Your Child with Type 1 Diabetes is Starting School

 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.


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?


The Barbara Davis Center for Diabetes

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.

 


Toes in the Sand and Pumpers

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


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


Symptoms of Type 1 Diabetes

I often had the question: How did you know your son had diabetes? I didn’t. Even as a healthcare provider Type 1 diabetes was not the first thing in my mind. Mostly because I am a mom before I am a nurse practitioner. Quincy did have most of the symptoms when I look back right before diagnosis. And because I am a practitioner I knew something was wrong and I had him into the clinic quickly. He was never in diabetic ketoacidosis upon diagnosis. So As a parent how do you know.

First If you think something is wrong with your child, take your child into your doctor. Nothing you can read here or anywhere else will substitute what a good provider can do when seeing your child and running some lab work.

Secondly the main symptoms of type 1 diabetes (or diabetes in general) is extreme thirst, extreme fatigue (more than you would see with a  growth spurt), extreme hunger but also weight loss, a fruity breath smell or loss of consciousness. The later are later symptoms and are indicative of diabetic ketoacidosis (DKA). DKA is when the body is breaking down large amounts of protein to make fuel and in turn makes the blood more acidic. This can render a person unconscious and without health care death.

If your child has any of the milder symptoms thirst or hunger that cannot be satisfied, fatigue or weight loss then take your child to the doctor. the symptoms could be diabetes or a number of other diagnoses.


Type 1 Diabetes and Friends

Friends can be a tricky thing with your type 1 child. Children want so badly to fit in with others, to have a group of people who accept them unconditionally. Type 1 diabetes can make your child have the impression of being unaccepted. Now not all children feel this way. Many children have a self-confidence that is made of iron and other children determine their confidence based on others. And let’s face it: other kids can be mean and use diabetes as a way to pick on and bully your type 1 child.  As parents we want to embrace our children, keep them safe, and have them feel confident no matter what and make all of their ills disappear. If we, as parents, could do that we would wipe out diabetes all together with our wants and desires.

Since we cannot wipe out diabetes, how do we help our children to be comfortable with this lifelong disease?  I believe it depends of your child’s age. With a middle, elementary school and younger child, parents need to enter the classroom each year and talk to the class about type 1 diabetes. Joslin has a great handout to guide you as a parent through this at http://www.joslin.org/info/classroom_presentation_on_diabetes_for_elementary_school_age_children.html   Beyond talking to the class, you can also enlist the help of the friend’s parents. They will need to know about your child anyways so why not have them help talk to their child about childhood diabetes? The friend’s parent may know how to talk to their child about specific for their child.

Then with an older child,  he should start to learn to talk to their friends about Type 1 Diabetes. This will help two-fold. First, it helps your type 1 child learn about their disease a bit more because he or she needs to talk about Type 1. Secondly, I strongly believe that encouraging your child to discuss this makes them more confident about themselves. When a child becomes more confident they are more likely to advocate for themselves. With advocation less childhood bullying could occur. Kids don’t tend to pick on kids that are confident in themselves. Self-advocation is a lifelong habit.

All T1D kids need to eventually be able to discuss how their body works, why they need insulin, to carry sugar, eat often, and sometimes feel cruddy because of their sugars. Teaching your child while they are with you by talking to the classroom and their friend’s parents about type 1 diabetes will enhance your child’s ability to make lifelong habits to talk and discuss about their diabetes.


Brand New Type 1 Diabetic Parent

I first want to tell you to BREATHE!

Okay now we can talk. There is so much information that is getting told to you and you feel like you are drowning. Breathe again! You will become the next expert on your child and type 1 diabetes. But how do you get there and when will that happen?  Take small steps to get there. You will learn all of the information and will be that expert. Parents I have talked too say they really felt very comfortable around a year. Not that you won’t understand what to do until then; however, type 1 diabetes becomes second nature around then.

Not everyone is the same. Some parents are type A organized and have every paper ever given to us by the doctor to reference back too. And some of the parents have what is exactly needed and nothing more. Each has it merits. But what we do have in common is we keep all this stuff in one spot to find and reference. Usually all of the information is from a diabetic educator. Diabetic education is wonderful. They take you step by step through all things diabetes. So how could you break that up a little bit more for a not so structured person. Start with a list of how to focus on aspects of diabetic care. (And yes I am the type A personality, so planning is how I function. I recognize that planning is not everyone’s strength. And it is not a downfall). Start with a few weeks as a new diabetic parent and just get to know your child’s type 1 diabetes. As a parent of a newly diagnosed diabetic I learned my child; for example I learned that his legs were hungry when he was low. While you learn your child also spend time with a basic diabetic book to understand high blood sugars, low blood sugars. insulin, and carbohydrate counting. Then I would start to dive into each topic more in-depth.

