Children with type 1 at school

[C.Connolly]

Hi, does anybody have any young children at school with type 1? My son is 5 and I'm starting to get really fed up with his hypos and how they're treating him. Does anybodies children have extra snacks inbetween school?

 

[CathP]

Hi, I've got a 5 year old daughter with type 1. She has sugar free jelly as her mid morning snack at school, so they don't need to bolus for it, and has a packed lunch that's carb counted by me. What's going wrong with hypo treatment at school with you? Have you got a care plan in place?

 

[C.Connolly]

Hi, I've got a 5 year old daughter with type 1. She has sugar free jelly as her mid morning snack at school, so they don't need to bolus for it, and has a packed lunch that's carb counted by me. What's going wrong with hypo treatment at school with you? Have you got a care plan in place?

Yeah we have a care plan in place, but it's starting to annoy me because it's like as if they don't want to listen to any of my suggestions as his parent because it goes against the nurses guidelines. I'm trying to tell them what works for him and we have no problems at home, it's always school where there's issues. For example, if he is low on his lunch time check which is nearly all the time, they will just give him his dextros to bring his levels up, check him again, put his carbs into the meter, give him the insulin the machine says then 2 hours later he's having a hypo again...why.... because the dextros are temporary sugar and not long lasting and he now has no extra carbs laying around because they've just given him all the units he needs to cover the carbs in his meal. I've said to them so many times he needs extra snacks in between but I get the whole "it's not fair on him to always get taken out of class because he misses out".... "it's not fair on the other kids in the class if he eats his snacks in front of them".... As of today they have allowed him to have his own flask of milk which he can have in class whenever he wants. His lunch and 1 break time snack just isn't enough for him for the whole day at school

 

[catapillar]

If he's hypo nearly all the time at lunch and nearly all the time after lunch, maybe his ratios need looking at - it could be a breakfast ratio issue, or maybe too much basal? If he needs to be constantly eating, that might be too much basal.

Does your bolus wizard do negative corrections? So, if you are bolusing but starting off below target will it "round down" the suggested dose?

I think you should discuss with DSN about having another meeting with the school to get the care plan updated. If school are only following the care plan, and not listening to your less formal input, then can you make sure these points are covered off in an updated care plan?

 

[C.Connolly]

If he's hypo nearly all the time at lunch and nearly all the time after lunch, maybe his ratios need looking at - it could be a breakfast ratio issue, or maybe too much basal? If he needs to be constantly eating, that might be too much basal.

Does your bolus wizard do negative corrections? So, if you are bolusing but starting off below target will it "round down" the suggested dose?

I think you should discuss with DSN about having another meeting with the school to get the care plan updated. If school are only following the care plan, and not listening to your less formal input, then can you make sure these points are covered off in an updated care plan?

We have just recently changed the ratio, he was originally 1 unit to every 25g then they changed it to 1 unit every 35g and breakfast 1unit to 30g but his levels are still the same in school. What I don't understand is how can everything be fine at home with us but things are so different in school, I know they do more activities etc but this has been taken into account. In general his appetite has always been big, even before he was diagnosed, so the extra snacking isn't something I'm trying to avoid. Maybe because he has such a high appetite this plays a part in it as well... I just don't know! Extremely fed up of it... been like this for the last 5 months.

 

[C.Connolly]

If he's hypo nearly all the time at lunch and nearly all the time after lunch, maybe his ratios need looking at - it could be a breakfast ratio issue, or maybe too much basal? If he needs to be constantly eating, that might be too much basal.

Does your bolus wizard do negative corrections? So, if you are bolusing but starting off below target will it "round down" the suggested dose?

I think you should discuss with DSN about having another meeting with the school to get the care plan updated. If school are only following the care plan, and not listening to your less formal input, then can you make sure these points are covered off in an updated care plan?

And about the negative bolus, do you mean if hes low will the meter detect this and automatically decrease his unit intake?

 

[azure]

@C.Connolly If you're not happy - and it most certainly sounds like you're not - I suggest putting something in writing to the school saying that you're not happy with the number of hypos your son is having nor the way your wishes and knowledge as a parent is being ignored.

Could you put down in writing what you want them to do eg in a flow chart "If blood sugar is 3.5 or below, give....then...."

I'd put my foot down. If he needs a snack he needs a snack. Personally, I don't see why he has to be taken out of class? Isn't there a quiet corner where he can eat a snack? It's up to the teacher to explain/control the class. Your son shouldn't be penalised or made to feel different.

 

[Nikki_S_]

Hi my son has just been diagnosed with type 1 3 weeks ago, he's only 4, he went back to school on Monday and he is on injection, which he needs one at lunch time which I'm in every lunch time just now to show a teacher how it's done. His school has been absolutely brilliant with hypos extra snacks, hope you get it sorted soon X

 

[shelleyh]

Hi, This must be driving you mad. Although I don't have young children, I am Type 1 and have worked in education for 17 years so have had some experience of the problems you have posted. Could you give your son a sugary drink to take into his classroom to have during the morning when his levels drop? Other children have water in a bottle but you could give him Ribena for example. As he is probably very active during the morning, this should keep his sugar levels from dropping. I know from experience that a hypo can turn into a day of roller coaster blood sugars and me feeling lousy.
Otherwise I would contact the School nurse and arrange a meeting to review the Care Plan as it needs fine tuning. You could do that with your son's diabetic nurse also. As a parent, you know what your son needs and that should be considered at every point of his diabetic care.

