“How can I manage my son's type 1 diabetes while he's at school?”
My son has type 1 diabetes, and I'm worried about how well his school nurse would monitor this condition. Is there anything I should tell his nurse so I can be sure it's managed while at school?
2 Answers
Managing type 1 diabetes in children can be very challenging. Managing their diabetes at school can be even more challenging. Because this involves the school environment, the school bus, the teachers, nurses, caregivers, diabetes educators, the child and parents. This can cause immense problems in delivering optimum care of the child's diabetes. But if the above mentioned actors work as a team, the care would be reasonable. Therefore these actors should work at a team in harmony. The parents should have a very important role in the decision making and care delivery of the child's diabetes.
Childhood diabetes is managed at school the same way that it is managed at home. The primary goal of managing juvenile diabetes is to deliver the right amount of insulin at regular intervals to maintain near normal or reasonable blood glucose levels throughout the day. Blood glucose levels should be checked at regular intervals (before meals and snacks) and as needed. At meals (and snacks times if indicated) short acting or fast acting insulin should be given to match the amount of food eaten with additional correction insulin if blood sugars are above target range. Intermediate, long acting or basal insulin should always be given regardless of food intake in addition of the fast acting or short acting insulin. If the child does not want to eat or is not meal or snack time and blood sugars are high fast acting insulin should be given to correct the blood glucose closer to the target range. Long acting insulin is not given as correction insulin.
There are different Insulin regiments. From insulin infusion pumps to basal bolus injections based on carbohydrate counting and a scale of Insulin based on algarythms. They all work well if used correctly.
For each child with diabetes their Insulin regiments, blood glucose target ranges should be established. Blood glucose should be tested before each meal and snacks and also as needed depending how the child feels. Insulin should be given for meals and to correct high blood sugars. If the child is not eating and blood sugars are higher than say 300mg/dl correction insulin should be given. If child is not eating and blood sugars are low the child needs to get fast acting glucose such as juice. Correct blood sugars below 70 food (drinks or tablets etc) and with Insulin if blood sugars greater than 300mg/dl.
If the child is sick check blood sugars more often as often as every hour and bring blood glucose less than 200mg/dl. You can give correction insulin as often as every hour to keep the blood glucose reasonable. Treat fever like you treat any child and hydration is the most important issue. Give him plenty of hydration. If the hydrating fluid has carbs give more Insulin to cover the carbs and to correct the blood glucose. Check the urine ketones if blood glucose is consistently high and or if the kid is sick. The goal is hydration, hydration, hydration and insulin. If blood glucose is consistently high or the child is sick you can give insulin more often and also increase your insulin regiment 20% more until he/she feels better. If the child is sick and vomitted more than twice and you can not hydrate him well you need to go to the ER for iv hydration. Remember with hydration even you give him more Insulin it will not get absorbed. It will not work.
If the kid is sick but blood glucose is lowish and the kid is not eating. You can try to give him glucagon up-to-date 20 units every half hour to bring the blood glucose up. You can pull the glucagon will insulin syringe once you mix it.
If the blood glucose is high but the child is not sick give correction for the high blood glucose and let him participate in any activity. You will always see blood glucose variability (excursions) with diabetes. Blood sugars will be high and low, but as long as you give him carbs for low blood glucose and correction insulin for high blood glucose his school activities should not be interrupted.
Target blood glucose are usually about 120+-20. Blood glucose between 70-140 are good. A reasonable blood glucose control would be about 50% of the blood glucose in target range.
How often can one need to check blood glucose?. As often as necessary. At least before each meal and bedtime, before and after spots activity. High or low blood glucose are not limitations for sports. As long as you treat the high and the low blood glucose and child is not sick, he can participate in sports activity. Do not do excessive Blood sugar testing that will stress the child. Only do reasonable blood glucose testing. Be realistic but not idealistic. The child will be fine if you provide a reasonable care.
To answer your question about your child's management of diabetes at school is that he needs to be managed the way you manage it home. But some one is doing it for you and you are supervising them by phone etc and if they have difficulties they inform you how to proceed with the issue. You can involve your diabetes educators if you need too.
The care givers at school should know when to give insulin, when to test blood glucose levels, when to give correction, to recognize low blood glucose and take action and when to call you without stressing you or your child. They need to understand what to do when the child is sick. They should not restrict his physical activity for high or low blood glucose unless he is sick. They should be taught how to manage it. You should work with them as a team. Remember you are the team leader. You should involve his physian as well. The care givers at school should have a guideline or the care plan. And they apply it with commen sense and should not stress you or the child. Work as a team and talk to your physician or diabetes educators.
