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So, we're bad parents or what?

Discussion in 'Parents of Children with Type 1' started by Hudson_Rocks, May 21, 2012.

  1. Hudson_Rocks

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    Hudson goes to Outdoor School next week (leaves Tuesday). We were planning to bring him home the first night to see how the activity affects his blood sugar overnight; I was waffling on that but he told me tonight he wants to come home that first night. The district nurse has made a plan for him and met with the teachers in charge. The plan was approved by his endo.

    He has a friend who attended Outdoor School this past week; the friend has a pump and apparently something happened with the pump at some point & he wound up in ketoacidosis and was Life Flighted to a major hospital away from here. Talk about a nightmare! He's home now and recovering but yikes, you know? Hudson is still on MDI so no worries about a pump issue, but still.

    I've been told in not so many words that one of us should be going to ODS with him. It's not really possible for that to happen. We're compromising by allowing him to go (at the beginning of the year I was going to keep him home entirely this week) and bring him home the first night, and let him stay the other nights depending on how the first goes.

    We started tonight to pull his Lantus back by 20% at the suggestion of some other parents. I've got all manner of snacks portioned out for him (jerky, cans of apple juice & counted Skittles for lows, peanut butter crackers). The nurse did carb counts of all the foods they will be eating at meals and snacks, and we are opting to have him shoot after meals this week. If he's below 200 at bedtime, he eats a pack of peanut butter crackers. They are doing midnight checks (waking him for that). I've asked to be called with bed time numbers. I feel like we're doing all we can to make him safe. But then I think - are we terrible parents because one of us isn't going??
     
  2. Paula+four

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    My son attended outdoor school in April. I was very concerned but I had several talks with the camp nurse and all the teachers who were attending. They were all committed to checking him during the night as per the endo's orders as well as checking in with me. We also saw the endo the week before camp and worked with her to adjust the settings on his Omnipod.

    The first day was great with his numbers looking fantastic. The second day his pump was bumped during an activity and the cannula came out. He didn't realize it happened, was a bit high before dinner, ate and by the next check he was HIGH. The nurse called me immediately, stayed up all night working with me by phone and getting the blood sugar down. The next two days she continued to monitor him closely and all was fine.

    So the experience was not without incident but I'm glad he got to go. We were also really fortunate to have a great nurse and I called her supervisor to tell him how much we appreciated her.

    I hope you guys can make it work too!
     
  3. caspi

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    The fact that someone that he actually knew (and not just something heard via gossip) was actually LIFE FLIGHTED due to ketoacidosis would be a HUGE red flag for me.
     
  4. Hudson_Rocks

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    There was a pump issue; I am not sure what happened. My thought was something with the set was bad and no one realized it, for whatever reason. From what little I know, the boy's parents were contacted as well and he still remained at camp.

    I think I'll be in touch with the nurse tomorrow.
     
  5. Sarah Maddie's Mom

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    I'm not sure I get how long this camp is ( a full week?) or how far away, but fwiw my dd just went on her first overnight school trip and I refused to be a chaperone because I felt that it was time for her to do this sort of thing on her own. We did similar preparation and stayed in contact by text and phone. She did great and it was an important step, I think, for us both.

    You have to do what you think is best for your kid and your family and not worry about those who advise, but don't live it.

    Good luck. Hope he has a wonderful and safe time.
     
  6. GaPeach

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    Since he is on MDI, a pump/cannula issue is a mute point. Lows would be more of a concern due to the activity level.

    When my DD goes to a very active week-long overnight camp, we have her Basal set to allow a little bit higher BG's. Also, at night, she drinks a Yoo-Hoo chocolate drink prior to bedtime (It has whey protein in it). This has worked beautifully for 5 years of overnight camps and several church and school trips.

    Stay in touch by phone or text. Let him stay overnight. (Coming home that first night will single him out.) Just my humble opinion.

    As his parent, you have the ultimate responsibility. Bottom line - you have to be confident in whatever decision you make. There is no wrong decision - just the right one for you in the moment.

    Best Wishes!!!!!
     
  7. MomofSweetOne

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    My daughter went to non-D camp last summer and had a great week. We didn't drop her basal insulin enough in the beginning, so she had major BG plunges the first two nights. This year we're sending her on 30% less based on last year's experience. Her target number will be 150 rather than 100/110. Last summer she also had 20-30 uncovered carbs at bedtime each night. (She was on MDI then, not pumping.) Send all supplies needed (ketone strips in particular and have him test with every 250), call and text daily to get updates. Make sure they know it is not a bother to call you at any time with any question.

    This year we've been advised to drop her bolus doses by 50% if she's going to be very active immediately following a meal or by 25% if the activity will be an hour later, to avoid having to feed her as often.

    He should test every 30 minutes or more with swimming, hiking, etc.

    I would probably let him stay the first night but want tests at 12 and 3. Be very cautious with correction doses at bedtime until you know if he's going to drop.

