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Who gives kindergartner insulin corrections at school?

Discussion in 'Parents of Children with Type 1' started by teachermom, May 22, 2011.

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  1. teachermom

    teachermom New Member

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    For those of you with young school children who are not able to administer their own insulin, who gives them insulin at school to correct a high?

    My son is turning 5 in July and starting kindergarten. He wears a CGM and we use syringes for insulin. The school will have a district nurse come and give him a shot at lunchtime, but the principal told me she will not authorize anyone at the school to give him a correction dose for unanticipated highs. I'm willing to leave work to give him insulin, but with 20 minute travel time and then the time it takes insulin to act, this is an unacceptable amount of time for him to have high blood sugar.

    In a couple of years I believe he'll be able to administer his own insulin, but for now he is not mature enough. He is not on the pump because even after four years he requires little insulin (meal bolus is 1 unit Humalog), and with the CGM I don't want another device on his little body. What options do I have, besides 504 plan and big battle with the school?
     
  2. sage68

    sage68 Approved members

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    Really??? I don't think that the principal can do that. My DD is also starting Kindergarten in the fall and there will be several people trained in the school to administer her insulin (she is on a pump though but this year there is a kindergartener there who is on shots and the front office staff administer his insulin). I would find out who is in charge of the 504's. For our district, it is the ESD. Talk with them and see what they say. Im guessing that the principal just doesn't want any responsibility and is hoping that you wont push it.
     
  3. timkris724

    timkris724 Approved members

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    This is what I would do.

    Ring Ring... Hello Superintendents office, yes my son will need insulin shots during the day if he has a high. Since you are legally obligated for his care either the Principal needs to train someone or we need a full time RN or LPN in this school. My lawyer son's endo and I will be reviewing his 504 plan to make sure if we need any other changes.:)
     
  4. Lakeman

    Lakeman Approved members

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    My daughter is in kindergarten.

    The school provides a "health clerk" to administer snack boluses and corrections. I did and do all the training (and would have it no other way). She is great; always willing to do what needs to be done (though she catches on slowly - not that I blame her, this is hard). She is even willing to check urine ketones though I always go there to do it myself just to be polite. Evey day she calls me and we talk about her math and I confirm that she has calculated what to do correctly. If nothing out of the usual is happening I might just say that everything sounds ok based on a rough understanding of her math. If there is a real high correction or it does not sound right I walk through each step with her.

    From the first the principal wanted to do whatever she could too. Perhaps it helped that my wife is a school teacher who is very familiar with 504's and we came back to school after diagnoses with a 504 in hand.

    I agree with the others that it is the schools responsibility to find a person to do what needs to be done.
     
  5. Becky Stevens mom

    Becky Stevens mom Approved members

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    If this is a public school that receives federal funding then they have to go according federal laws on disability. Does your child have a 504 plan yet? If not, arrange a meeting with the 504 coordinator at the school. This is often the school social worker or psychologist. Do not speak to the principal about it unless the secretary says that this person is the 504 coordinator. Often principals have no clue who needs a 504 and who meets the requirements. In the 504 there will be detailed instructions of who will be giving your son his insulin whenever he needs it. By law, it does not have to be you taking time off of work. The school has to make arrangements for that.
     
  6. Flutterby

    Flutterby Approved members

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    If the the school receives ANY federal funding then the school MUST provide someone that is trained to do insulin at ANYTIME. Some states say it MUST be a nurse, others it just has to be a trained diabetes person (TDP). It doesn't matter if the principal likes it or not, he doesn't get a say. If your child is high and needs a correction they have to do it, its medically necessary and dangerous for your not to get a correction.

    Do NOT let the school talk you into letting your son doing his own pump/corrections. When my daughter was in kindergarten her teacher was trained as well as an aid that was in the classroom, we have no nurse. All her teachers have been trained and they'll all continue to be trained until she's ready to do it herself.
     
