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School....

Discussion in 'Parents of Children with Type 1' started by jules12, Aug 17, 2011.

  1. jules12

    jules12 Approved members

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    Can't it ever be simple to start school? Our nurse is really nice and even though we don't always see eye to eye, we agree on the important things. This year, I had to fill out additional forms, and I even had to adjust the dr orders to be very specific about how many carbs to use to treat a low - the dr orders suggested 15 and that is way to much for him at school.

    It is also appears to be a big deal that my son is dosing his lunch carbs in the classroom. I think she is going to get it all worked out but he has to follow all these checklists for the first two weeks to prove he can do it....even though he did it all last year without incident.

    I really thought that from 2nd to now 6th grade things would be simplier. When I talked to the endo, they said they supported the school in having the nurse check his insulin for lunch prior to dosing. I give him a carb count and what the amount should be each day. Really isn't that big of deal....

    Am I suggesting something way out there? How many of your kids dose without the nurse watching over their shoulder? Again, I think the nurse is working with me to eventually get us there but I was curious how others handle it.
     
  2. Sarah Maddie's Mom

    Sarah Maddie's Mom Approved members

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    Another mom in a similar thread just posted something like, "I listen and smile and then say, "That's very interesting but we find that for our child XYZ works better. But let's meet again in 30 days if you feel that any issues have come to the fore" " ;)

    I think that's brilliant. The kid lives with D 24/7 and probably knows more about management than any, albeit, helpful and well intentioned school nurse ever will.

    If the above approach fails, I'd call in the endo's office and have the affirm your ds's ability and to state that requiring him to submit to such measures would be detrimental to his self-care and well being.
     
  3. PatriciaMidwest

    PatriciaMidwest Approved members

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    Does your district have a form for the self administration of insulin? Do you have a 504? Why does your endo support this - did the school nurse call them? I'm a little surprised if your child has been on their own for the past couple years.

    This may sound paranoid, but we moved to the high school this year and I called our endo and told them I didn't want them discussing DD T1 with the school nurse. The school nurse is brand new and not well versed in T1 care and I really don't want her deciding on appropriate care or meddling in this.

    Let us know how it goes.
     
  4. jules12

    jules12 Approved members

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    Yes, we have a 504. Yes, I signed a self-administration of insulin form. Therefore, I don't think You sound paranoid at all. Our school nurse cannot call the endo because I didn't sign the Hippa (sp?) form and the only reason I didn't was because she was going to contact them directly to get his orders changed and I said no. If she needed a change, she was to let me know and I would get her what she needed. I don't want her changing what the doctors orders are without me being in the loop. She said there was no point in me signing the form then if I wanted to make the calls.

    I have an endo appt in early September and will discuss this with him. I talked with a nurse in the office this morning....again, I think she was trying to find a one size fits all solution as well and said it was a big deal during the meeting with the endo clinic and school nurses this year.

    From the what the school nurse implies indirectly, it appears that the other parents at my school who have children with Type 1 just sign the forms and do what the nurse tells them. I think I am the only one who does things differently....

    I guess I was caught off guard because I am really not asking for anything different than what we did last year so I didn't expect any issues and certainly didn't except her to start the school year off with him going to the nurse on Day 1 to bolus for lunch. I am trying to be nice and calm and give her a chance to get her "check list" completed and see what happens after that before I say too much at this point. You always get more flies with honey....
     
  5. selketine

    selketine Approved members

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    I think here is your problem. I don't quite know why the nurse and the endo agreed last year that he was fine to dose himself but this year they do not (different school? endo? nurse?). I don't think it is unusual in schools that have nurses that the nurse, doctor and parents and child all agree on what to do, how to do it, and that the child is capable. Generally if the endo thinks "X" and the parents agree - this is what will eventually happen. If the endo disagrees with the parents then the nurse will follow what the endo wants - I think she is obligated to follow the doctor's orders.

    I can see the reasoning on this - I would think the issue is more between you and the endo on what your child can handle than you and the nurse. If you can't get the endo on board then I think you will be hard pressed to move forward.

    If your child has to so something for two weeks to show he is capable then this won't be so bad.
     
  6. PatriciaMidwest

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    It does appear as though the school nurse was able to bend the endo's ear. I guess you are saying your endo presented a school nurse training of some sort?

    It's weird because if the endo agreed to this for your son (and not just in general terms) he should have noted it in writing somewhere, such as on the self administration form. Whatever you have in writing from the doc is what she has to follow, not just what she heard at a conference. I would point this out to her.