A good example would be carbohydrate counting. To do this start to learn more about how to measure and weigh carbohydrates. The package carbohydrate counting is sometimes correct and sometimes way off. So measure with a good old-fashioned scale and use that carbohydrate counting book at diagnoses. If you have that book mark the pages you use most.If you don’t go buy one. If your preschooler will only eat macaroni and cheese then mark all of the pages. (We keep one of these books in a carry bag, in a kitchen draw, at grandmas house, in all the cars. One year we found older versions at the bookstore for a dollar a piece. You guessed it we bought every single one of them). Now that the pages are marked you will find it easier to start counting carbohydrates. Live with the carbohydrate counting and then move on to the next topic of your choice.

Over the next few weeks learn in-depth a certain aspect of the new diagnosis. With breaking it down into smaller steps it becomes easier.taking it step by step allows you to master your understanding of your child’s diabetes. Also remember you are still caring daily for your diabetic child.  The first year is the hardest because type 1 diabetes is not second nature. It will come it just takes time. But the thing that is most important to emphasize is a parent can become caught up in trying to do all of the diabetic stuff and burn out easily. So BREATHE often and frequently!

It is important to stay on top of it but you as a parent needs to know when you need a break even for a few hours. You can better help you child with their diabetes if you are not burnt out from care giving. to do this use all the resources you can, books, family, spouse, to make learning and caring easier for you and your family. Diabetes did not just

life-with-diabetes

impact your child, it has changed the whole family unit.

One place to start with a new diagnosis is with our book. It is for babysitters, but as authors we broke the book down in very basic topics to help people learn. The intended people are the sitters, but with a new diagnosed child the parent can also be that person to learn. And the plus side is that you will have all your kiddos information in one area. Diabetes is hard on the whole family and the primary parent tends to be the caregiver. You as a parent will learn it all and hopefully do so with as little stress as possible.


Grandparents and Type 1 Diabetic Grandkids

Off to grandma and grandpa’s house we go….what goes in the diabetic bag (besides everything)?

The first few times Quincy went to grandma and grandpa’s I was a mess. He was excited! He got to play with grandpa and his flight simulator. Help grandma cook and play board games. The normalcy of childhood. The blessing to be able to find it with family. However, this did not take away my fear.  I wasn’t a mess because I did not trust my in-laws. I did. But WHAT IF always lingered in my head. So we had the house type 1 child proofed. We hung carb counting cheat sheets and hypo cheat sheets in the kitchen cabinet. Quincy had his own supplies at their house, 4 ounce juices, easy to eat and will eat snacks, favorite foods, a glucometer, syringes. We even kept insulin there at times.  All this to go down the street and to keep him safe.

Of course he did fine. Me on the other hand slept with my cell phone (now to have a type 1 and no cell phone…scary thought!). He had fun! He had a “normal” time with grandparents that love him and would sacrifice everything for him. His time with grandma and grandpa gave him memories that will stay with him forever.  Funny how flying a plane on the computer and hanging out with some of your favorite people erases diabetic stresses for a child. I look back and the work was worth it. Yet, getting there could have been easier (at least hind sight).  Now he goes out and about as a teenager with out much thought in preparing.

Even so my three ringed binder was always in the bag or on the counter (and still is). Everything was there, Doctors numbers, my number (like family would forget that!), what to do with lows or highs, calculations when he was on shots, You name it or we got it from the doctor or educator, it was in the book! Seems a little overboard now. But then I had no other answers on the how to. How do I make it easier for my son (who did not understand it fully) and how to make it easier for my in laws? Hopefully our book makes it easier for grandparents and extended family everywhere to get through that special time with their type 1 grandchild.

What is your story about extended family. Who has taken classes and done the work to care for your type 1 kiddo? What memories did you make with that family member with your type 1 child recently or in the past? How is that loved ones house type 1 child proofed?


Sleepovers and Type 1 Diabetes

Type 1 diabetic children and sleepovers

What was your childs first sleep over  as a type 1 diabetic? How did it go with the other parents? How did you prepare for the sleepover?

My sons first sleepover was stressful for me as a parent and a professional. He was going over to a wonderful families house to stay the night just 4 blocks away. I had trained the mother and she said she felt very comfortable helping him give shots and counting carbohydrates. I felt comfortable leaving him. But only after we had talked and discussed it thoroughly! He had only had diabetes for 8 months or so. So my husband and I had some time to ourselves for a while. Then dinner time came. The mother had called me upset because she just couldn’t give him his shot. The idea of putting a needle in another person upset her so much. This was something she did not expect to feel.  I went over and gave him his shot and then went the next morning to give him his shot. He did his own blood sugar testing. I was lucky because it was just down the street.

Once he had a pump he had an easier time with sleepovers. I still was very strict on where he could go. If he had a friend with physician parents they had an easier time keeping him overnight. They did get easier each time and as he became older.

I am curious about how this has worked for others. How did you teach families and parents? What materials did you use to teach these parents?

But mostly what is your story about the first sleepover and your type1 diabetic child?