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.

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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The “Weekend Away”

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The Weekend

Here it is our first real out-of-state vacation without the kids.  My mother-in-law took them for us while we scooted off to Seattle, WA for five days.  This would mark our first “BIG” trip without the kids.  We have had others: to the mountains for a night or they have scooted over to friends’ houses overnight.  But to go out-of-state without me being in complete control of Quincy’s diabetes for five days (and he was not at camp)?  My feelings: excited, scared, curious to see if I could do it and not go psycho crazy and need to control everything! So I plotted my obsessive need to control all the details.spaceneddle

The details

Five days at grandma’s house.  She had a mini-trips planned with the kids.  This meant I needed to plan and discuss what is expected for Quincy when you are more than 30 minutes from home, staying in a hotel, and then going on a fabulous train ride (which was way more exciting for my kids than going to some silly city!).  I, of course, have the “travel overnight” and not being at a hotel down to a “T” with skiing.  But I actually had to think my steps through and decided what a non-routine caregiver would need to do for a fun-filled grandparent weekend.

The steps

We do use our book for our son.  Now that he is a young teenager he does quite a bit on his own with lots of supervision.  He needs his travel bag and then several smaller bags for the train ride.  The travel bag consists of several pump site changes, insertion device (it is never fun to leave this at home), insulin, Lantus (just in case the pump fails all together), syringes, test strips, glucagon (in every pocket imaginable), alcohol wipes, sugar, and an extra glucometer.  That is the big bag.  Now experience has taught my family that taking one to two extra glucometers is a must, and keeping things in several places is a must.  So my mother-in-law had a baggie with a glucometer and sugar for her purse, and my son took the site change (only one) in his diabetic bag on the train. Then came special training about keeping all diabetic supplies from being too hot or too cold in the event they may not function right.

The result

We had an exceptional time in Seattle.  The kids had fun with my mother-in-law.  Mobile phone communication was mostly about our trips and very little about blood sugars until the last day and that will be the next post.  My mother-in-law utilized the book when she needed to and it kept everything running smoothly.  It’s amazing how a full scope of knowledge helps care for your child! Everything she needed to take care of Quincy was right in the our book, “Type 1 Diabetes and Babysitting: A Parent’s Toolkit”.

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.

 

Childhood Diabetes: The Halloween Candy Killer

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Halloween is right around the corner and it is not necessarily the best food holiday for a type 1 diabetic child. Sugar in itself is not bad but the overindulgence of candy is. At no other time of year can a person knock on a door and fill a pillowcase full of candy. I am not so sure this is how most diabetic families want their child to eat – a buffet of sweets!

I know the Type 1 Kids are allowed a “normal” eating habit. But somehow overindulging on candy seems wrong in so many ways. I think this is true for all children. Yet Halloween can be fun in so many memorable ways. Going around from house to house with friends and dressing up in fun or scary costumes will last a lifetime. Quincy was diagnosed young enough that I began to focus on all the fun, fabulous aspects of Halloween and not necessarily the candy. We always had the fun of Halloween, whether it be a party, trick or treating, or decorating the house.

In my opinion our best years occurred when we made Quincy’s costumes, decorated around the house, had a pumpkin carving contest, or were growing enormous pumpkins. Some of the fun has been the costumes. Our favorite costume year was Harry Potter. (Or at least that was mine.) I think he would say his politician year was his favorite. There was the year of the orange Lego and the computer monitor (I love empty boxes – they make so many things!). We still trick or treated and brought the treasure trove of candy home. After the candy inspection, I made both kids choose 5 pieces they really loved and wanted to eat (usually it included the one or two full-sized bars we would have!) and we saved them for a treat with a meal. Then I went through the candy and kept pixie sticks, Smarties and the like for low blood sugars. The rest of the candy never went to waste. We would take it into work or ship it off to the military oversees while they were at war. For us this has taken the emphasis off of candy at Halloween and focused on all of the other fabulous aspects of Halloween.