  7. nyholli

    nyholli Approved members

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    My daughter started K this year in a public school with a RN on staff. I went into all meetings at the start of the year, being flexible when it came to everything. I can not tell you what a nightmare this year has been. My advice is do your homework and know your child's rights. I'm not saying be unreasonable, just stand strong and advocate. I so wish someone would have said that to me. After repeated mistakes and lack of care for my daughter, I have learned that being flexiable and so forgiving actually put my daughter's health at risk. Please know that I think my case was a bit out of the ordinary and from what I have read here, most schools are very helpful.

    Regardless if it is a Nurse or not, I strongly suggest that there are a couple of staff members in the school that are properly trained to handle his care while at school, including BS checks, meal time insulin injections, corrective dose injections, signs and treatment for highs and low, and glucagon injections.
     
  8. mmgirls

    mmgirls Approved members

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    WELL it is not up to the principal!

    Unfortunately I have no personal experience with isue in regards to school, our kinder year with 1/2 day has be a blessing.

    I would more forward and IGNORE the pricipal, Have your kiddo kinder eval. done and then contact the school nurse/secratary they will know more than the pricipal!

    Where are you located, I am sure someone can point you in the right direction.
     
  9. miss_behave

    miss_behave Approved members

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    Can't help you with the school, as I live in Australia, but wondering about your concern with the pump. The pump is an excellent tool for those on tiny amounts of insulin. They put newborns with neonatal D on them. The MM Revel can deliver basals of just 0.025 units and the same for boluses. Impossible with syringes! They also have an integrated CGMS, so he would only have to wear one device (2 sites though). The pump would allow you to give tiny corrections for even only slightly above range BGs, plus the nurse would not have to calculate correction doses as the pump does it for you AND takes into account insulin on board (from previous corrections, this would prevent stacking insulin). This could eliminate any of the school's concern of miscalculations etc. I understand if you don't want to pump, but just making sure its not because of any misconceptions :cwds:
     
  10. mmc51264

    mmc51264 Approved members

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    My child had D when he started More at Four pre-school. This was pre-pump. His teacher and a back up person were taught how to give shots. They have to treat him per fed law. NOT up principal. Zach is now finishing 1st grade and has had a pump since K. They were trained how to use the pump (he has a Ping, so it helps). They have no choice, they must treat your child. It doesn't have to be the nurse (I am not sure where CA is on that as of now), is doesn't have to be you. THEY need to do it. I bet your endo has a CDE willing to train. Ours does it as a service.
    Good Luck! I know it is scary letting someone else treat your child.
     
  11. PixieStix

    PixieStix Approved members

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    My son was dx a couple weeks before K. When I called the school nurse, first she told me he would have to attend a different school with other D kids b/c she was only part time. Went straight to the superintendent who immediately agreed this was not going to happen. Then the nurse said he needed to be put on Reg/NPH b/c she had not given a shot in >10 years and he needed to get all his insulin at home!

    So needless to say we took this nurse right out of the care loop--I met w/ the teacher & aide, knew them well from when my older son had them. They both agreed to learn all his care, the aide did everything and the year was wonderful! He started a on the pump about a month into school which made it easier but the aide delivered injections/corrections via syringe w/o any concerns. From this experience I learned that it really isn't necessary IMO if a school has a nurse, just takes caring individuals willing to learn and be responsible.

    I would be asking for a 504 meeting now and be very clear what the school is expected to do for your child at any minute the care is needed--check & appropriately decipher BGs, correct highs, treat lows, administer glucagon. Agree w/ other posters regarding a pump, it does boost the comfort/confidence level of care providers, plus you can always see exactly what was administered. Sites work well for the tiniest kids, and delivers teeny boluses exactly tailored to your child's needs.
     
