remember one day is rarely enough time to see if something is working. But if he is struggling with more morning highs than daytime, then maybe the night dose is where you start.
     
  5. mwstock

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    The doctors note seems reasonable given the high number of absences.

    The bigger issue here to me is the ketone issue. I would be more concerned about that, the repeated loss of school and visits to the ER. Ketones are normally the result of illness or continued high blood sugars. Usually pushing fluids and insulin offsets the production of ketones. My first impression was that your son needs more insulin. The 1:30 ratio vs. a 1:15 ratio seems like a huge variance. I would expect 1:20 vs. 1:15 but not 1:30 ratio. When we were on shots, we heard about splitting the Lantus dose, but never really had very good results when doing it. It is important to be consistent with the time the Lantus is given. It was one more time to remember and one more shot for my son.

    The blood ketone testing is more accurate and up to date, but a lot more expensive. We have used the urine ketones in the past during severe illness. In my opinion it is more important to do frequent blood sugar testing and keep the blood sugar in a normal range.

    I think it is important to continue to communicate and work with your healthcare team to find the correct dose to offset the high blood sugars and ketones. It is not my place nor anyone's on here to be critical of your D parenting skills or second guess your decisions. I hope you are able to get to the root cause of the ketones which are contributing to the loss of school.
     
  6. bisous

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    I agree that I would try to get to the bottom of the ketone issue. I'm not sure if you are testing at night, but I would start. Also, I think you'll find that once your blood ketone meter arrives it doesn't take 6 to 8 hours to get ketones down. It hasn't for us at least, but admittedly we don't often get ketones. Of course, I wouldn't KNOW that the ketones had cleared unless I had used my blood ketone meter because urine ketone testing is so delayed. Does that make sense?

    With regard to the doctor's notes, I personally think that requiring one is silly. We don't have a ton of absences or tardies because of D but it DOES happen to us. In fact, it happened this morning! DS woke up at 348 (he had turned off the high alarm on the Dexcom and I didn't realize!). It took me an extra half hour to get him in range to eat breakfast and show up at school. I simply had to note "medical" as the reason he was late and that was that! I know across the country there are widely differing policies on missing school. I'm in CA and things seem pretty relaxed here. All that is needed is a parent to say a child is sick and that's that! I think part of the reason that 504's exist is to take into account special circumstances. Your special circumstance is that due to your child's disability (diabetes), there will be days that you need to monitor more closely, deal with ketones or whatever. I don't think going to an endo 3 hours away is a reasonable request. I would fight it. But will you win? That's another whole issue!
     
  7. BarbDwyer

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    I would for sure fight it. If the endo signs of on the plan of care (ie when to stay home and when not to stay home based on verifiable tests like ketones) - that should be the end of it. There is A LOT to do and follow up on when treating the medical issue - wasting time and/or resources getting a note should not be one of them IMO.
     

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