So far this has worked in our house. Now that Quincy is a teenager, he is more interested in handing out the candy and seeing what the little kids are dressed like and he is a numbers guy…so keeping track of how many Halloween kids we have is his top priority! It has been fun seeing how he is growing into a man with control over how he handles himself. Dealing with Halloween in this way has helped him grow and become accountable with his diabetes.

I do know other families do the candy holiday differently than we have. And my take on it is not for everyone. I love that we all have options on how we can handle candy at Halloween with our type 1 children. So how do you handle Halloween as a type 1 family? Do you still get dressed up and make it fun? Do you allow the treasures of candy to linger around the house? I know everyone participates in Halloween differently. If the candy stash is the treat you let your kids have visit the carbohydrate count at JDRF website http://neny.jdrf.org/wp-content/uploads/sites/36/2013/09/candy-carb-counts.pdf

Have a Happy Halloween!

Toes in the Sand and Pumpers

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Its summer time and most of us are heading out for a vacation. Some to big cities, some to forested mountains, some to lakes and camping. And then there are those of us headed to warm sun, sand and ocean! Think of it, seeing to the bottom of the ocean and the fish swimming and surfing, sailing, and sand castles! But wait….

sandcastle

….There is insulin and insulin pumps and strips and all that fun stuff to figure out! Hot weather and taking the pump off to play in the water and then putting it back on every two hours and trying not to get sand in everything!!! Here are some tips to save the sand everywhere (and if you are at a beach, have been at any time in your life then you know sand just sticks to everything!):

1. If your child or self uses an insulin pump. always put the site cap back on. If sand gets into the site then it is site change time.

2. Have a dedicated cooler for only insulin supplies, (insulin, strips, sugar etc )that is large enough sand will have a hard time jumping in!

3. Consider going back to shots for the time you will be at the beach. No pump, only glucometer, and strips to worry about.  If doing this connect with you Diabetic educator and review what basal insulin and an insulinshot schedule.

Our book has all of the equations to determine correction factor and insulin needs for food as an easy resource for your beach travels!

While at the beach have fun and keep you r toes in the sand for those of us by the Rocky Mountains

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 Diabetes Apps Do You Use?

Technology is great! It allows us to keep connected with other people in our lives. For example, It allows my teenager to contact me always. So when he is over at a friends or out with school activities he texts me his blood sugar numbers when they are out of range. So my question is what apps for your smart phones do you use for your type 1 diabetic?

Type 1 Available apps

There are so many apps available for use. Some seem perfect for a type 2 diabetic because  they help with meals and weight loss. The few type 1 diabetic apps I have reviewed and looked at are ManageBGL, My care Connect, and Go Meals or Calorie King. ManageBGL website talks about real-time Blood sugars (a sitter/child enters it and it gets to the parents), predictive lows or highs, ans so much more. What a wonderful way for parents to help easy an overnight with others. Then there is My care Connect. This one allows information from school, child, parent to communicate back and for as well as with the endocrinologist. I have not had the chance to use either one but have look at both closely.

 

Then there is the applications that help you carb count:Calorie King, GO meals. We utilize apps and books. Usually just what we can get our hands on fastest. They have allowed my teenager to feel more comfortable counting carbs.

Pros and Cons

Apps help so much and in so many ways depending on which app you decide to use. Apps need good cell service or wi-fi to get the information live. Don’t get me wrong I utilize every thing I possibly can to help me with my sons diabetes management, but there are times a book or a phone call is easier or more reliable. So a mix of technology and old school paper is good.

Knowing when to tell your child or other adult if the app, phone call or consulting a book, like ours “type 1 Diabetes and Babysitting”, will be the fastest or safest method. We can rely on technology until it does not work then we need to rely on paper. Plus there are things that are tangible like having a flow chart right infornt of you to know management. Let me know which do you prefer: paper or a screen?

Type 1 Diabetic Apps

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