Your Child with Type 1 Diabetes is Starting School

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 Type 1 Diabetics First School Year

The first year of school is approaching for your child. Going to school is such a joyous milestone for you and your child. And for the diabetic family it can also become very overwhelming for the parents. As a parent you have been in control over all the blood sugars, injections, food intake, and what to do during exercise (recess). Now it is time to start school, kindergarten is right around the corner and what do you need to do? To start you need to talk to your diabetic educator and gather information and orders from the doctor.

Getting Prepared

First you want orders from the endocrinologist. Those orders will come need to go to the school nurse about 2 weeks before school starts. Then you will meet the school nurse. At that time she will review the orders and talk to you about your child. This helps the nurse make a care plan (this will be the same for what you do for your child at home-our book can help keep all of this information sorted easily to discuss with the nurse) for your diabetic. The next meeting will be with the teachers and nurse. Before this meeting you will want to make individual care packages for each teacher. Things to have in this package is a description of your childs hypoglycemia and rescue medications like juice or smartees.

This is to ensure when your child has a low blood sugar during class then the teacher can treat in the class room if needed. Also your child should have some kind of sugar in his or her pocket and know what to do with it. Sometimes walking to the nurse is not appropriate especially with an extreme low blood sugar. Also specify that your child is never to walk to the school nurse unattended with a low or high blood sugar. The child needs accompaniment by another adult, not another student.

Next  is important to know what your services your school[provides. Some schools have a full-time nurses or a health aid directed by a nurse.  Some aids are able to give shots and some are not able to give shots (this will depend on the state and city in which you live). Most schools will have a diabetic plan in place at the beginning of each school year to help guide your childs care. If you child will at school over the lunch hour you will need to decide if your type 1 diabetic will eat sack lunch or school lunch. If you decide on the school lunch the school can provide the carbohydrate count for the meals served. With sack lunches you should send the carbohydrate count with lunch. Writing on a plastic sandwich bag or disposable container (I know it is not green to use disposable but very easy for carb counting) for each object in the lunch. Assigning carbohydrate counts on each food piece allows your child some flexibility with what he or she will eat.

504 Plans

Finally, there is the 504 plan. A 504 plan is a legal plan put in place for diabetics (or other medical reasons). As a parent of a type 1 diabetic it is your right to use a 504 plan for the treatment of you diabetic child during tests, standardized tests, during class period so they are not unfairly treated when it comes to school work and missing class time. 504 plans are not always necessary during the first few years of elementary school. As your child progresses through school this may become more important with standardized testing. The school sets up the 504 plan and you will meet with the school consoler, nurse, and any teachers you deem important.  During this meeting you will decide what incluison criteria and all party to the meeting will agree upon the academic plan.

All of this feels like more than enough to remember for the first year of school. Once you do this it gets easier (Diabetics will go through the same process each year).  Most schools have had a type 1 diabetic before and will navigate you through this process. If you hare having issues with the school enlist your diabetic educator or endocrinologist for help. They will either help you directly or get the right person to help you with the school. Once all of the medical details straightened out, then as a parent you can enjoy sending your child to kindergarten for the first and last time. Those milestones are precious.

Low blood sugars or hypoglycemia in type 1 diabetes is an immediate concern. Hypoglycemia is a blood sugar below a child’s predetermined range; for example less than 70mg/dl. Low blood sugar symptoms are shaky; sweaty; dizzy; weak; irritable; extreme hunger; drowsy; confused; headache; pale, grey, or flushed; restless sleeping or nightmares.

Low blood sugars require immediate treatment.

To start the child should test his or her blood sugar.
Then treat the blood sugar with 15 grams of a simple sugar.
Simple sugars are 4 oz of regular soda or juice, glucose tablets, 2 packages of smartees.
Simple sugar is not a cookie, ice cream, chocolate or the like.
Then wait 10-15 minutes and have the child retest his or her blood sugar.
When the blood sugar is within an acceptable range then have the child eat a 15 gram carbohydrate snack with protein.

Things that cause low blood sugars are: exercise, more insulin than carbohydrates, to much basal insulin. For frequent low blood sugars a review of a child’s blood sugars and potential causes examined to rectify the low blood sugars.

Hypoglycemia and Type 1 Diabetes

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The ins and outs of insurance

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3a118a835fd0d6d253f49acc9ed5697aA Bedtime Story: Insurance Heartache and Stress.

Knowing what the insurance will pay for and what they won’t and when the insurance covers everything.

My lesson the hard way.

Recently my son’s continous glucose monitor (CGM) stopped working.  And my descriptions of  stopped working is it would not charge, blink or the OK green light.  So of course I went about calling our CGM company for the arduous process of replacing the CGM.  After a long conversation we decided (the company rep and myself) that it was truly dead. With this fabulous information the next step was to await the doctors new prescription. Obtaing this elusive prescription seemed far reaching. First I had asked for the company to acquire the needed paperwork form the physician and not the diabetic educator, as we had not visited with her recently. However the company decided to go about this in their own way. They proceeded to contact the educator and she would not fill out the paperwork because she had not seen him. Now The educator we have seen in the past is FABULOUS; simply my son really prefers the male doctor. Because of this we then played a waiting game from November to January. And so the story continues.