    I hope he has a great time! (And with a hospitalization having just occurred, he'll probably be even safer since they'll be aware of the dangers!)
     
  8. Marcia

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    With MDI, ketoacidosis is not the issue. I would reduce the lantus by 50% instead of 20%, simply because once it's injected, you can't do anything but give carbs for hypos all day (and night) long. Send him with a cell phone with the expectation that all pre-meal bg's and bedtime bg's be phoned to you, along with the midnight bg. I would be satisfied with a bg between 150-200 during the day and going to bed around 200. The frequent contact by phone should put your son at ease, and depending on how things are going you could decrease the number of daytime calls as the week progresses. I would convey to your son that the other student had a different insulin therapy and that you will always be a phone call away. I hope he has a great experience.
     
  9. Lisa P.

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    Not to nitpick, but while I love being back on MDI Lantus can go bad, get old, get lost, not get delivered properly, get forgotten. Even while pumping, it seems to me that you would normally need to go several hours without checking and correcting to reach DKA. I'm not being critical, I'm sure it's extremely difficult to manage a number of kids with health conditions on this kind of trip, but it's not a matter of the cannula got knocked out and you call the helicopter, the nurse in charge probably made some mistakes.

    So, is the same nurse in charge? She may be self-aware and realize she is not "good" at diabetes. More likely, though, she got herself a good scare and is maybe under fire. I would guess that those times when people don't understand how tricky diabetes is applies to nurses, too -- her coworkers might be looking askance at her, maybe it's a tough time? So I'd first evaluate whether you trust the person in charge. Then I'd look to give her support and encouragement and maybe have a talk to go over things a few times to help her ability and her confidence. Also, your son is old enough, I'm sure he can be a backup for the nurse, noticing if he doesn't get a night check, etc.

    But in the end, it is the strict obligation of the school district that is taxpayer funded to provide universal education to make sure your son can attend functions. If he were in a wheelchair with a colostomy bag they'd have an obligation to make it work. Diabetes is difficult, but your son will have to deal with it himself for years so the nurse can do it for a week when that's her job. Would I send a kid off without me there? Doesn't matter. What matters is that the school is obligated to professionally care for him during school events without parent presence. Personally, my experience has been that the schools we've known may not be able to fulfill this obligation. But if you feel they can fulfill it safely, then you have every right to expect them to fulfill it safely, without guilt.

    You have a parental responsibility to make sure your child is safe, etc. You don't have a parental responsibility to alleviate the anxiety of the nurse and staff. If you feel like helping out, that's great. If you can't or don't choose to, you should feel no guilt, IMO. It's. their. job.:cwds:
     
  10. KatieSue

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    When my daughter did a similar outdoor education thing it was before she was diagnosed so I can't really help there other than to say the area where their camp was located didn't have any cell coverage at all (they weren't allowed to bring phones anyway) but there were landlines for the adults to communicate.

    When she was 13 (6 mos after diagnoses) she went on a non-school sponsored trip to Washington DC, Philadelphia and New York. Time changes and go go go go go schedule not to mention odd foods and eating times, I didn't breathe for the first few days but she did fine. There was no nurse or medical personnel on the trip. There were paid chaperones and a few parents.

    I'd say as long as your comfortable that your child knows what to do and can call you if needed to walk through stuff you should be fine.
     
  11. Lee

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    My child did an outdoor school camp for 4 days at 12. Not a bad parent at all. I would just make sure that the grown-up in charge of him communicates with you daily.

    It sounds like, with his friend, there was no communication. You don't just have a bad site or a pump issue and go into ketoacidosis - that takes time.
     
  12. swimmom

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    Sounds like you have a good plan in place. I just wonder about execution. Was the other boy responsible for checking his own BG and didn't tell anyone that he was having problems? If an adult was supposed to be monitoring, what happened? Was it the same nurse? I would want those questions answered.

    That said, my dd has done camps by herself and done fine. It's always nice to be able to touch base by texting. I did go to Outdoor School with her in 5th grade. Not sure whether it was really necessary. It was a fabulous experience and I would not have wanted her to miss it.
     
  13. Daddyto4

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    "Assuming he's now old enough to start learning"
    NO. Are you going to be there his whole life? No. Does he need to learn how to handle his own mangenemnt? Yes. Is this a good first step? YEEEES.

    It could be argued that you'd be bad parents if you DIDN'T let him go; Not letting him go will deprive him of an event he will remeber for the rest of his life. My son had a school trip to Astoria last year- But some clever finagling, his instructor managed to get him excluded from the trip. Now he won't HAVE that memory, but he will have the memory of sitting in class all day pretty much alone. How is that fair?
    Yes, do it CAUTIOUSLY, but let him go- Tu eres bien madre y padre (you are good parents). (Please excuse my VERY mal espaniol, still learning.)
     
  14. wilf

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    I think the 20% reduction in Lantus was appropriate. He'll be home tomorrow night and you can see how he's doing and lower further if needed.

