In episode 2 of Dia-Logue: The Diapoint Podcast, Pam Durant, and Sara Adhami, Dubai-Based Certified Diabetes Educator & Accredited Practicing Dietician, talk about preparing for and managing diabetes at school. Sarah walks us through what should be in a Diabetes Medical Management Plan, and how to navigate food and carb counting while at school.
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Sara Adhami is an Australian Accredited Practising Dietitian (APD) and Credentialled Diabetes Educator (CDE) currently working at Mediclinic City Hospital – DUBAI.
In 2005, she began her career as an APD and advanced over 12 years working in both clinical and private practice settings during which she also studied further and became a CDE. Her experience included adult type 1 and type 2 diabetes care and gestational diabetes whereby she covered out-patient clinics and ran diabetes group education sessions to help reduce waiting times for those newly diagnosed with type 2 and gestational diabetes. Her research interests have been in the area of first trimester weight gain in women who developed gestational diabetes. After moving to Dubai in 2016, her experience furthered to include diabetes care in the pediatric population. This coincided with the increase in use of the Continuous and Flash glucose monitoring which has been an opportunity for research that she participated in to compare the 90 day CGM hba1c prediction to the laboratory Hba1c. In 2019, the abstract submission for the study got her selected as part of the ISPAD 2019 Science School which has been a motivator for further research to explore the impact that structured education can have on metabolic outcomes and Time in Range (TIR) for youth living with type 1 diabetes. She is passionate about diabetes education that is patient centered and the use of diabetes technologies to help guide education and diabetes care.
Follow Sara on Instagram @diabetes.simplified_bysaraa
Episode 02: Managing Diabetes At School, with Sara Adhami
Part 2 of this discussion is here.
Pam 0:05
So before we get into more discussions around health and lifestyle and wellness and food nutrition, which we all love to talk about, I want to take this time because for many people in the world, August and September is back to school time, that’s when we start sending our kids back to school, we have to either buy uniforms or new clothes, because they’ve grown over the summer, new shoes, and new notebooks and all those things. But when you have a child with Type One Diabetes, it becomes a whole different kinds of preparation. I think probably the most terrifying thing that I had to do, after getting a diagnosis and learning everything that I needed to learn about diabetes was to send my child to school, and let someone else care for him, especially in the earlier years when he was very small and young in preschool, and primary school. And when I was still learning about it.
So back in 2020, we had a event prepared, where we’re going to have a picnic. And then we all know what happened in 2020, with COVID, and we went into lockdown. But I still wanted to have this event. So we did it virtually. And it was a series of interviews and discussions and different topics throughout a week, later in the year. And one of those was with Sarah Adhami, who is a excellent certified diabetes educator and an accredited practising dietitian. And she supports people with diabetes all day every day, and has become quite an expert in this area. So last year about this time, her and I had a very lengthy discussion about preparations and all the challenges and what it takes to send a child to school with diabetes. So I thought it would be relevant to share that here for those that need it. And the the discussion was so long, not because it’s so difficult, but because there is so much to think about and and discussing it with Sarah was such a pleasure that I’ve split this up into two episodes. So in this first episode, we’re going to talk about diabetes, medical management plans, lunch and snacks and food and how to count carbs during your child’s time at school. And there’s a lot of good suggestions and tips and tricks in here. So I hope that you’ll take the time to listen to it. And then when we get to part two there we talk a little bit more about the special situations.
Okay. Hello, everyone. Good afternoon. Thank you so much for joining us. In today’s discussion and the Diapoint Virtual Picnic, we will be talking about diabetes at school. I am Pamela Durant, the Founder and Managing Director of DiapointMe. And diabetes at school is a very personal topic. As the parent of a child with Type One Diabetes after diagnosis, my biggest concern was how am I going to send my child to school, he was only 20 months old. So I was working full time and he was going to nursery and finding my way around that. And then when he went off to big boys school, as we called it was it was a huge step. So it’s something that was not easy to do. And I’m super happy that you all are here today. And before I introduce our guests, I actually want to share with you just before the call, I’ve been working on different things. And I looked at my WhatsApp to see if there was anything I needed to respond to. And I had over 80 messages in my son’s school whatsapp group. I don’t know how many parents are in there. But this is only for the grade that he is in. And I actually went back and counted and 30 minutes ago, there were 82 messages. And there’s been more coming in since that time. All of the messages are about where to buy paper, where to get folders and notebooks. A couple are about you know, that’s the start times and staggered start times. There’s nothing about COVID it’s all about school supplies. And even though this will be the 11th year my child is going to a school with diabetes, my heart still sinks. It’s not easy to do. And nobody can understand the challenges that you’re facing, until you actually have to face it. Now I’m not you know, upset or angry at those parents and I understand why it’s a concern. You want your child to be ready. You want them to have school supplies. We want that for our children also, but we want them to also not have to worry as much about their day to day diabetes management. We want it to go smoothly and facilitated as much as possible. So that’s why we are all here today. And it’s such an important topic. So so thank you for joining us. And a special thank you to our guests Sarah Adhami, I say guests, but she’s She’s one of us. She’s an accredited practising dietitian. She’s a credential diabetes educator. She has more than 10 years of experience in this area. And she’s worked in both Australia and Dubai, some of you may actually know her. And she’s passionate about diabetes education that’s patient centred, and the use of diabetes technology to help guide education and diabetes care. In her current position, she works as the diabetes educator in Dubai, the medic clinic hospital, and she is a key touch point for families, when they’re getting their child ready to go to school with diabetes. She is one of the key people that helps her patients develop their diabetes medical management plan for school. So she has also extensive experience in this area from the clinical side. So that’s why I’m super happy. She’s here to talk to us about this today to share also her expertise and insight. So welcome, Sarah, thank you so much for joining us.