    If I remember correctly?? we live in the same general area (from a pm a while back). I could have you confused with another poster, if so, never mind. I had no idea that the endo's interacted with school nurses. Come to think of it, our nurse did comment on attending a conference done by the Children's hospital and mentioned our pump rep was there so I guess it makes sense. I assumed it was because she was brand new to school nursing, but perhaps this is an annual cme thing.
     
    Last edited: Aug 17, 2011
  7. sarahconnormom

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    Connor is going into 5th grade. Since the first day of second grade he has been dosing himself for lunch through his pump with no one checking him. So far he has never made a mistake. He takes his lunch everyday and I write the carb count and what kind of bolus I want him to do on a sticky note that I put in his lunch kit. While the class is lining up he tests and boluses then gets in line with his class as they are leaving the room.
     
  8. jules12

    jules12 Approved members

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    PatriciaMidwest - we are in the same area. I think the meeting is an annual thing. Our endo sends out "generic" type orders every year and while they had some wording on them, it was too general this year for him to self administer and the carbs to treat was intended by the endo to be a guideline but our nurse said if it says 15 carbs, then I have to be sure he gets 15 carbs. I guess my shock is that this is the same form we have used for the last 4 years. So I really wasn't expecting issues. This is the first time I had to go back to the endo to get different orders. The school nurse also asked to get his basal information which she never had before - I told her the endo orders do not even mention basal so I don't think it is relevant for her to have it plus it will change but I went ahead and wrote down where we are at now - her comment - wow, those are a lot of different rates - I was expecting one!

    I did finally get the new orders from the endo office and it did say he could self administer, adjusted the carb amount to treat, mentioned with his sensor that he would not need to check his bg as often. I guess I just don't understand why the endo nurse (who I didn't recognize) was saying things like "elementary and middle schoolers really should be doublechecked when giving insulin - after all we do that in the hospital too" rather than I will get that sent off for you. I will talk with our endo personally when we go for an appointment in early September. When I actually talk with him or our cde that we see all the time, they are very helpful.

    When he got home from school he said he had to go to the nurses office before Lunch (his stuff wasn't in his classroom as requested). He said he passed the "checklist" and then promptly rolled his eyes. Later that day he checked in the classroom before catching the bus without any follow-up from the nurse. He still has to log everything in a notebook in the classroom which I think is overkill but if it makes it so she is comfortable with him dosing and checking in the classroom, he is willing to do it for now. He said the nurse was going to continue to check in on him this week.
     
  9. selketine

    selketine Approved members

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    I'm glad it you got some specific orders that apply to YOUR child. IMHO I don't think your endo should be sending out "generic orders" for school that are the same for each kid. Our kids are so different - such as you mention for correcting with 15 carbs would be way too much for some kids and not enough for others - that seems irresponsible on his part.

    Or is it unusual for the doctor to actually write up orders that work for just that child? Our pedi endo has always done this. Actually now I fill out the forms based on last years orders and forward to her - she can either make changes and sign what I filled out with all his rates and corrections or she can rewrite on a blank.

    I hope it works out!:cwds:
     
  10. PatriciaMidwest

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    I'm glad he passed the "checklist". Maybe the notebook will be forgotten about in time. My daughter was asked to do this last year, but our nurse never followed up with it. Our new nurse at the high school hasn't brought it up, but she's just getting settled in too. I don't love the idea either, mainly because I saw a district memo once to the school nurses that says if a student has 3 highs or 3 lows in a month, self care should be re-evaluated.

    Ugghhh...Our nurse also asked me for basal rates, which I chalked up to her being new, but I told her she would not need them. I think this came out of the local conference. I honestly can't think of a reason why a school nurse would need basal rates. They aren't going to be giving Lantus or making pump adjustments. She wanted insulin to carb ratio too, which I also didn't give out, I just changed the conversation back to treating lows. I did share ICR of course when my child was younger.

    Our doc uses the same basic medical managment plan as Children's with the 15 carbs for low blood sugar. I haven't turned it in (yet?). I have turned in the required district forms signed by our doctor (glucagon RX and self mgmt of insulin) and our 504 has a sliding scale on it for treating lows. I have a feeling the endo's form will just bring up more questions from the nurse and she'll want to be more involved so I'm going to hold onto it for now.

    Hopefully all of this will calm down and fade away quickly for your son.


     

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