 

[catapillar]

And about the negative bolus, do you mean if hes low will the meter detect this and automatically decrease his unit intake?

I think some bolus calculators do this - you'll need to check whether the metre you are using does. If it doesn't, that could be a step added into the flow chart plan

• I.e. If he is over 5.5 dose whatever the bolus calculator tells you to
• If he is under 5.5 look at what the bolus calculator thinks he need, deduct 20% or 10% (whatever works according to his insulin sensitivity) and then does the x% less figure.

If school are treating the care plan as the bible (which in some ways might be a good thing, although really frustrating for you in terms of being listned to like, you know, an actual person) then you just need to make sure the care plan is as detailed as possible and sets out step by step response for the common situations. Including what to do when hypo - I can't see why ther would be any problem in lettin him eat in class to treat a hypo, talk of "unfair" just seems like nonsense.

Hopefully you can get some support from your DSN to get it sorted.

 

[C.Connolly]

Thanks for all the replies guys. I have been piping up and saying what's what but I just feel like it's falling on deaf ears. The diabetic nurse keeps saying his insulin needs adjusting because realistically he shouldn't have to always rely on having snacks. I've stuck to my guns and said he'll be bringing in milk everyday to have in class and if the insulin adjustments don't work I will be seeing the specialist to discuss with her and get it written off on how I want him treated.

 

[MaisyMoo10]

Hi, does anybody have any young children at school with type 1? My son is 5 and I'm starting to get really fed up with his hypos and how they're treating him. Does anybodies children have extra snacks inbetween school?

Our 6 year old was only diagnosed earlier on this year (aged5) and school have been fantastic, Maisy has breakfast around 8am and then mid morning snack around 10.30am she now has half a peice of fruit and one rich tea as we were having same problem she was getting towards lunch time and having hypos But since we've introduced the fruit with a starchy snack this seems to have worked for us and the teacher also checks he mid afternoon and if she tends to be dropping low she has the same snack. Your diabetic nurse should draw a care plan up for school..

 

[C.Connolly]

Our 6 year old was only diagnosed earlier on this year (aged5) and school have been fantastic, Maisy has breakfast around 8am and then mid morning snack around 10.30am she now has half a peice of fruit and one rich tea as we were having same problem she was getting towards lunch time and having hypos But since we've introduced the fruit with a starchy snack this seems to have worked for us and the teacher also checks he mid afternoon and if she tends to be dropping low she has the same snack. Your diabetic nurse should draw a care plan up for school..

Hi, we do have a care plan, but they are not listening to me about adding in an extra snack somewhere. All she wants to do is adjust the insulin all the time.

 

[Faethebath]

I have a 6 year old Type1 on an insulin pump and CGM, we have a care plan and EHCP with a full-time 1-1 TA, they carb count, bonus in pump etc, why should care in school be any different to we give as parents?

 

[T1Dad]

Hi @C.Connolly, sorry to hear you are having these issues with the school. My daughter is also 5 (around 11 weeks since diagnosis) so she started Year 1 with Type 1. The school have been absolutely fantastic about this. She is allowed to eat snacks during class in front of all other children. This has been down to the teaching staff just tackling this hands on. On a recent Parents evening, the teacher informed us that the other children do not even care that she's chomping through a Digestive biscuit right in the middle of a class activity. It's just become natural.

We do have the problem that you mentioned with the hypo during prick...treat with tabs, then bolus...then hypo 1 hour later!! We have adjusted lunch ratios to counter this but it still occasionally happens. The way we see it is that the school are really helping us with this and they have many other children to look after so it is much easier for them to follow the care plan. Both her school teacher and welfare nurse have been on a full day training course run by the clinic. They said this really helped raised their awareness of the issues that are faced. Maybe see if your clinic offers such a course.

Another thing to check is if your child is finishing the lunch completely...although you have stated he is a good eater am sure you can rule that out.

Finally, we are on the Freestyle Libre which has really helped school staff...in fact...not sure how they would cope in school without it so we are completely tied in now.

Hope it improves for you...sounds really frustrating

 

[jharding]

Our school have been good. They demanded that they follow the care plan that the paediatric DSN issues, which is a NICE guideline one I believe, but we've tweaked that and they have accepted our amendments.

If you have the AccuChek monitor, the target range can be set differently at different times of the day. This is helpful.

You may want to run his bloods a little higher during the day; whereas the target range might be 4.5 to 7.0 normally, what this does is two things:
If the bloods are below 4.5 it deducts a small amount of insulin from any insulin it would give for a meal; if the bloods are above 7.0 it suggests a correction. It uses the insulin sensitivity value for these calculations.

So, if between 8am and 4pm you set the target range to be 5.5 to 6.5, for example. If his bloods are 5.0 then it would automatically deduct some insulin from the lunchtime bolus to bring him up.

You didn't mention if you are on pen or pump; if you are on insulin pen, is it the Novopen Echo that allows 0.5U increments? (or equivalent).

Lastly, is there a correlation between weather and hypos or days and hypos. I.e. is the good weather making a very active playtime or do the hypos always occur on days with PE/Dance/etc. If so, that might be worth exploring ...

Good luck.