Sarah 5:55
Thanks, Pam, I really appreciate the introduction. And it’s a pleasure to support this cause. And, look, I think the more awareness you raise, the more you advocate for diabetes, especially type one diabetes, the more people will accept, the more action you can take into place and you’re speaking so much about just from the from the government authorities point of views, like you know, just inclusion and the importance that children no matter who they are, and what they have, they should have the Equal Rights, on education like all other children, they should be able to participate in all forms of learning and activity and sports and camps and excursions, etc. And for this, this conversation is important, I think it is something that every parent needs to take a proactive approach in. And so yeah, today, I’m happy to sort of go through all the nitty gritty with you.
Pam 6:49
Thank you so much. So very loosely, to give you an idea what we’re going to be talking about, we’re going to talk about planning why it’s important, we’re going to talk about the plan that you need to take to school for your child’s medical plan, and how we might manage the day to day some tips, tricks, thoughts, ideas, and how to deal with some special situations. Because diabetes, No two days are ever alike. No two children are ever alike. And no two days of school are ever alike either. So there’s a lot of things that can come up that might make you change your your routine, sometimes plan sometimes not planned. So without further ado, intro Why do we plan, I just want to say a couple things about planning. One of the reasons we plan in anything in life is to mitigate risk. That is not necessarily risk that something bad is going to happen, but risk that things will not go as we expect them to. And with diabetes, everyone here knows that no matter how much we plan, things still may not go as we would like them to. But the more that we plan, the better chance we have of things going well and the better chance to win, they don’t go well that we will have action plans in place and be able to kind of follow up on on the various things. So decrease your risks for the year. Also, it opens the door for communication immediately with the team that you’ll be working with in the school. And you’ll learn about your child’s rights. Legally, we’re no matter where in the world you’re living in, in most developed countries, children with diabetes do have rights. And that’s important wherever you’re living, that you become familiar with those and at least know what they are and where to find them. And as I mentioned before, we just want our child’s ear to go smoothly. So it really supports us in helping our child. And the first step in the planning process is going to meet with your physician or your diabetes educator and talking to them about the diabetes medical management plan. And so I’m going to turn it over to Sarah. So she can take us through what is included in that this is something you want to do before you get to school. And it’s really important to sit down and do it face to face, especially if your child’s newly diagnosed. After a few years when I felt a little more confident with it. What I would do is take the draft of last year’s plan. And I would write in my thoughts what I thought might work and might not work and then I would take it to my doctor and I still do that. And I have him review it. And then we talk about it. So Sarah, can you please walk us through this very lengthy document that we should have?