    The ketoacidosis is not an MDI issue - but the lack of regular testing during the day (or lack of judgement in dealing with high BG numbers) is a concern.

    I would make sure you are fully aware of and in support of the details of the endo's plan.
     
  15. Beach bum

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    First, you would be a bad parent for not letting him go. Second, I think the plan you have, having him come home is a good one because it seems that everyone will be comfortable with that plan of action.

    We do the camp in September, 3 hours away. Luckily, our school nurse goes on this trip since the entire 6th grade goes. She's comfortable with my daughters care and our endo and I have already discussed a plan of action. She feels it will be best to follow her diabetes camp plan, since they already factor in high activity levels, that is a 30% reduction in basal and upping of the 1:C ratios. We do untetherted for the summer and I'm thinking to just carry it through for the first few weeks of school until camp is over. This way my daughter won't worry about getting the pump wet, loosing things etc.

    Let us know how the week ends up.
     
  16. Tigerlilly's mom

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    I don't think that you are a bad parent by not going....You have a good plan in place. I think as long as the camp or your child can get in touch with you via telephone and you can "monitor and make adjustments" based on the information that they relay to you.


    You can't go by what happened to another kid unless you know the ENTIRE story...so many things could have gone wrong to lead a child to DKA and it being necessary for medflight.

    Hope your son has a great time!!!
     
  17. MommaKat

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    I'm not quite sure I read the OP correctly, but is it the school that's led you to question whether you're a bad parent or not?

    Typically, schools don't like helicopter parents, and they work hard to help parents, especially of 12 year olds, start the process of letting their kids take on more responsibility. That's why outdoor ed takes place at this age - it's a big away trip to help kids build autonomy, self regulation, interpersonal relationships with peers and adults outside their family circle. They need parent chaperons for these trips, true, but you know your child and whether or not that's appropriate for him. For me, D has required I be a bigger part of my kid's daily life than we'd have at 12, so a trip like this would be a welcome opportunity to both of us for her to grow and develop some of that independence with guidance - the endo plan you mentioned, the carb counted meals and snacks, a trained staff member responsible for helping if / when needed, etc.

    If they are so freaked out by whatever happened on the last trip, or the scary possibilities they perceive, it's our job as parents to help alleviate those fears by educating or referring them to a source of education - you've done that. You are NOT a bad parent for not going, and they cannot by law even suggest that one of you really should have to. If the school is concerned, they can ask the district to send someone with greater training / higher qualifications, but that's on them and guaranteed by federal law (ADA, IDEA, etc.) Hope he has an incredible time and enjoys the trip!!
     
  18. Hudson_Rocks

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    No, it wasn't the school, it was my perception mostly based on things other D parents said.

    Here's the latest --

    1) There is no nurse at the camp, at all. The district nurse is the one who made the plans for both Hudson and the other boy, with endo and parent input. I have seen everything for Hudson and the other boy (with permission). They are fairly similar, with of course the pumping/MDI and some slight range differences.

    2) This is what the nurse said in an email:

    3) Went up there this evening to get him. His teacher told me Hudson's numbers had been great all day. I checked his meter and no kidding! Not one reading over 100 all day. Lowest was 73, the others in the 80s and 90s. He started climbing on the way home (217) and was in the 300s before bed. Corrected and just checked that, 305. Sigh. Looks like lows at night probably won't be as much of a worry as I am concerned about, but never say never.

    4) At this point we'll let him stay the next 2 nights. Tomorrow they are supposed to do a night hike, and he begged to stay for that. I don't know how strenuous that is and so I do worry a little that something may hit him tomorrow in bed, *but* with the Lantus drop and the snack if under 200 before bed - I think we're playing as safe as we can. The teachers really do seem ultra-conscientious, and they've been great all year.

    Thanks to all! Good thoughts and prayers for the next 2 nights appreciated. Kind of a big step for all of us. ;)
     
  19. Mimi

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    Sounds like a good start. :)

    While we don't enjoy seeing 300's, in the grand scheme of things I wouldn't worry about it too much. Your son is going to have a great experience with his friends and classmates. He'll remember that...not what his BG was this week. :cwds:

    Oh and not bad parents, not at all!!:)
     
  20. Hudson_Rocks

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    Well, I held my breath a few times, around midnight when I knew they were waking him to check, and again in the mornings :)( ) But, he came home today safe and sound and he had a GREAT time!

    His teachers were phenomenal and I'm very grateful to them for all the learning they did for this and all the care and concern they showed this week. Hudson managed fabulously and only had one "bad" reading, all things considered (300). He actually stayed really close to his range and while he had some lower-than-typical readings, nothing too bad. He was aware of the lows and as he was dropping, and managed himself. I am so so proud!! :D:D

    They received badges for a variety of activities this week. He came home with a huge string on his necklace, and told me that he told his teachers they should make a badge for themselves (he didn't have the materials). He told them if he could make it it would be in the shape of a blood drop and be red and say "Type 1" - because they earned that, this week. <3
     

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