School Days
School has always given me mixed feelings, even before all the diabetes fun. My kids have a great time at school, are doing really well academically and have made so many friends. And some days the most beautiful sound in the world is when you hear those screechy breaks from the bus coming to pick up your little angels. But, I still miss them when they’re away all day, and of course worry about the typical stuff—-are they kind to their peers? Are their peers kind to them? Are they achieving expected milestones? Are they happy? Yadda yadda, yadda.
Diabetes brought on a whole new level of worry. Every second of every day is spent thinking about blood sugars. With the CGM (Continuse Glucose Monitor—-we use Dexcom G6), I am lucky that I can check in. And I know it’ll get easier the older she gets, when she will text me back and we can talk about how she can treat a high or low.
I’d be interested to see how other T1 parents deal with sending their kids to school. I start immediately thinking about her blood sugar when she is up. We have to time the bolus right (obviously that’s always the goal, right!?) but depending on what she chooses for breakfast, I want to make sure there isn’t a chance that she could drop too low while on the bus or send her to school when her blood sugar is running high. So about 2 hours before she gets picked up, I wake her up and immediately ask about breakfast. There are many mornings that I’ll bolus her while she’s still laying in bed, which gives her another 15-20 minutes to sleep afterwards.
Breakfast comes and goes, and then we wait. I make sure that her blood sugars are okay before sending her on the bus. If there is even a slim chance that she will drop too low while she’s on the bus, we’ve made the decision to treat as if she has a low, send her when we see her sugar coming back up, and have her check in with the nurse as soon as she gets to school. In fact, I often text the nurse and her teacher to give her a heads up if I’m concerned.
Then she gets to school. I feel like it deserves a post all of it’s own, but we did finally come up with a 504 plan this year for her. So there is a plan in place. But she also has amazing teachers. I am constantly texting back and forth with her teacher during the day. We keep a bag of starburst in the classroom so that she can give my daughter one if she starts to go low to minimize how much classroom time she misses from leaving for the nurses office.
Lunchtime is another one that really is a whole story of it’s own. Celiac disease along with her diabetes diagnosis really makes for some planning for lunches. But in short, she will go to see the nurse and say what she will eat at lunch. We’ve found that at home, she eats quickly and will go high so I should bolus all of it up front. After some trial and error at school, along with some really scary lows, we realize that she is more interested in talking to her friends. So basically she’s a normal 8 year old girl who wants to socialize. She eats, but at a much slower rate than she would if she were at home. The nurse helps her to bolus for the amount that she eats, but they do a 50% bolus up front and extend it over an hour so that she doesn’t drop low. That system has helped stabilize her blood sugars more than I can explain.
Making sure her blood sugar is stable before she gets on the bus to come home is key as well. There have been times when the bus is delayed for whatever reason, and honestly, we have lucked out that there hasn’t been a low while she is riding the bus. She does keep a gel packet, juicebox and starburst in her bookbag with her. I’m looking into keeping the Basquimi in there as well, but currently no one on the bus is trained on how to use this.
The thing that has helped me feel more comforatble with sending her to school is having some go-to staff at the school. There are some teachers that she has had who are also moms and just appreciate the constant worry that I have for her. They have been great about texting me throughout the day if there is ever a question about anything, including special snacks for celebrations, if she seems off, how to help her with her pump, etc.
I met with the school nurse to go over how to change her pump site if it fails or falls off, specific signs that my daughter has a low or high blood sugar (since not everyone exhibits the same), the medical plan from our endocrinologist, and how to use the insulin pens. The nurse really appreciated the review and had questions——it had been a while since they had taken care of a diabetic. I opened up the communication and told him to PLEASE text or call me with any sort of question, even if he thinks it’s silly or that he should know. The T1 parents become the experts for caring for our kids, and as we all know, the plan doesn’t always follow what the textbook says. I also met with her teacher in the beginning of the year and explained my daughter’s level of comfort for caring for herself, where she may need help, and again reviewed the signs of a high or low.
What I’ve had to come to an acceptance on is that no one will care for our kids as well as we do at home. Especially when there are 20 in a classroom. It is unrealistic for me to think that they can keep my daughter at 100 all day, everyday. That they may overtreat a low and she shoots up to 200. It’s a work in progress. The non-negotiable for me was if she drops too low, and I made that clear that it can be fatal. That I would always prefer they treat if in doubt and we will use insulin to correct afterwards. I just needed to know that she will be safe. That is what I’m looking for. That is what all of our goals are.
Over time control has gotten better while she is at school. The teacher, nurse, and my daughter work together to keep her blood sugars stable, have learned appropriate amounts of corrective carbs, and how to communicate as a whole about this. So right now we have a great system—and we’ll start the process again when she switches teachers next fall.