While we are in waiting questions such as does a CGM make or break a diabetic day? Really, why not just go old school and just test all day long? But for my son it can make or break his day and week and month. His blood sugars tend to be wildly all over the place causing him to test his sugars more than the 8-10 times a day. Also he has recently started in a running club and driving.  So having a CGM that will shut off if he cannot detect a low blood sugar is a life saver, literally.  Besides saving his fingers from repeated testing. Moreover, he is able to simply look at his pump prior to sitting behind the steering wheel, at schimagesool, or before running. His CGM can make or break his daily management of his diabetes causing us to miss it horribly.

With the passing of months of mourning we have finally heard from the company!YAY! There is no paperwork form the physician. UGH. The holidays are here! I have called the physician’s office, they already have the paperwork done and faxed back; and we finally have the prescription to the company, creating a no out of pocket payment with our insurance. SIGH–calm and relief set begin to take over. Or so we thought! A few weeks pass. Mind you we are in mid-January, and the company calls me and states they just received the fax from the doctors office. Huh, you mean the one that was faxed in December? (You thought this tirade was complete and our family’s stress was finalized.) This then lead to a 2 hour phone conversation with the company. Me stating and restating that I was informed by the doctors office they had confirmation recite from the fax before the new year began. The representative and manager stated their paperwork demonstrate otherwise. What is a family to do!

The End of the Story

The company did not have the paperwork in hand before the end of the year so it is to be billed on 2016 insurance! UGHHH. Lesson learned (The financial lesson). Don’t wait for the company call and harass everyone until its done right! He has his CGM and all is now going smoothly and with lots of basal rate changes, very few lows and a green light indicating all is well with our CGM.

Moral of the story

Know your insurance and the companies you are working with. you can save money in the end and the ability to maintain a full head of  hair at the end! Happy New Insurance Year!

 

All Work3a118a835fd0d6d253f49acc9ed5697a and No Play

How is life going?  Have you found yourself recently trying to do all diabetes all day and night?  Has your child been ill, leaving no room for anything (even a shower)? Or are you just trying to be the best parent/caregiver you know how and that means an A1c less than 7!images

This can mean living with too much stress and creating a more clinical environment for your type 1 child.  What has your family done recently that has been fun and not structured around diabetes (at least to the best of your parental abilities)?  Or structured around diabetes as a learning experience or game?

Here are some Ideas to try for a week

  • Diabetes is never fun, but sometimes it’s good to change things up a bit.  For example, only do the basic things for meals like carbohydrate counting and giving insulin.

 

  • The whole family checks their blood sugar – new lancets!

 

  • Everyone does a site or CGM insertion

 

  • Different treatment, see post on treatments

 

  • Low-key approach to lows and highs, be calm

 

  •  The other parent takes charge: spa day!images

All Work and No Play Can Make Diabetes Unbearable

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Diabetes educators: Who are they and what do they do?imgres

Likely every type 1 child and their families have seen an educator: at the hospital, for insulin management, to start on a pump, or for school paperwork.  But what do you really know about your diabetes educator and what are their backgrounds?

The Definition

According to the American Association of Diabetes Educators (AADE):

A certified diabetes educator (CDE) is a healthcare professional for diabetes or people at risk for diabetes with behavioral goals to achieve better clinical outcomes.  So what exactly does that mean? The idea is an educator helps a child with diabetes (or family members, in the case of children) with eating habits, exercise habits, insulin dosing, sick day management, and basically the day-to-day activities for a child that affects blood sugars and A1c levels.  A diabetes educator’s background is varied.  He or she may have a background as a registered nurse, a nutritionist, a pharmacist, a physician, or a mental health professional, to name a few.  He or she must take a certification exam to become an educator.  The basis for their education revolves around what the AADE calls the 7 self-care behaviors:  healthy eating, being active, monitoring and taking medications, problem-solving, healthy coping, and reducing risks.

Who Pays to See a CDE

Typically a person with diabetes can see an educator more often than the endocrinologist; however, this is based on insurance coverage.  Insurance coverage for an educator will differ between plans (so check your insurance plan out).  Usually you need a referral from the endocrinologist.  After the referral is made you can typically see the educator more often than the endocrinologist depending on the reason for seeing the educator.

How do you use your educator in your community?  Is he or she helpful or is the endocrinologist you see more helpful?  Have you seen your educator lately?

Here is the link to the American Association of Diabetes Educators with a full-page on what an educator is:

http://www.diabeteseducator.org/export/sites/aade/_resources/pdf/Definition_Diabetes_Educator.pdf

What Exactly Does a Certified Diabetes Educator Do?