Sarah 9:33
Okay. So, first of all, I think you know, it is so important to have it when you think about how many hours in a day your child spends at school, they spend, you know, a good eight hours or so of the day at school. It’s a big chunk of their lives that is spent in a facility that’s away from their home, and they’re potentially in the care of people other than yourselves. And of course you as the parents you always feel like you’re the best person to look up to your child, but you know, you have to let go to them to grow and, and get educated, they need to get out. I mean, now we’re living in COVID times, and yes, some people are choosing to keep their kids at home. And I’m sure, if I were a parent with a child with Type One Diabetes, to get the COVID part, just having them near me and being able to know exactly what they’re eating, and I’m going to decide on the doses and I’m going to decide on the corrections and all the rest of that, then, of course, it’s a relief, because there’s less that you have to leave in the capable hands or hopefully the capable hands of a nurse or somebody else in the classroom. But going back to the template, so it is generally a template we start off with, it’s approximately seven to eight pages, it can be longer, but it really is basically an agreement between you, as the parent of the child with diabetes and your healthcare team on how your child is managed. So it’ll it’ll go through the obviously type one diabetes, the types of insulin that they take where the injections are usually given it, I’ll usually specify that the long acting insulin is given at home, I may specify whether it’s given at night or, or in the morning. And I usually will specify how many injections potentially may be required during the school hours of the fast acting insulin, then we have the date of when it’s been done and review as needed. So the review of the care plan or the school plan can happen. As insulins change or as anything specific in the school plan needs changing. So it’s an need to be sort of basis, then you go into understanding hyperglycemia. And I think one of the scariest things about sending your child to school with diabetes is how they’re going to be managed. If they have hyperglycemia. Before even the treatment is, you know, raising awareness about what can cause hyperglycemia, what are the symptoms that your child may be experiencing. And so there will be about a half a page there on just the causes, the symptoms, and then you’ve got also the management. So step by step on what needs to be given. Now if you’re sitting with me, I can be specific to write down what you prefer to give as a fast acting carbohydrate to treat the hyperglycemia. I can also be writing the specific symptoms, your child experiences, when they have high progressing, I can highlight them. So that way, if a child looks like they look like very tired and sleepy or pale, this is something that we can highlight as the signs that your child could potentially behave in a court, of course back to you to go through these symptoms with the the main class teachers or PE teachers or nurses. So that way, if a teacher is in the classroom, she sees something in your child that could potentially indicate hyperglycemia, she may just, you know, quietly pull them to the side and say, you know, they’re wearing a glucose monitor, or they’re not sure just get them to check their glucose levels, because she’s aware of what could potentially be causing hyperglycemia. And this is especially important for the younger children who may not be able to express their feelings or they’re too shy, they’ve, they haven’t had diabetes for a very long time. So they’re just not sure how to deal with it. So the hyperglycemia. And then we also have the section on what to do in an emergency case of hyperglycemia. And again, I, I asked the parents, whether they are sending a glycogen pen to school and keeping an up to date one in the school, I do personally feel that it’s better to include the use of a glycogen pen, in the case of an unconscious hypo, where the child is unable to swallow and taking a fast acting glucose, of course, then followed up by calling the ambulance and the parents. I would say most parents agree to put that in the school plan, but it is it is up to you. And then we go into the glucose monitoring. So how is the glucose being monitored in the school? And what is the child able to do by themselves. And that’s a really important point, that you need to be able to show the capabilities of the child, what they can do, what they’re independent doing and what they need supervision with or even assistance with. So when it comes to glucose monitoring, are they able to check their glucose levels on their own? Are they using a glucose monitor? Will they need to have a smartphone with them? All these things need to be indicated in the in the school plan. And then from there, we have the injection time. So when do they usually get an injection? So whether it’s at snack time, or just at lunchtime? When do we give corrections should that be at the snack time as well as the lunchtime. And of course, if they’re on flexible dosing, then you attach the dosing chart so it’s referred back to the dosing chart that they may have. So they the nurse is not confused about how much insulin to give. Then you also have the PE section. So what is the safe level for your child to participate in PE and so they need to be again checking their glucose level before that. So it’s an indicator for the teacher to remind the child to check the glucose level and what is the safe level and the snacks that can be provided, which, of course, is the responsibility of parent to keep providing those snacks and topping up those snacks in the child’s bag. And then the roles and responsibilities of the school parent, the healthcare professional, it needs to be signed by all three parties. So it needs to be first signed by the healthcare team and the parents. So obviously, once we discuss it together, I sign that they sign that they then take it to the school, you need to sit down with the principal or the main class teacher or teachers, the nurse, the PE, whoever, the more I think you get involved with the school, teachers and staff, the better it is, I think, and then get a signature on board there so that it’s agreed. So it may not have every single thing clear to the nurse or the teacher but it’s a good starting point. It’s your it’s your it’s your go to portal for reference for the nursing staff or the teachers. It’s your education point where you can start educating, of course you can add on from that you can we can add instructions on how to give glucagon we can add instructions on incorrect insulin injection techniques. So as needed, where the staff need extra support, we’re happy to provide that support. I know parents that have given PowerPoint presentations beforehand in conjunction with the school plan. So it really is up to you. How much further you want to go from there. But I think just to have that document in the beginning, just formalises things and has all the information there for you. Sorry, I ran by No, no,
Pam 16:38
no, that this this is diabetes. And this is how the plan is and it feels like it’s so much information. So thank you, that was an amazing overview. And I am one of those parents that gives a PowerPoint presentation I always have. And because of all these documents and everything that I do, I actually that’s why I created an online course. And the presentation that I give is in there. The reason I give a presentation is because it helps me remember everything that I need to talk about. Because I’m sure if I go in there without anything, I’m gonna forget something. And it’s much more appealing to look at then the document, that’s the medical management plan, what I do is, and you can do it any, there’s many ways to do it. And this year, also with COVID, I’m really not doing it the way that I usually do a couple reasons. One, my son is older, and I know that you know, the school he goes to is very well prepared, and they’ve had other type ones and, and he can manage himself. But usually what I would do is I reached out to the school health office and I asked them, because we don’t always know who the teachers are right away, I asked them to please call a meeting and a time convenient for everyone with the health office and the teachers. And then that’s when I would go through the presentation about what diabetes is just very basic, the difference between type one type two, what are Why does type one happen? What are the symptoms in my child for high blood sugar, low blood sugar, and what needs to happen. And that also helps the health office communicate with the teacher so that teachers know how to, you know call the nurse or what to do if they need to, because sometimes those are not things that are really discussed, because you know, there’s only maybe one or two type ones in the school. So it’s not a question that a teacher would be used to asking, but it does give them something to think about and fosters that communication. So having an a presentation is a very high level brief form. Then with the nurse in the health office or nurses, I go into the details of the diabetes medical management plan, the teacher is not going to really be worried about the dosing here. You know, if you’re in a country where the teachers are giving injections and making those dosing decisions, then for sure you want them involved in that discussion. But for the details that I’ve talked about with my doctor and diabetes team, I go through that with the school health office. And as Sarah pointed out, it is not set in stone. Usually after two or three weeks, sometimes I noticed doses have to change because it’s a new schedule for everybody and the way their little bodies are behaving to the new the new programme. Sometimes the doses are different than what we expected. So we’ll go back we’ll update it or you know, I make a change in the document glucogan, everybody needs it. As parents we all need to know how to use it for sure. And I do have a glucagon, glucagon. glucagon I’m not sure which one they have here glycogen in my son’s school, and I teach the health office how to use it. It’s scary. I’ve had to use it twice. Not at school but at home. And I keep my expired once and I take that to me.
Sarah 19:55
Give them to me, I’m like you. I
Pam 19:57
you want to I got I got I got so well. No you
Sarah 20:00
They’re a great education
Pam 20:00
Yes, they are, I have some I’ll give you I give some to the school and I still have some, because unfortunately you don’t use them.
Sarah 20:10
I hope they explain, exactly. You want them to expire.
Pam 20:14
So what I do is I take an expired one to the school and show the nurses, this is what it is, this is how it works. Now could I have done that really, you know, kind of the first year I did, but I was not really confident in talking about it. But it’s important because they themselves, even though they’re nurses, they have medical training, their training very general, you know, in very general terms, they don’t come with the background that their diabetes educators, and they know all of this. So sometimes we learn together, and that’s okay, too. So those are just some some things that I wanted to say are super important that Sarah pointed out.
Sarah 20:51
And I also add, can I also add that I know that so many of you have regular phone calls with the nurse, and many would say, Oh, they just call me at break time or at lunchtime, and I told them how much to give. So, I mean, most people I know do have a school plan. But I’ve met like newer patients who haven’t had a school plan set to school. And so I just feel like especially if they’re newer to having diabetes, rather than just saying to the nurse, just call me, I think having that documented and having that information there. And going through a little bit of the background education just gives reassurance to the nurse, this reassurance to the school. And that’s less likely for them to sort of, we’ve heard stories of how schools get scared of having children with type one diabetes, and they might feel they might feel overwhelmed about all the different steps that are involved in looking after your child. But I think when you show them that, you know, these are the main areas that need to be focused on these are the main times of the day that I want my child to come to the nurse, I’m happy to be available over the phone, but you have a reference point for potential treatment of hyperglycemia. It’s there, it’s documented and time after time, it gets easier and easier. And I think it just sets up a much better foundation for you as the parent and creates a better environment for your child that they’re not stressed or anxious or you’re not stressed or anxious about your child going to school.
Pam 22:18
That’s that’s really good advice. My my son’s nursery, they used to call and I got really used to that. And you know where I was working at the time too. At first they thought it was a little crazy. But you know, they just got used to it. You’re just rattling off all of these numbers. When we transitioned into primary school, they’re like, nope, we’re not going to call you. I was like what your What do you mean, you’re not going to call me. But and that was a lot of control to let go of. And I think a lot of people, you know, now my son didn’t have a CGM back that back then. And he has one that I’m not able to see on the shared app. A lot of people a lot of parents can see, you know, through the app, what’s happening. And if you want to share that with the nurse, that’s also a lot of people find that helpful. So you can watch you know, as a parent, and I understand when they’re smaller, and when especially also new diagnose, you may want to do that for a short time. But the social benefits of letting go dare I say when when the time is right? Not Not everyone, there’s no set formula that like after two weeks, you must let go and let them do it. There’s no set time. It takes a lot to learn about diabetes. Like I said, even for some of the school nurses and there might be some things after some time you go back and you re educate on. But there’s a lot to be said also for the social aspect of this and the time that if your nurse your school nurse is educated well enough, and she’s following your directives and the child’s diabetes medical management plan correctly, then that child will be back to his classroom or wherever his classmates are as quickly as possible. Adding the phone call even though it seems quick, it adds to that time and for for my from my experience for my son, the biggest challenge was not, not the diabetes care. It was the fear of missing out on what his peers were doing. That was the hardest part. So we came up with a way where you know before an activity he loved before when he was very small before music day Miss Fran would come in with her guitar and they would sing and before Miss Fran came, they make sure they check his blood sugar because otherwise it’d be too late and you know, these little kind of workarounds so that your child feels like this is not interfering with their daily life. And that sets them up for success in the future when they’re ready to start taking over it themselves. So I think we’ve kind of exhausted the the medical management plan but for sure any questions, put them in the chat and we’ll be happy to answer So now that you have your once you have your plan and you met with the school, and then you’re ready to go, and the first day of school comes, then you’ve got to start managing your day today. What do you do? So, Sarah, I’ve got the way I do it. But I think it’s good to hear from the way you do it, because the way I do it, it’s probably you know, it’s definitely not perfect. It’s worked for me. But what what do you do? Well? Well, amazing comments.
Sarah 25:28
Well, I’m just thinking of lunchboxes. And I know how much I hate doing school lunch boxes, but we have to do them and we have to feed our kids, right? And there is that added step for all you parents out there of knowing what you’re packing into your child’s lunchbox, and how they’re going to get the insulin, how’s it going to work? How’s it going to be calculated, etc. So it really, I mean, as much as we can be as detailed as possible in the school plan, I really dislike when I get some of the school school plans, because some of them have their own templates. And they ask them and the parents will say to me, can you fill this in for the school? And I’ll be like, well, I could fill it in. But we also have our own template, and I’ll have a look at it anyway. And I look at it and it will say what will the child be eating for break and food lunch? Now come on? How can we be knowing every day what the child is going to be eating? Are we going to be giving this child a regimented same thing every day with there’s no flexibility. And I’m sorry, that’s not the way we educate and we help our families we help them to be flexible, we help the child to be able to eat the portions and it might vary. They may go from eating a 45 gramme carbohydrate, lunch to a 60 gramme carbohydrate lunch or a 75 carbohydrate lunch, it can vary from day to day, depending on what the parent has, and what they’re packing what the child may have requested, or whatever it is. So no, I mean, I can’t write down. But what I what I do encourage parents to do is to label the food. So that’s going to be a day to day thing you know, where you have to be packing the lunchbox, I do, say to make it easier to have a separate container for first break if it’s smaller break, and labelled that as first break and a second container, which would be for the lunch break. And every item in there is labelled, then the child will go to the nurse the foods will be taken out what they’re going to be eating, and the child is usually I mean, the parents understand the appetite the child has established and put into a routine which I’m a big advocate of routine and establishing sort of knowing your child’s appetite and what they tend to eat. So you don’t want to be unrealistic and pack 80 grammes of carbohydrate for lunch for your for your transit, or half of it comes back and like Well, probably because 80 grammes of carbohydrate for lunch for your talk was too much to begin with. So don’t overpack it, don’t unpack it, try and understand what is the usual routine. And I usually say use that the week leading up to school to get into that time routine, like a similar sort of waking up time for breakfast, then you have the snack, then you have the lunch so that you can see, well, you know, how much carbohydrate do they tend to be eating and then pack that amount, label it, they go to the nurse in the beginning, you may want that phone call to happen, you know where the nurse goes, look, they’re gonna have their banana. And they’re going to have, you know, just that, for example, they’re going to have their cucumber and carrots with some cherry tomatoes and some blueberries. And you’ve labelled it all up as 10 grands, for example. That’s it done. And lunchtime comes you know, they’ve picked up their sandwich and the yoga and their fruit, and if they’re going to have that and so they follow the dosing chart that you have, and they know how much insulin to be administered. So, labelling food, I think is a big one, not just depending on the phone call, but you just never know, if you get held up you don’t get the phone call, they don’t call you at least there’s some information and of course going through the kit, the school plan with the dosing chart, the nurses still aware of what to do in an emergency situation with the parents not answering and the child needs to have their lunch and you know, it’s they’re more confident in knowing what to do rather than being completely in the dark and just depending on the parent to tell them what to take and not knowing why they taking what they’re taking.
Pam 29:10
Those are such good advice that that yes because sometimes you know maybe you went to the washroom and your phone was on the desk and you missed the call and then your child will end up having to wait for them to find you or you to come back to your desk and then again that fear of missing out so that’s that’s really good advice post-its are like the best friend for labelling. And it does help for with the carb counting and for small children and helps the nurse they don’t have to look it up. But what I found also now that my son does his own dosing and his own bolusing he’s on an insulin pump is this label is there for him. He doesn’t need anyone to oversee his his dosing
Sarah 29:51
and you want your son to transition into that phase.
Pam 29:54
Exactly. And sometimes they would fall off but always having everything labelled teaches your child, how many carbohydrates is in something that they like to eat? And my son, you know, my brain is old and full of probably useless information. Now, his is young and fresh. And he’s like, no, Mom, it’s this many carbs. And I’m like, are you sure he knows, he knows the food and carbs. And even now he’s at a point where he can sometimes eyeball a portion and get it really, really accurate. So it’s an educational tool at the same time. So yeah, we did the same separate, separate snacks, separate lunch and everything was labelled. We also sent a notebook back and forth to school. And I started with just plain paper notebook, it would fall apart by the end of the year. And then I decided about two years ago, to create a notebook that I call the diabetes school journal. Actually, I have one,
Sarah 30:48
I’ve got one here to!
Pam 30:49
Oh you have one? hey!
Sarah 30:52
I think it’s fantastic, I think it’s a fabulous diary.
Pam 30:55
So I’m going to talk about this because this is just the outline, whatever you use is fine. And I also want to say that in times of COVID, and I think it’s, you know, not just from the school perspective, but from the government perspective, they don’t want so much paper going back and forth and being exchanged. So you need to speak to your health office about what they’re allowed per school guidelines to take back and forth. Now, this is quite medical, and it is important that you have it written down somewhere, maybe you want to get a journal, and you want to leave it in the health office, actually, Sarah gave me this idea, leave it in the health office, and have the health office, scan it to you and send it to you at the end of the day. So you can see what happened in your child’s care. It is so so very important that that is documented somewhere.
I think the, having a CGM and seeing the number is one thing. But you also want to document why the number may have gone up or may have gone down? Did Did someone, you know did a someone in the health office misunderstand the directives and they’re not giving the correct amount of insulin, for some reason? Are they forgetting to do it? Are they overwhelmed and can’t follow up? Are you know, if your child’s involved in the in the care? Is there something there that they need to be re-educated? So this will help you understand trends? and things that are that are happening and what’s going on?
Sarah 32:19
Pam?
Pam 32:19
yes, no, no, no, you go ahead, go ahead.
Sarah 32:21
I was just gonna say if you’ve got so many like right tabs in this page with where so much communication can be added in. So not just can you write down what the child ended up eating for the morning snack, how much carbohydrate was counted, what the glucose level was before and how much insulin was given. You can also write down if there was correction doses given. So if you add up that this child needed an extra one unit of correction at lunchtime, and this is being tracked day after day after day, this is really important information for me. So when I am following up, and I’m noticing that you’re you’re you as the parent is saying to me, based on the notebook that we have, you know, they’re requiring a correction every day at snack time. Well, I know breakfast is a problem, there could be there could be not enough insulin given at breakfast breakfast, so your child is coming to school with really high glucose levels. And by the time First Snack comes around their sugars are really high. And you’ve indicated in the school plan that you want them to get a correction at snack time. So the nurse comes, collects the child at lunch, a snack time, the child’s gonna have this snack, but the glucose levels high and based on the on the chart they require. So if that happens, you know, once in a blue mood, it’s a different story, but if it’s a regular pattern that’s occurring, then maybe the carb ratio needs to be changed at breakfast.
Pam 33:44
Yes, and that is one of the many reasons why I write down breakfast. While breakfast happens at home and not at school. It is important because those of you that have been doing this, you know, for a while we know, that what happens at breakfast kind of sets the course for the day. And if the blood sugar’s high, it’s really hard to get get it down. And I always found that giving my nurse notes of just like, hey, he woke up this morning on the low side, or he woke up on the high side, he’s had a lot of insulin this morning. So you might want to ease back on the snack dose, you know, so we can have that conversation and if I don’t see her, because you know, they do have hundreds of other students to deal with. So I may not have seen her in the morning, but at least the notes are there so that she can see it. And I’ve highlighted this, this journal is not dated, so you can use it anytime. And I’ve highlighted where in black are the things that the parents write down and the green fields is where the nurse tries to step down. And what as a parent you need to write what the planned carbohydrates are that they’re going to eat, and how you know the plan food how many carbohydrates and then the nurse especially for small children can go and write what is eaten. Now this journal is really designed for younger children. Not necessarily those that are, you know, doing their own care and high school kids, certainly not. They’re they’re not really you know, going to go into….
Sarah 35:07
Sorry Pam, the 16 year old boy didn’t like the idea of it yesterday.
Pam 35:10
Yeah, no, I know. Yeah, they won’t. And you know, even my son’s kind of like, but but when my son was younger, he loved this, my son actually chose the design for this. So it’s kid friendly. He chose it, there’s also space for lunch. And then if they do after school activities, if there’s anything or PE day, then you know, and my my driving reason for this. So before years ago, I worked in hospital management, I was involved in quality management and hospital accreditations. And when we got to the medical record review, my favourite quote that I will never forget, was, if you didn’t write it down, it didn’t happen. And Sarah, working in a hospital may have heard this before, but this is like from someone in Joint Commission themselves. And I thought, isn’t that so true? Because if it’s not written down, and then you need to go back and find the history of why someone made a decision about your child’s care that yeah, that that you didn’t agree with, you need to you need to really know why. And you know, God forbid, if there’s a time when you really disagree with what was happening, then you you need that documentation for support. So it’s super important. I’m not saying you have to use the journal, it’s already formatted for you. But a regular notebook will work just fine as well. But just try to get them to write it down. I know one parent, she’s she uses a spreadsheet, they have an Excel shared document, she’s a statistician whiz. And so they do you know, they do that. So do what works for you find something that that works for you and the school and and go with it. But whatever it is, you know, make sure that you’re getting it documented that just
Sarah 36:58
that just to go back to the day to day things. I mean, again, what you’ve got on that day to day page, that’s I mean, that’s what you’ve done, you’ve done a whole diary of day to day, and you’ve outlined in that on each page, basically everything that will need to be done on a day to day basis. So the glucose levels, the carbohydrates, the insulin doses, what happens in during PE are they being checked is the glucose level being checked, what are the snacks that are consumed, everything can potentially be documented on that page. And it, you don’t have to collect all of that information every day, if it’s too overwhelming, or maybe your most important part is just the snack and lunchtime, you know, and potentially the PE, so you don’t have to be like, oh, every single section needs to be filled in I know
Pam 37:46
No. Yeah, some days, it will be helpful. Other days, there may have been some days where it was crazy, and it’ll be more full. And the nurse will have a lot, a lot of notes to write. And nurses are trained to document when they go to school, they are taught about medical documentation. So this kind of speaks to, to their profession as well. And there’s also space at the end of each week at the end of each five days, where you can go back and write notes and observations. And sometimes I’ll admit, sometimes at the end of the week, it is hard, you’re exhausted, you are like full of diabetes, you’re making lunches and snacks and labelling it and doing it all. And sometimes you need a break. But especially when the year starts, I find going to the end of the week. And there’s that empty page for notes. And a lot of us, you know, if you’re using a CGM or a pump, you can download all this data. But what I do is I make a very simple graph for the five days and I just draw the lines of my son’s blood sugar, maybe not even charting it to the exact number. And I line them up, kind of a geek. But I line them up and I look at the trend. And if I see a spike after the snack, then I know that maybe the insulin might need to change after the snack and that’s something I’m like, asking my doctor. So what do you think about this effort?
Sarah 39:07
Do you prefer your graph over the Care Link graph? Do you Pam? (Editors Note: Care Link is the disease management program used by Medtronic insulin pumps. This is the place where all the user information and analysis is stored.)
Pam 39:10
Well, okay, currently, you know, it’s so funny. I was just kind of speaking with them this morning. And I said, Yeah, I would take a training on the Care Link. But because I’m a Mac user, also I struggled to upload it as much as I should. I love I love all that data, but it’s overwhelming sometimes. So just as a quick and I also like paper I love paper. I when I when I write so so there’s that. But again, whatever you use is is great. And then also if your child is older, and they’re participating in after school sports or some kind of activity, or sometimes on PE days you might want to put an extra snack in there because they may need it depending on what time of day that is.
Sarah 39:54
So can I just add on also about the older children. Again, just just touching on my conversation from With my 16 year old boy that I saw yesterday, and he, you know, he’s had diabetes for a number of years, and his school never asked for a care plan. So, you know, I was asking him, you know, is that something you want? And he’s like, I don’t know. And I’m like, look, it’s you know, we’re just discussing the benefits of it. And I said, so how do you get insulin? Because I just, I just get to the nurse’s office and I just dial up the dose, I show it to her and I, and I take it I’m like, Okay, well, let’s you go into the nurse’s office number one, she’s, she’s observing that you’ve taken insulin. She’s seeing how much you’ve taken. She’s, and she’s an algo? Is she documenting it? And he said to me, yes, she’s I got All right. Well, that’s, that’s fine. She’s documenting it. You know, he’s, he’s engaged in his diabetes care. He’s wearing a CGM. He has his regular follow ups. So you know, he’s, he’s safe enough, I’d say. And, you know, teenagers were definitely, definitely the most difficult age group to deal with. And so we have to always be a little bit more open minded, and how we listen to them and really take their opinions on how they want to self manage,
Pam 40:58
that is so important. Like when my son, and I didn’t, I felt he wouldn’t need to carry something back and forth to the school, he goes to now. And they do have their own documentation system. So they document everything. And I asked him, I said, Do you think you need this? Do you want to do it? And he’s like, No, you know, so I do definitely listen to him. And I take his his advice, unless, of course, it’s something that’s going to affect his safety, his immediate safety, then for sure, I’m going to step in as his parent. But they always say they don’t have a lot of choices when it comes to type one. So when it comes to like, the kind of CGM that they want to use, you know, if your insurance,
Sarah 41:36
do they want alarms, do they not want alarms?
Pam 41:39
That Yeah, exactly that kind of stuff, then I try to be really, you know, open to that, and I let him choose. Um, so that’s kind of like most of the data, the day to day is mostly around the food and getting the doses and everything.
That was a lot of information I know and a lot to take in. Thank you for listening. And if you have a child with type one diabetes, and you’re sending them to school this year, especially if it’s your first time, it is a little bit scary, a little bit challenging, both socially, emotionally, and also the physical side as well. So I do wish you a lot of luck with it. But please refer back to this podcast at any time that you need it or feel free to send us an email if you have any questions. And always, always ask your doctor and your health care team. Follow up with them if you have any questions at all, because Diapoint we are not here to give you medical advice. But we are here to talk about topics and subjects that help you understand the questions that maybe you want to ask your doctor. So if you have any questions about what we discussed today, please take those back to your diabetes team as well. And I hope that you’ll be around for next week because that is where we get to more of the juicy bits of how to manage parties at school we talk about after school activities and school trips, and if your child’s on a bus and all kinds of different things that that you would never even think might be affected by diabetes. But actually diabetes can come into play because diabetes is all day every day. So I look forward to seeing you at next week’s episode where we talk about special situations in school. Thanks for joining.
Show Notes and Links
Disclaimer: It should go without saying that the Diapoint podcast is not intended as or should not be used as personal medical advice. You will hear us interview medical experts and others, but please always always ask your qualified doctor, diabetes team or other expert about your health. What works for one person does not always work for another person. What you should always do when you discover any new health information is ask YOUR doctor about it. This information should empower you to have a discussion with your healthcare providers about it. Diapoint, our guests, sponsors and business partners are not here to replace that advice. Living a full, healthy life means taking the proper medical advice from your qualified physicians, diabetes team or other healthcare providers.
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Today’s episode has been brought to you by My Diabetes School Journal. My Diabetes School Journal is formatted to take the guesswork out of documenting carbohydrates, insulin doses and other things while your child is at school, you will speak with your school nurse and teacher daily about your child’s diabetes. In addition to your verbal communication, documentation of daily discussions and treatment are so important. Each page has a dedicated space for parents and school caretakers to document the day, including a space for snacks, lunch school activities, as well as an area for additional notes of things that happen throughout the day. It also includes pages for weekly reflection and review. This nine-month, five-day week journal is not dated so you can start using it any time of the year in any school system in the world. It’s recommended for the management of Type 1 Diabetes in nursery elementary and primary school aged children. The interior pages are designed to match the colourful motivating exterior and it was also selected by a child with Type One Diabetes himself.
This episode is also brought to you by The Ultimate T1D School Game Plan, the online course for parents of school children with Type 1 Diabetes. We have it on sale now for just $17 in our back to school special offer. The Ultimate T1D School Game Plan is a video-based, self-paced online course for parents and caretakers of school children with Type 1 Diabetes. It was created by the Founder and Managing Director of DiapointME with her extensive knowledge gained from her professional background in international Healthcare Management, as well as the firsthand experiences she had in caring for her own son, who has had Type 1 Diabetes for more than 11 years now. In this online modular program, you will learn about planning the day to day management, special situations and get special links and tips for resources that will also help you along the way. You can enrol now at diapointlearning.com or at diapointshop.com
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About Dia-Logue: The Diapoint Podcast and Pamela Durant
Here at Dia-logue: The Diapoint Podcast, we talk to experts and people living with diabetes about social situations, nutrition, mental health, travel, and many other topics related to health and wellness.
The Founder & