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Suggestions for starting school with Ping and CGM??

Discussion in 'Parents of Children with Type 1' started by polly, Jul 27, 2011.

  1. polly

    polly Approved members

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    Hey guys! We have been VERY busy the last 6 weeks as we have transitioned to the pump and CGM. Noah is starting kindegarten in 2 weeks and I met with the nurse today. Anyone have care recommendations? The CGM is completely new to the nurse and she isn't familiar with the ping. How often do you test? Does your child or the teacher carry the CGM? Preferred training methods? Prebolus at lunch (he's a very predicatable eater but am worried that there may be a lag time before he eats)? I am meeting the teacher and nurse for training next week but our 504 mtg. won't take place until school is starting. Any advice is greatly appreciated! I'm finding that have a TYPE1 kiddo is really bringing out the TYPE A personality in me! :)
     
  2. selketine

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    Wow - that is a lot to learn but both are great devices.

    My son didn't get his cgms until 1st grade but he carried it always - and we keep the high alarms off at school. If he is high - he goes often enough to the nurse that they would catch it. I prefer at school to use it only to catch lows and many highs - like after breakfast or lunch - cannot be treated anyway because of too much IOB.

    If he beeps low, or projected low or if he feels low or acts low or requests to go be tested - he was escorted to the health room by an adult -or they watched him walk to the health room (small school - they could just watch him go down the hall). Now that he is older he carries tabs and can take 1-4 of them if he wants to before going anywhere.

    The only times he is "required" to test is before lunch and before P.E. Since PE is only once a week then he really only has one required test per day. However he did come in and let the health room check his cgms number before recess.

    Although I"m a HUGE fan of the prebolus - I don't have them do it at school. The nurse corrects a high before lunch but boluses after. I've found that for him, prebolusing is most important before breakfast but hasn't affected the after lunch number so much. I suppose you have to weigh the benefit of prebolusing with the possibility (although slim) that lunch could be interrupted by a fire drill or a school lock down emergency that would interrupt lunch. Or even that your child said he ate it all and he didn't (but it got thrown away) - that sort of thing. Or what if he got distracted talking (happens!) and didn't eat it all - and didn't want to eat it. I don't want to play any eating games (making him eat) so bolusing him after is the way we go.

    All of the diabetes management stuff is put into the health plan and THAT is attached to the 504.

    For training, our school nurses required a company rep to come out and train - they wouldn't allow me to do it. For the cgms - since technically they cannot dose by it or anything else - they let me train them. The cgms is just a "tool" - the same medical/testing plan is in place regardless of whether he has it or not. I have sometimes requested that they do extra checks and they agree to do them (cause of problems with lows at a certain time of day for example) - I don't have to have the doctor's orders rewritten to request extra checks.

    I guess in other words - I'd not write the doctor's orders/medical plan or 504 around the cgms. The big issue there is if it beeps low/projected low that there is adult supervision at all times, testing very soon and treatment if needed.
     
  3. joy orz

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    Here's a copy of Ava's plan. We had the teacher carry the CGM and if it beeped, she would go to the nurse. We set the high alarm to 400. If she got that high even after lunch then usually it was a set issue, and I'd have to come change it anyway. We set the low alarm to 90 because she'd have breakfast at 8, lunch at 11 and snack at 1, so if she actually ever came down to 90, she was usually dropping.

    We do pre-bolus, then have a cafeteria aide or teacher aide keep an eye on her at lunch to make sure she finishes her carbs. Typically, I'll pack a lowish carb lunch about 25 carbs with plenty of veggies and cheese if she's still hungry. She knows she has to eat her carbs but can graze on her snacks.

    For snack we had a range, if she was under 140 at snack time, she could have a bar with carbs. If she was above 140, she'd have more veggies.


    Ava has type 1 diabetes and wears an insulin pump and continuous glucose monitor. She also has multiple food allergies including soy, gluten and nuts. Ava?s diabetes is treated through administering insulin via an infusion set inserted under her skin. Her basal insulin (to cover general functioning) and bolus insulin (to cover meals and correct high blood sugar) are given through her insulin pump. Her blood glucose is checked by a blood glucose meter. Additionally, she wears a continuous glucose monitor sensor on her arm to detect trends in her blood glucose.

    Because of her age, she does not do any of her diabetes care independently. She will need to have her blood sugar monitored regularly throughout the day by a trained adult. She will also need to have someone administer insulin before lunch and snacks. Of particular concern is the fact that Ava is hypoglycemic unaware. This means she can have dangerously low blood sugars and be asymptomatic.

    Her blood sugar can also drop quickly while playing hard on the playground. Staff will need to be trained in signs of hypoglycemia while she is on the playground or during physical activity. Because she is hypo-unaware, she does wear a continuous glucose monitor. This is relatively new technology, that alarms when she is low or high, but it's NOT a perfect tool. A trained adult will need to respond to the alarm and take action either by providing a carbohydrate to bring up low blood sugar, or give an insulin bolus.


    Diabetes Care
    Ava will be driven to school by her parents ? no care is needed on the bus. She will arrive at school for the 8:20 start and will have breakfast at home before school. Her parents will check her blood sugar before dropping her off in the classroom. If she her blood sugar is in range at that time, no action will be taken. If her blood sugar is low or high, her parent will either provide a snack or an insulin bolus and inform the teacher and nurse.

    Meals
    Ava?s blood sugar will be checked using her meter by a trained staff member, an insulin dose will be administered by the school nurse, (or trained staff member when the nurse is unavailable) delivered through her insulin pump. Ava?s parents will provide meals and snacks with the carbohydrate count clearly labeled. A trained staff person will supervise Ava?s meal to insure that she ate all carbohydrates that she was dosed for.

    Exercise
    Ava?s blood sugar can drop quickly with exercise. A trained staff person will be with Ava and monitor her on the playground, during gym, etc. This person will watch for any symptoms of hypoglycemia, and respond to any symptoms she is exhibiting. (whining, crying, lethargy, clumsiness)

    Blood sugar checks
    Ava?s blood sugar will be checked by a parent before being dropped off at school. She will routinely be checked by the school nurse or a trained staff member at the following times: Before lunch, before scheduled activity such as gym class or dance class and before heading out on field trips.

    Additionally, Ava will have her blood sugar checked anytime the following happens: She exhibits signs of hypoglycemia (lethargy, confusion, whining, crying) or hyperglycemia (thirst, needing the restroom frequently); OR if her continuous glucose monitor alarms.

    Food Allergies
    Her food allergies are treated through avoiding the foods and products

    Gluten/Soy Allergy:
    Gluten is a food protein found in grains such as: wheat, rye, and barley. Ava will bring all meals and snacks from home. A trained staff member will watch Ava during meals to make sure she does not share snacks with friends. This staff member will also watch to make sure Ava has eaten all the carbohydrates that she has been given insulin for.

    Typically, children?s play dough is made from a flour containing gluten. To avoid allergy issues, Ava?s parent?s can provide the classroom with play dough made from rice flour and canola oil. Ava?s parent?s can also supply the classroom teacher with supplies and a recipe to make more play dough as needed.



    1. Two adults will be trained in administration of medication and blood glucose testing and testing for ketones when necessary. One trained adult will be available in the building or on field trips to address Ava?s medical needs. Parents will provide training prior to the first student day. Training will include administration of medication, which involves knowing how to perform insulin boluses using Ava?s pump and knowing how to administer both insulin and glucagon via injection in the event of a medical emergency.

    2. Parents will supply medication dosage and update it as often as needed. This information will be provided prior to the first student day.

    3. Parents will provide a test kit that will be kept by the supervising staff member with Ava for her use (classroom, playground, field trips. etc.) Ava will have her diabetes kit immediately accessible; the supervising staff member is responsible for ensuring that Ava?s kit goes wherever she goes. In addition, supervising staff members will know how and when to use the contents of her kit: blood glucose meter, fast-acting glucose (juice, fruit snacks) and glucose gel to be used to smear her gums in the event that Ava can?t drink juice because of a low blood glucose level.


    4. A trained adult will monitor the quantity of food Ava eats during snack time and lunch for carbohydrate amounts so the insulin bolus can be administered according to the insulin/carbohydrate ratios provided by the parents. Parents will also provide carbohydrate and bolusing information on any food Ava brings to school and for snacks commonly eaten. Parents will be contacted at [phone] when there is any type of party.