Good luck
Childhood diabetes is managed at school the same way that it is managed at home. The primary goal of managing juvenile diabetes is to deliver the right amount of insulin at regular intervals to maintain near normal or reasonable blood glucose levels throughout the day. Blood glucose levels should be checked at regular intervals (before meals and snacks) and as needed. At meals (and snacks times if indicated) short acting or fast acting insulin should be given to match the amount of food eaten with additional correction insulin if blood sugars are above target range. Intermediate, long acting or basal insulin should always be given regardless of food intake in addition of the fast acting or short acting insulin. If the child does not want to eat or is not meal or snack time and blood sugars are high fast acting insulin should be given to correct the blood glucose closer to the target range. Long acting insulin is not given as correction insulin.
There are different Insulin regiments. From insulin infusion pumps to basal bolus injections based on carbohydrate counting and a scale of Insulin based on algarythms. They all work well if used correctly.
For each child with diabetes their Insulin regiments, blood glucose target ranges should be established. Blood glucose should be tested before each meal and snacks and also as needed depending how the child feels. Insulin should be given for meals and to correct high blood sugars. If the child is not eating and blood sugars are higher than say 300mg/dl correction insulin should be given. If child is not eating and blood sugars are low the child needs to get fast acting glucose such as juice. Correct blood sugars below 70 food (drinks or tablets etc) and with Insulin if blood sugars greater than 300mg/dl.
If the child is sick check blood sugars more often as often as every hour and bring blood glucose less than 200mg/dl. You can give correction insulin as often as every hour to keep the blood glucose reasonable. Treat fever like you treat any child and hydration is the most important issue. Give him plenty of hydration. If the hydrating fluid has carbs give more Insulin to cover the carbs and to correct the blood glucose. Check the urine ketones if blood glucose is consistently high and or if the kid is sick. The goal is hydration, hydration, hydration and insulin. If blood glucose is consistently high or the child is sick you can give insulin more often and also increase your insulin regiment 20% more until he/she feels better. If the child is sick and vomitted more than twice and you can not hydrate him well you need to go to the ER for iv hydration. Remember with hydration even you give him more Insulin it will not get absorbed. It will not work.
If the kid is sick but blood glucose is lowish and the kid is not eating. You can try to give him glucagon up-to-date 20 units every half hour to bring the blood glucose up. You can pull the glucagon will insulin syringe once you mix it.
If the blood glucose is high but the child is not sick give correction for the high blood glucose and let him participate in any activity. You will always see blood glucose variability (excursions) with diabetes. Blood sugars will be high and low, but as long as you give him carbs for low blood glucose and correction insulin for high blood glucose his school activities should not be interrupted.
Target blood glucose are usually about 120+-20. Blood glucose between 70-140 are good. A reasonable blood glucose control would be about 50% of the blood glucose in target range.
How often can one need to check blood glucose?. As often as necessary. At least before each meal and bedtime, before and after spots activity. High or low blood glucose are not limitations for sports. As long as you treat the high and the low blood glucose and child is not sick, he can participate in sports activity. Do not do excessive Blood sugar testing that will stress the child. Only do reasonable blood glucose testing. Be realistic but not idealistic. The child will be fine if you provide a reasonable care.
To answer your question about your child's management of diabetes at school is that he needs to be managed the way you manage it home. But some one is doing it for you and you are supervising them by phone etc and if they have difficulties they inform you how to proceed with the issue. You can involve your diabetes educators if you need too.
The care givers at school should know when to give insulin, when to test blood glucose levels, when to give correction, to recognize low blood glucose and take action and when to call you without stressing you or your child. They need to understand what to do when the child is sick. They should not restrict his physical activity for high or low blood glucose unless he is sick. They should be taught how to manage it. You should work with them as a team. Remember you are the team leader. You should involve his physian as well. The care givers at school should have a guideline or the care plan. And they apply it with commen sense and should not stress you or the child. Work as a team and talk to your physician or diabetes educators.
Good luck
Make sure they are checking glucose before lunch and as needed if symptoms occur. Leave guidelines of highs and lows to call you and steps to take if glucose is high or low, i.e., give a snack if less than 60 on the sliding scale for insulin if too high and make sure you are sending lunch and snacks or have gotten with a dietician for carbs that he needs for his meals.
