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Suggestions for including CGM in 504 plan for non-independent 10 year old w/fabulous school nurse

Discussion in 'Parents of Children with Type 1' started by virgo39, Aug 10, 2014.

  1. virgo39

    virgo39 Approved members

    Jan 8, 2010
    We started using the Dexcom G4 in June and really like it (though we are swapping out our receiver, which stopped alarming audibly).

    DD just turned 10 a few days ago and will be entering 5th grade. We have a great school nurse and a good relationship with her and the school (not to say that everything is perfect, but we have been able to work through any hiccups satisfactorily). I am looking for ideas as to how similarly-situated parents use the CGM at school.

    Last year, DD went to the nurse for testing and bolusing before snack and lunch and at other times as needed (when she was feeling low, before certain tests, less frequently to follow up on a high BG). She leaves her PDM in the nurse's office at the beginning of the day.

    DD prefers not to test in the classroom. She does not want to have to carry the PDM or a meter with her or test in the class with other kids (she otherwise tests in public and in front of family and friends and will have to test in the classroom in junior high school, so I don't see a reason to push her on this).

    Despite, how we actually do things, her 504 permits her to test and treat at anywhere at any time and to use her cell phone to contact us on diabetes-related matters.

    My expectation is that we will primarily be using the CGM at school to head off lows. (I expect it will also help a bit with a persistent high BGs--given a goofy snack schedule it is not uncommon for DD to be on the high side before lunch--but there are a few days a year where DD has a "high" day that the nurse and I manage through temp basals, shots, etc.). If the CGM alarmed, DD could treat based on the reading and her feeling (she seems to fairly reliably feel lows during the day), avoiding a trip to the nurse. She would go to the nurse if BG wasn't coming up or if she felt the need to.

    So, my specific questions are:

    1. What works for you?
    2. Is there anything that hasn't worked for you?
    3. Should I have endo include DD's use of the CGM in orders (we have an appt. on Tuesday)?

    I do wish I could set different alert profiles in the Dexcom--I would definitely have different high and low alert levels for day, night, and school!

  2. Cheetah-cub

    Cheetah-cub Approved members

    Feb 18, 2014

    It seems our situations are similar. My daughter just turned 11. She was diagnosed at age 10, during 5th grade.

    We also have a great school nurse, and wonderful school staff. We are using the Omnipod with Dexcom too. When we first got our Omnipod, the Omnipod trainer came to our school and trained the school staff, when we got our Dexcom a few weeks later, we just showed it to our school staff, and they thought it was very cool.

    My daughter used the Dexcom to treat lows during class. We put on vibrate, if it hit 80, then she would take a glucose tab or two. The Dexcom was also helpful during PE or her 5K Girls on the Run practices, if she was low and heading low, she would sip juice etc. My daughter treated these lows on her own.

    We don't use the Dexcom to correct highs without a finger prick. If she was very high, then we finger brick to confirm, then used the PDM to give correction. My daughter did the finger prick in classroom to confirm high, and bolus herself for insulin. If your daughter does not want to do that in the classroom, then you can have her go to the office to correct highs. If she is not that high, you could wait until lunch to bolus/correct.

    For lunch, my daughter went to the office to check BG, and calibrated her Dexcom, and bolus for lunch.

    My daughter carried the PDM with her at school, (brings down to the office during lunch to bolus). So, for snacks, she simply gave herself a bolus to cover the carbs, we do not have her brick for BG for snacks.

    When we got the Dexcom back in April, we just started to use it at school, the Dexcom was not in our doctor's instructions to the school. Everything was fine.

    Have a great new school year.
  3. Mom2CNC

    Mom2CNC Approved members

    May 1, 2012
    Thanks for the thread, OP. We are in the same position- my daughter was dx in 1st, going into 4th, pumping all the while. Just started Dexcom in July and wondering how we will use it in school.

    I like what Cheetah-cub above said about using it to treat lows. I just don't know where/how she will keep the receiver?? That is my biggest question. In her backpack probably, and then she can check on it as she feels the need. But what about when she leaves the classroom for math/specials/ect... she'll take it with her? How do other kids carry theirs at school? I also hate the idea of it looking like an attractive ipod device & go missing if it's left behind.

    I would love to hear how other kids use theirs at school.
  4. rgcainmd

    rgcainmd Approved members

    Feb 6, 2014
    My 12-year-old daughter keeps her Dexcom receiver in a Spi-Belt around her waist at all times. She has a two pocket version and keeps some Skittles in a baggie in the other pocket. If you use a tubed pump, your daughter could keep her Dexcom receiver in one pocket and her pump in the other pocket, which has a buttonhole in it for the tube.

    ETA: My daughter usually wears jeans to school, so she just lifts up her top a little to get at her Dexcom. If she is wearing a dress or skirt, she wears shorts underneath so she can hike up her dress or shorts to get at her Dexcom without showing everyone her undies.
    Last edited: Aug 11, 2014
  5. Nicole N

    Nicole N Approved members

    Feb 18, 2013
    My 5th grade, 10 year old son wears the 2 pocket spi-belt - one pocket for pump, the other for CGM. This is how we treat during the day:

    Treatment for LOW:
    76-80 value 1) Give 1 Glucose tab ONLY if he feels low
    2) No retest
    60-75 value 1) Give 2 Glucose tabs
    2) Wait 15 minutes and retest
    3) Text mom
    4) Give snack with insulin if Christian wants one
    40-59 value 1) Give Juice box
    2) Wait 15 minutes and retest
    3) Text mom
    4) If after 15 minutes < 70, provide 2 tabs
    5) Give snack with insulin if Christian wants one

    Treatment for HIGH:
    AM 1) Correct via insulin pump wizard
    2) If > 200 then carb free snack only
    3) Encourage water
    PM 1) Correct via insulin pump wizard
    2) If > 200 then carb free snack only
    3) Encourage water

    AM and PM BG checks: If CGM is between 100 and 150 then no meter check is necessary

    Lunch check: Always use meter

    He has no problem checking in the classroom. The nurse comes to him - once in am, right before lunch, and once in pm. This routine works so much better than when he went to clinic. He misses much less school time. He never goes to clinic, even if low. Every teacher will call the nurse if he feels low and comes to him. Any child who feels low should never walk anywhere - even with a buddy - it's just safer.

    Good luck!

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