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School plan states you have to suspend pump for lows- I disagree

Discussion in 'Parents of Children with Type 1' started by Wendyb, Oct 1, 2010.

  1. Wendyb

    Wendyb Approved members

    Nov 6, 2007
    I'm just not sure the teaching is right on this one. They even talked about unhooking the pump or CUTTING the tubing. Can you imagine having your kids tubing cut if he was under 70. So my thinking on suspending the pump is that it's not going to help raise the bg in 15 minutes and only pop up the BG in two hours. I had my Ped endo write that we didn't have to suspend. What do you all think?
  2. NeurosurgeryNP

    NeurosurgeryNP Approved members

    Jul 5, 2010
    I agree. Suspending the pump shouldn't help with a low currently happening. The insulin on board is already working. Makes for a mess later too.
  3. Christopher

    Christopher Approved members

    Nov 20, 2007
    Sorry, but since when do schools make medical decisions about how parents manage their children's diabetes? Did I miss something?
  4. wilf

    wilf Approved members

    Aug 27, 2007
    I think they're idiots.

    I'd ask to have them show you in writing which so-called medical professional(s) came up that whopper. Then file complaints against them with their medical association.
  5. funnygrl

    funnygrl Approved members

    Nov 2, 2005
    I can see cutting the tubing if the child were unconscious and there wasn't anyone that knew how to suspend or disconnect the pump, but that's IT!
  6. sooz

    sooz Approved members

    Dec 4, 2009
    Our endo told us not to suspend the pump for lows...
  7. Bsbllmom

    Bsbllmom Approved members

    Jul 23, 2007
    If they cut the tubing won't the remaining insulin from the part of the tube that is connected just go in through the site? Then there is a bigger problem.
  8. Lisa P.

    Lisa P. Approved members

    May 19, 2008
    Where are they getting their direction from?

    I'd examine and question every part of a plan that included that instruction.

    Pre-pump, cutting off basal insulin would not have been a possibility.
    We certainly would never consider cutting basal off for a normal low. A consistent, very deep low? I guess on a case by case basis we might consider it, for up to an hour. But if they turn off the pump for very long, they risk not only a high later but DKA if there's some kind of mix up and it doesn't get turned back on. I'm cautious about suspend, anyway, but playing around with suspend when you're working as a "team" could be bad, especially if it's done frequently.

    My biggest concern, though, would definitely be less the particulars of the plan than that it seems this plan is district driven, instead of child, parent, or endo driven.
  9. ecs1516

    ecs1516 Approved members

    Dec 11, 2007

    Couldn't have wrote it better. 'Cutting' the tubing or turning the pump off brings up very slowly. Not fast like juice. Then you have to put on new tubing and prime?!:p I would love to hear your endo reactions.
  10. deafmack

    deafmack Approved members

    Sep 22, 2006
    The people who put out this idea are idiots. Suspending the pump could have bad consequences. Cutting the tubing would be even worse. I can see lowering the basal but suspending the pump or cutting the tubing is wrong, wrong, wrong.
  11. kimmcannally

    kimmcannally Approved members

    Feb 28, 2010
    I would be FURIOUS if anyone cut my son's tubing! Only if he was passed out would I think that's ok. I frequently treat lows (60's or higher) by doing a temp OFF basal (he does respond to this well and it doesn't take a couple of hours for him). Sometimes it's just not worth the fight to get him to eat/drink when he's low if he's not dangerously low.
  12. Sarah Maddie's Mom

    Sarah Maddie's Mom Approved members

    Sep 23, 2007

    Before I comment, I'd want to know if this was just people who know very little about D trying to think of ways to problem solve or was this said as a statement of school policy?

    If someone didn't understand how insulin works or failed to appreciate that the pump is a smart little piece of technology, I can see them imagining that cutting the tube on a dangerously low kid could be helpful - just as long as there was someone there to intervene and make them aware that pumps can be suspended or disconnected but moreover that lows are best treated with carbs.

    I guess I'm unwilling to get in a huff about this because it doesn't sound malicious, it just sounds like well intentioned ignorance and ignorance is curable. :cwds:
  13. Diana

    Diana Approved members

    Aug 23, 2006
    This is on our standardized plan for an emergency - like a 911/glucagon situation - but not as a treatment of an ordinary, treatable low.
  14. Beach bum

    Beach bum Approved members

    Nov 17, 2005
    That's my first thought too.
    Who is coming up with this directive?
    Time for a meeting with supporting info from your endo.

    The people who are putting down this directive obviously aren't clear in their understanding of D. Suspending a pump for a low really won't help, it's the IOB that's caused the low.
    Tell them instead of taking the time to suspend, cut, they need to be giving your child sugar or juice to help bring them back up. Then, call you!
  15. chbarnes

    chbarnes Approved members

    Jul 5, 2008
    Hmm. Using CGM, we sometimes cut basal when we see a downward trend. It actually works very fast - not in 2 hours. You can see a high in a couple of hours, but not as high as when we correct with carbs. That being said, I don't know how the school can have a protocol that wasn't ordered by your doctor. I also consider this the sort of technique that should not be attempted by staff. Even if someone was unconscious and needed glucagon, I would assume it would be better to stay attached to the pump with at least some basal.
    I could see EMS removing a pump after starting an IV, because they don't know how to run every brand of pump and want to control what is going into the patient. This is stuff that is far outside the experience of most school nurses.

  16. mmc51264

    mmc51264 Approved members

    May 2, 2006
    I live in NC, they can't do that. If they insist, write EXPLICITELY in your health care plan that they are not to do that. After we hired a lawyer, we found the "NC template for Diabetes Health Care Plan" it is pretty good. It had more things in it than the 504 plan that we submitted.

    This drives me nuts!!!!!!!! Juice, cake icing, glucose pills, and in emergencies, glucagon. Never touch the pump.

    We would never think of suspending pump for lows. Not that I am criticizing those that do, I just wouldn't have thought of it. We treat the lows and go on.
  17. MamaBear

    MamaBear Approved members

    Jul 20, 2010
    Really. It's my understanding that the endo writes up orders on treatment for the school. And those orders allow the PARENT and DOCTORS to make adjustments to treatment as necessary, NOT the school. I'd be challenging that too.
  18. Sarah Maddie's Mom

    Sarah Maddie's Mom Approved members

    Sep 23, 2007
    Could the OP come back and clarify this statement?

    As I noted before if this was just "talk"... the talk of folks who haven't worked with a pump or who haven't been educated yet about basic diabetes management and how insulin works, then it's one thing. And it's something that could be straightened out in a matter of moments. If it's something that was included in a final care plan then obviously that's a different thing all together.
  19. KHM

    KHM Approved members

    Mar 24, 2010
    I second. The endo writes the orders, the school makes a health plan from orders. The school does NOT make these decisions.
  20. Flutterby

    Flutterby Approved members

    Nov 11, 2006
    Cutting the tubing is dangerous, they could force insulin in through the infusion set.. a low bg doesn't need a suspended pump.. suspending the pump draws back insulin, which could cause problems later.. doing a simple temp basal or unhooking the pump is fine if a low bg doesn't come up first after being treated..

    The school doesn't have a right to make this type of decision.. They need to follow dr's orders.. I'm pretty sure cutting the tubing is not part of the dr's orders!

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