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Posted by on Aug 10, 2017 in Diabetes Management, School

Making the Grade: Back to School with Diabetes

Making the Grade: Back to School with Diabetes

As a parent or caregiver of a child with diabetes, your back-to-school checklist includes more than a backpack, notebooks and writing tools. You also have to add visits to your child’s healthcare providers, forms to complete, supplies to provide, and connecting with the school personnel to your list.

Each child and each school year is different. It’s influenced by your child’s characteristics, age, how long they’ve had diabetes and their abilities to manage their diabetes at school. The school and school personnel, from teachers to school health providers, factor in, too. One year your child may be in a familiar school; the next year they may be in a new school or in a completely new district. What’s always the same is that you know your child and their needs best.

While we cannot provide you with legal advice, we’ve compiled a few details about certain federal and state laws and regulations that may be helpful in managing your child’s diabetes during the school day, along with some practical pointers.

Select U.S. Laws and Regulations Help Schools Ace Diabetes Management

As a parent or caregiver, consider developing written plans under two key federal laws that protect children with diabetes. Be familiar with these plans and know what services your child might receive:

  • The 504 Plan: Based on Section 504 of the Rehabilitation Act of 1973, which prohibits discrimination by any entity receiving federal funds including public, private and religious schools and any program offered by a public school system, this is the plan in which your child’s required accommodations in school are documented. Each school-age student with diabetes should have an annually updated 504 plan to establish how the school will meet their needs. Another law, the Americans with Disabilities Act (ADA) prohibits discrimination on the basis of disability by places of public accommodations, including public and private schools.
  • Individualized Education Program (IEP): The IEP is developed for students qualifying for services under the Individuals with Disabilities Education Act (IDEA), another federal law. Under IDEA, the federal government gives money to state and local education agencies to provide special education to children with disabilities, including some with diabetes if their diabetes or another disability adversely impacts learning. Students who qualify for these services should have an IEP developed by school personnel which includes diabetes-related accommodations.

Collectively these laws require schools to ensure safe, fair and equal access to education and school-sponsored activities. Schools must meet the requirements of these federal laws regardless of state laws. State regulations, which vary state to state, may provide guidance on the skill level and training of school personnel, the individuals who can administer insulin, give a bolus, and/or treat severe hypoglycemia. Many state laws provide additional protections to children with diabetes.

At the Head of the Class: Your Child’s School Health Personnel

The number of school health providers required in your child’s school is based on the laws in your state. In some states, the direct care of a child with diabetes may be provided by a registered nurse (RNs), a licensed practical nurse (LPNs), a health assistant and/or other school personnel. The “school nurse,” which may or may not be a RN, typically provides direct care to students and may delegate diabetes care tasks to other trained non-clinical school staff. The school nurse provides training, ongoing supervision, evaluation of the trained school staff, and evaluation of the student’s health. The school nurse is typically a member of your child’s 504 or IEP team.

ABCs and 123s: Document Your Child’s Diabetes Management Plan

To provide your child with diabetes care during the school day, at the start of each school year you’ll need to provide the school nurse with your child’s current Diabetes Medical Management Plan (DMMP). The DMMP contains directions from your child’s healthcare provider on diabetes care at school and school-sponsored events. To implement the DMMP, the school nurse should combine the school health provider’s orders with information from their nursing assessment of the student and family. From the DMMP, the school nurse develops an Individualized Healthcare Plan (IHP) which should include emergency care plans for diabetes-related issues that can occur during school hours, such as hypoglycemia and hyperglycemia.

The Diabetes Learning Curve: Be the Teacher

As you and your child with diabetes start a new school year, keep in mind that you and your child (depending on their age) may have more expertise in managing your child’s day-to-day care with diabetes and the technologies they use than the school health providers. Recognize that these individuals may be relatively new to working with a child with diabetes and may have concerns and fears. Work with them early in the year to increase their knowledge and allay their fears. Try to establish a positive working relationship to make sure your child receives the best possible care all school year long.

Tips for Success:
• Be familiar with the relevant federal and state laws.
• Ask about the training and credentials of the person who has direct contact with your child and their supervisor.
• Work with your child’s care providers and school personnel to update their 504 plan, IEP or other written accommodation plan annually.
• Ask your child’s diabetes educator to assist in answering questions and training school healthcare personnel on new technologies.
• Have a back-up plan in place for situations where your child may require assistance (e.g., such as a Pod being pulled off on the playground).
• Make sure that adequate diabetes supplies are on hand at school.
• Tap reliable resources available at your fingertips (see recommendations below).