  12. Lynnieg123

    Lynnieg123 Approved members

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    My daughter was diagnose 1 week before she started at a new kindergarten. They have been FANTASTIC!!! I thought this was the norm but apparently not. The nurse or substitute nurse gives my D insulin for unexpected highs. It is only 1/2 day Kindergarten so she eats lunch before she goes. They are only there for 3 hours and sometimes they check her up to 3 times while she is there. It is a school of about 400 students in a small town in NH. I almost think they giver her BG a little too much attention but I'd rather have that than not enough. the only downside is the substitute nurse don't always know you can't give insulin an hour after I do but they always call before they do anything so I can head this off.
     
  13. akgiauque

    akgiauque Approved members

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    Motivation

    It is all about the motivation of the Principal. I would guess that He/ She are likely worried about the legality of administering medicine via injection by staff other than the nurse. They are under continuously pressured by the public, under threat of lawsuits, complaints etc on top of keeping their house in order. If there is not a nurse available the principal may be voicing concern of the staff or his concern for the staff. I would find it hard to expect a teacher or secretary to calculate carbs, sliding scale, corrections and give an injection. If they understand the responsibility and offer to do it that is great educate them but I do not think it is fair to expect it. I give my daughter injections but am not sure I would be comfortable giving another child an injection. The best way to get your principal on board is set up a meeting and discuss the concerns and options by both sides. I would however get a 504 in place; it does get the law on your side and help with district oversight. Because the principal does not understand diabetes for a young child they do not see it as a big issue. They do not see lows, highs and they are not in the hospital. Because our kids are "OK" most of the time they do not understand the bigger picture like a child with a noticeable physical issue. As parents we understand and need to get them on board and educate them.
    All of that said I am thankfull that I am Lucky my wife is the "Unoffical" Diabetes Liasion at her school (Teaches K and get the D kids in her room) and catches the mistakes. She has trained the school nurse, sub nurses and district wide nurse. My girls will go to school with her.
     
  14. Flutterby

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    It really doesn't matter or not whether the school principal wants to do it or doesn't.. it doesn't matter if he doesn't understand diabetes, what matters is every child with type 1 falls under the ADA, by law the school has to set up SOMEONE to be able to do all aspects of D care, during ALL school hours and school activities. Some states by law have to have a nurse, others it can be a trained person within the school. My daughter's teachers have stepped up and decided to learn all of the diabetes care. We have no nurse, and the district nurse is a freakin' joke. Personally, I'd rather have someone that is willing and able to learn to do all things D rather than fighting a nurse that thinks they know everything. The most important part of D care is that they WANT to help, because if they don't want to help they aren't going to be much of a help.

    For any school that receives federal funding (all public school and a majority of private schools) it doesn't matter HOW the staff feels, it doesn't matter if the principal doesn't want to do it, it doesn't matter what he/she says about D care because its NOT up to them. The school DOES NOT get to choose how the care of a child with diabetes is cared for, that is up to the endo. The school must follow dr's orders and protocols that includes when corrections are given.
     
  15. akgiauque

    akgiauque Approved members

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    You are legally correct but I think you missed my point. It is much better to get them on your side rather than go in demanding this and that because of the law. They know the law, or at least should, and the last thing they want is a parent in their face and threatening to file a suit.
    I disagree the school has leeway as to who is trained, it may not be a nurse but they can train an aide, secretary, janitor or teacher (that is here). As a staff member you cannot be forced to care for a child, most teachers are not willing to give injections, and I do not blame them. So it does matter how the staff feels. Besides do you want a person forced to get trained that has now ownership giving injections to your child?
    The original point and I have made it often, the last thing I want is a self righteous attitude from a parent that is telling me what I have to do. It is well within your rights to do so but I know what is expected, I know the law as a teacher and administrator. I will follow the law as guided by the district and there are shades of grey from state to state and district to district. I also know that you will remind me that you pay taxes and thus my salary (this occurs frequently when parents get mad). But the point is that an negative attitude causes more problems than it solves. Having discourse is what is needed to take place so your child get what they really need, which is an adult that will care for them, count carbs, give injections and look out for them when their blood sugar is up and down.
     