    5. During field trips, a trained adult will be assigned to monitor Ava.

    6. Parents must be contacted for any of the following reasons: Ava?s infusion set comes out (insulin pump no longer connected to her body), her pump alarms, her blood sugar is less that 60, her blood sugar is less than 75 on two consecutive readings, her blood glucose exceeds 350, her blood glucose exceeds 280 on two consecutive readings.

    7. The teacher will provide a spot in the classroom for blood testing. Additionally, Ava will be permitted to test or have someone test her blood glucose in any other location of the school or outside of the school building if a low blood glucose is suspected. Parents will provide training as well as informational charts (for classrooms) and cards (for her test kit) detailing how to identify a low (or high) blood sugar. Ava will not be limited as to the number of blood glucose tests performed per day.

    8. Parents will be informed if special occasion or party food will be brought into the classroom so that an appropriate snack can be provided for Ava.

    9. Ava will have access to her emergency kit (meter, glucose gel, fruit snack) at all times including fire alarms, field trips and emergency lock downs.

    10. If Ava behaves in a manner that is out of character (i.e. disrespectful/ belligerent/ defiant; hard time staying in her seat; sleepy, lethargic) then her blood glucose must immediately be taken. Blood glucose level should fall within normal range before disciplinary action is taken.
     
  4. Hayden'sMom

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    I wish my son was going to kindergarten with Ava... they sound like they have so much in common;)
     
  5. polly

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    Thanks so much ladies!! These are wonderful suggestions and I love the 504. If the teacher carries the CGMS, wouldn't it go out of range at times? I think our Dex says within 5 feet. Did you write a letter to parents of your child's classmates? Thaks again!!
     
  6. joy orz

    joy orz Approved members

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    Yep, it goes out of range all the time. ;) But I still think it works better than having it on her, and having her ignore the alarm because she's playing tag or busy painting. :p

    Generally her K room was small enough that when the kids were in the main room she was in range. On the playground she'd go in and out, but the teacher and aides were also all trained in her signs. At the end of the day, it's just another tool. If Ava is acting odd, no matter what the Dex says, she goes to the nurse.

    As for what to tell the kids or parents... I think that's entirely up to your kiddo. Ava specifically did NOT want to discuss her diabetes with the class. They ask about her sensor and she just says... "that's my sensor." They ask why she needs to have a bag of stuff when they go places and the teacher just says that many kids in the class need medicine. So all the adults in school know Ava and her needs, but there is no reason why the kids in her class or their parents need to know.

    Other parents on the forum have done info sessions for the class and it's worked well, but Ava does want it, so we just left it be.
     
  7. emilyblake

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    Hi Polly,

    My daughter is going into 2nd grade now, but did have a pump (Omnipod) and Dexcom CGM for K & 1st grades.

    This is what worked for us:

    1. Pod is attached but Pump computer (PDM) stays with nurse
    2. Dexcom stayed on Lila around her waist - she wore a spibelt.
    3. Snack around 10:30 - Lila goes to nurse with a carb count after eating. Nurse boluses (no bg check)
    4. Pre-lunch goes to nurse for BG check.
    5. Eats lunch in classroom (they all do - no cafeteria)
    6. Post lunch returns to nurse with carb count for lunch bolus
    7. Snack & bg check again in the afternoon around 1:30 or 2 (we dropped the 2nd snack in 1st grade, but still check her if Dexcom prompts us)

    Her Kindergarten class room had a Teacher (obviously) and a room helper. Though the teacher took lunch and was not in the room for things like spanish, the room helper was always there. Both teacher and room helper met with us before school and learned about how to respond to Lila feeling low and the dexcom saying she is low.

    The room helper (and teacher) read all our carb labels and carried glucose with her to the playground and to gym.

    Back up glucose & low snacks kept in the classroom

    Lila always had an adult escort her to the nurse for a low bg.

    For field trips, my hubby, myself or my mom would go along.

    For 1st grade, unfortunately her gym session is right before lunch - so for the early snack on gym day (1 per week) the nurse and i would discuss how much to bolus for the snack.

    Good luck and i hope this helps.
     
  8. emilyblake

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    Sorry - I forgot to respond about the class discussion.

    Lila wasn't interested before school started and I didn't push her.

    By the 2nd day of school she was all about reading a book with the nurse to the class :)
     
  9. polly

    polly Approved members

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    Thanks so much guys!! It's all in the details, huh?!? I really appreciate all the tips!
     

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