For more information about keeping children safe at school refer to the American Diabetes Association, the National Diabetes Education Program within the National Institutes of Health and the National Association of School Nurses.

– Hope Warshaw, MMSc, RD, CDE, BC-ADM

Thanks to our expert contributors: Crystal Woodward, Director of the American Diabetes Association’s (ADA) Safe-at -School program. Jade Bland-Slaffey, MSHCA, BSN, RN, Nurse Education and Practice Specialist, National Association of School Nurses.

 

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Posted by on Dec 11, 2014 in Diabetes Management, Fitness, Lifestyle, Pump Therapy, School

Benched for Diabetes: Trying to Educate Others on Diabetes Management

Benched for Diabetes: Trying to Educate Others on Diabetes Management

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I just finished up my third year of Varsity field hockey and found this past season to be a giant personal challenge. The coach I had is the same coach that I have had for the past two years and I have struggled with trying to get her to understand diabetes.  This season we started an intense conditioning process before practice with a trainer. I found that I was going low – very low – during practice on the days that I had conditioning.

My mom was in contact with the nurse after a number of times when my blood sugars were dangerously low. The coaching staff really did not seem to understand exactly how low my numbers were. On a number of occasions, they allowed me to walk away from the practice field on my own to treat numbers that were in the high 20’s and low 30’s. It got to the point where I was so uncomfortable asking to be able to check my blood sugars that I actually stayed on the field a few times in spite of the fact I knew that my levels were heading down.

After a few weeks of working with the nurse, my doctors and my parents – making adjustments, eating more and treating lows – things were still not where they should have been. I tried suspending insulin delivery with my Omnipod insulin pump, I tried reducing my insulin at lunch so I would go into conditioning a little higher – I tried basically anything we could think of. One day I came into school and the nurse informed me that until I had a clinic appointment she and the coach had decided to bench me. I was surprised and very upset, as we were actively working together trying to take care of the situation and this came out of nowhere.

I called my mom and let her know. My mom was also very upset and called the nurse to inform her that she thought this was inappropriate, as we had been working together and it was unacceptable to decide to bench me based upon my diabetes. My mom was able to reschedule my clinic appointment to the next day. When I informed my nurse practitioner of what had occurred she was amazed that someone would make this choice. She wrote a VERY clear letter to the nurse and my coach explaining that their decision was inappropriate and that if they had any questions in regards to my diabetes and treatment, they should contact her. I felt very grateful for her support and help.

The next day we had a night game and I was allowed to play based upon my visit to Joslin and the letter from my nurse practitioner. Our field hockey season ended last week and we as a team came in second in our district. I worked hard all season and love the sport of field hockey – although I must say it is a little worrisome for me to think that next year, I will more than likely have the same coaching staff. All I can do is try to educate others and help them understand what living with type 1 diabetes is like. I will not let anything stop me from pursuing my passions!

Insulin pumps help regulate blood sugar levels by reducing the instances of high and lows. Try a free Demo of the Omnipod insulin pump by clicking here.

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Posted by on Dec 4, 2014 in Diabetes Management, Lifestyle, Pump Therapy, School

A Caregiver’s Journey to Pump Therapy Part 5: Working with your Healthcare Professionals to Prep for an Insulin Pump

A Caregiver’s Journey to Pump Therapy Part 5: Working with your Healthcare Professionals to Prep for an Insulin Pump

How is the type 1 diabetes journey – from diagnosis, through starting on multiple daily injections, to beginning on an insulin pump and other milestones – viewed and managed from the caregiver perspective? Join D-Mom Leighann Calentine in this 6-part series as she discusses her experiences navigating the diabetes journey as a parent of a child with type 1 diabetes. 

Once we made the decision to start using an insulin pump and chose the Omnipod for our daughter, we began the process of working with healthcare professionals to make the transition from multiple daily injections.

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Talking to our Healthcare Provider about Starting an Insulin Pump

Our endocrinologist required a carb counting and correction assessment. The first of which was being educated on counting carbs. I felt like I could count carbs in my sleep, but I made an appointment with a dietitian to be educated again. The dietitian joked that I could probably teach the class myself.

Next we had to go to the monthly pump clinic at the endocrinology practice to begin a saline trial. The nurses trained us how to use the insulin pump as if we were actually using it. They helped us put the first Pod on her, but we would have to do it on our own in three days and again in another three days. They showed us how to check her blood sugar with the Personal Diabetes Manager (PDM), how to enter the number of carbs and how to begin a bolus. They also described the procedure for deactivating the Pod when it expired so that we could put the next one on.