  16. mmc51264

    mmc51264 Approved members

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    Federal law trumps ALL local law. They have to treat.

    I'd like to live in your world where the teachers and administrators are all altruistic and care about each and every child.

    After having to hire a lawyer for the second time in two years, this time it is going to federal court, I have a very different perspective. We tried the
    We did not start out like this at all. The first year he was in school, it was great, then we got a new principal who, the very first time she met us, lectured us that we needed to a better job of parenting and manage his D at home bettter and then there wouldn't BE the issues at school. She "knew about diabetes because her aunt had it" (type 2)

    School just does what it wants. Sad part is that they know the law and are finding ways to skirt it; getting as close to the line without actually breaking it. They don't care if they are damaging my child or not.
     
  17. akgiauque

    akgiauque Approved members

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    Yes it does but the district gets to dictate who does it. The district may not infringe upon the rights of an individual (employee) forcing them to administer treatment. So building a concensus amongst staff is better than trying to force them to do what you desire.

    I am not sure what to say other than you do, these people do not go into education for the money or the great travel plan they do it because they are altruistic and stay because they love it. There are a few that get jaded over time but most work hard and try to balance a myriad of concerns daily including your child?s needs.

    I have no doubt that you had this issue, Principals are all Strong type A people. If you push they may decide to push back to see how far you are willing to go. I would have done the same as you did but the reality is most problems can be solved through reasonable discourse. Thinking about what another persons motivation is and working with them is always easier. All I am suggesting is that instead of going straight to the lawsuit first try talking to the teacher, nurse, principal or any other party involved and resolve the problem.

    Just because you do not agree with the approach to a problem does not mean that it is not valid or they do not care. I doubt I will convince you but I firmly beleive that we need to see the good in people.

    I hope you win your case, set a precident and make diabetes care for our kids easier.
     
  18. mmc51264

    mmc51264 Approved members

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    First of all I was teacher in this district for 4 years. My tenure year they did not grant me career status so I know all about which teachers are in it for the kids and which ones aren't.

    We did try the path of least resistance and my 6 ear old K, then 1st grader kept getting in school suspension because of behaviors related to his D.
    The school nurse does not know the difference between Type 1 and Type 2 so she is useless, in fact the other day she sent him to lunch with a BS of 45 and never called us. We are in daily contact with his teacher and have worked harder than anyone else to make the situation doable without involving lawyers. I was unemployed. But they have now demoralized my child to the point that he talks of suicide. He is seven. It is heartbreaking. Now we get to take him to therapy.

    I tried to see the good in these people and thought we had it. I gave the principal a bracelet with a Bible verse in it that I bought from ADA.

    Then the proverbial poop hit the fan.
    Truly, unless you have lived the last 2 years that we have lived please do not judge us. We tried being nice for a very long time.

    We don't need to set any precedent, they are breaking laws that are already in place and depriving my child of his free and appropriate education.

    Now I am BACK in school. Nursing school. With a teaching degree, a criminal justice degree, and a nursing degree, I should be a fairly good advocate when all is said and done :)
     
    Last edited: May 25, 2011
  19. akgiauque

    akgiauque Approved members

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    I a not judging. I just get tired of the school bashing that goes on at this site when it is more often than not a communication problem. I see alot of advice start online with get a lawyer, Get ADA involved or file a lawsuit. I contend that this is not the best practice for creating a working relationship and start with communication at the school. A parent advocacy group, talking with the staff and PTA/PTO is a great way to inform and educate your community. If they understand they will be more willing to help from the start, yes I know it is the law but implementation varies.
    I had a great discussion with a school nurse, she was telling e that the 504's are very vauge so there is "wiggle" room. That tells me the interepetation is important and a sympatheic person will be more open to your interpetation.

    Obviously this is not so in your case that is why I hope you win. I by no means meant any personal jabs but rather a view from a classroom & school.
     

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