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Type 1 Diabetes and Growth Spurts

Growing children seem to eat parents out of house and home.  There is never enough food for them!  For example, my type 1 13-year-old is eating me out of house and home!  And the result is a three-inch growth spurt about every three months.  The problem (beyond the obvious sugar control!) is that he wants to eat all day long.  Waiting until the next meal might as well be giving him a “death sentence”.  The recommendations we received was to eat every two hours.  He is able to have an entire meal every two hours.  I thought what a great compromise!  But he still wants to graze all day long like a cow in pasture!  So I try to help him eat good food and sometimes fun foods to encourage eating well.

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So why is it a big deal for him to eat constantly?  It has to do with insulin, whether via shot or pump.  Eating more often requires insulin.  Each time he takes insulin he is stacking it on the last dose and essentially giving himself mega doses of insulin, setting himself up for a low.  Rapid insulin like Novolog or Humalog have about a 3-4 hour active time in the body. The insulin works quickly but does not leave the body quickly.  It basically means we can expect many and frequent lows.  Eating every two hours helps with this but does not necessarily eliminate stacking of insulin.  But for us it works.

Growing and grazing.  Eat, beef up and grow taller.  Type 1’s can navigate this easily without negative consequences.  Go forth and chow down!

Portrait of a boy holding fruits

Growing and Grazing

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The Barbara Davis Center for Diabetes

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The Barbara Davis Center in Denver, Colorado has been a center for all people with diabetes to receive care. The center began as a way to help underprivileged children with type 1 diabetes to receive care and supplies. Over the years the center has developed and written several books and added programs like classes for grandparents, for families of persons with diabetes.

One popular book that you may be familiar with is Understanding Diabetes by H. Peter Chase, otherwise known as the Pink Panther book.imagesThis one of the books in the Bag of Hope that many children with type 1 diabetes receive when they are newly diagnosed. What a great book it is!  The Pink Panther book is an essential reference to understanding all things diabetes.

The Barbara Davis Center mission statement is:

Our mission is to provide state-of the-art care to children and adults with type 1 diabetes and to teach our patients how to prevent or delay complications. Our research is devoted to finding prevention, cure, and most effective treatment of diabetes and associated disorders.

Recently the center has combined with the University of Colorado Health Science Center.  They still provide easy access for care and the variety of programs the center originally created.  The Barbara Davis Center is still acting as a funding raising entity. You can find out more at:  Barbara Davis Center.

 

Stomach Bugs and All the Fun

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Sick Days and Type 1 Diabetes

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Your type 1 kiddo is sick.  Whether it be a stomach bug, head cold, or bacterial infection, the consequences of a sick type 1 kiddo can be serious if not treated right.  Likely you endocrinologist or educator has gone over what you need to do for a sick day.  But a quick review never hurts!

  • Always check blood sugars every 2 hours
  • Check ketones with each urination
  • If unable to correct low blood sugars decrease amount of basal insulin
  • Encourage plenty of fluids especially if ketones are present.
  • If your child is not eating you may need small amounts of fluids with sugars.

If you are following the above very basic guidelines and working with your sick day management plan and you find yourself struggling, call your endocrinologist.  They will give you advice on what to do next and when to call back.  You can never go wrong with this approach. 

What happens if your diabetic child is sick while with a sitter or grandma and grandpa?  First head home!  But if this is not feasible, we keep a basic sick day management plan in our book that anyone can follow. Then you as a parent have peace of mind until you get home!

 

 

What is normal?

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Type 1 Diabetic and a “Normal” Life

Normal.  What is it?  Such and easy word to say and toss around.  We all have a concept of our “normal.”  But can we really define it?  Websters online dictionary defines normal as: ” usual or ordinary: not strange, mentally and physically healthy.”  Our type 1 children are not the first part.  I would not define my child as unusual or strange, and he is well but not always physically healthy.  Then in daily life how do we as parents achieve normalcy for our children?

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Finding the Norm

The start of finding our normal is not letting diabetes rule our lives, but be an aspect of our lives.  Easy…right!  Not always.  Sick type 1 diabetics tend to not be normal, eating is not normal, exercise is not normal.  So we need not to let it be a big deal.  Treating diabetes as this is just the way it is and we keep going.  Keeping this attitude helps our diabetic children get the norm down as they enter into adulthood.

Practicing the Norm

Get the practice of the norm down.  Eating at regular intervals, not snacking all day (which is good for everyone!),  having play dates and sleepovers, participating in sports, or anything any other child would do.  Years ago a type 1 diabetic was not allowed to do many of these things.  But with all of the new technology and medications our children are able to live a regular life.  As parents, we need to figure out how to do this and feel safe about it.  One way to do this is have a guide-book that helps you as a parent feel safe about leaving your child places with another educated adult.  Check our book out for guidance and the many websites and forums for other parenting advice. Now go out and find your norm!