During this Omnipod saline trial my daughter was still getting her regular daily insulin injections, which felt like we were doing double duty diabetes management during. Plus I had to keep good records, documenting all blood sugars and carbs and pump changes for the week.

The Benefits of Doing an Insulin Pump Trial

Although we had intellectually decided that we wanted our daughter to begin using an insulin pump, we needed to experience it to know for sure. I recall two exchanges that helped cement our decision.

My daughter and I were in the restroom after school. She and another girl were at the sinks. My daughter looked over at the girl’s wrist and said, “I like your bracelet. Look at all the colors. It’s fan-TAS-tic!”

As I reached down to snap her pants, I lifted her shirt. The other girl, seeing the Omnipod on my daughter’s tummy, asked what it was.

My daughter explained, “It’s a pump. Do you know what a pump does? It gives you medicine. I’m diabetic and I need insulin. But it’s pumping saline this week. Saline is a type of water.”

I was taken aback by her matter-of-fact-ness and with the accuracy and maturity of her explanation. Over and over throughout our saline trial she showed off her pump. She wanted to show anyone and everyone.

On the last day of our trial, I was at school during lunchtime. The substitute nurse that day, who must not have been familiar with patch pumps like the Omnipod, asked me about placement, rotating sites and getting kinks in the tubing. I said, “What tubing? The Omnipod doesn’t have tubing.”

I motioned my daughter over and asked her to reveal her tummy. My daughter asked the nurse what she thought of it, to which the nurse replied, “It’s magical!”

At the end of the week, we packed up the PDM and shipped it back to the endocrinology office. Having made our decision to begin insulin pumping with the Omnipod, we submitted it to insurance for approval. We were happy when we received the approval and were able to make an appointment for our pump start date.

Be sure to come back for the final installment of this series: how life has changed since starting on an insulin pump. And if you haven’t already, take a look at the first four posts of this series here.

To help with your decision in starting an insulin pump, you can order a free Demo of the OmniPod.

 

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Posted by on Jun 5, 2014 in Diabetes Management, Diet and Nutrition, Lifestyle, School

Managing Middle School with Diabetes:  Handling Lunchtime with My Insulin Pump

Managing Middle School with Diabetes: Handling Lunchtime with My Insulin Pump

Peanut butter and jelly or a turkey sandwich? That is the lunch choice most middle school kids have as they look in their lunch bag each day in the cafeteria. At my middle school in New York City, we go out to lunch every day. My choices are more along the lines of sushi, pizza, deli food or hamburgers. I love getting a break in the middle of the day and walking over with my friends to the local sushi restaurant and sharing California rolls, miso soup and shrimp shumai. And of course, the chopsticks make great hair clips – just use them before you eat with them!

Having type 1 diabetes adds another layer of consideration to my lunch plans.

On days I have track after school, I try to eat something with more carbs, like pizza. On days when I am just hanging out at the local ceating-lunch-at-school-with-diabetes-225x400offee shop after school, I will try to eat something lighter like a salad at the diner. And of course, sometimes I just end up where all my friends are and I have to try to make the right choice quickly.

Inconveniences Eating Lunch with Multiple Daily Injections

When I was first diagnosed with type 1 diabetes, I had to go to the nurse before lunch, then test my blood sugar and then she would give me my insulin injection. I hated doing that because I never really knew what I was going to eat before I got outside, so there was so much guesswork involved. Often, I would end up with a high or low blood sugar and I was scrambling to catch up with my friends.

Flexibility with an Insulin Pump

Once I started the Omnipod insulin pump, eating lunch at school became so much easier. Now I can wait to see where we are eating, test my blood sugar and quickly bolus for whatever I am having that day for lunch. If I want to eat a little more (hmmm, are you eating that last dumpling?) I can just bolus again on my Personal Diabetes Manager (PDM) and it is no big deal. Most of my friends are not even aware of what I am doing.

Sometimes I think it would be easier to eat lunch from my mom in a school cafeteria, because I would not have to worry about carb counting or making sensible choices. However, as soon as I walk along First Avenue to my favorite sushi place or the best pizza shop ever, I am so happy to be in NYC and have the Omnipod insulin pump to help me out!

The Omnipod insulin pump gives flexibility when eating different meals at restaurants, discretion for bolusing and precision for insulin dosing. Click here to order a FREE Demo.

 

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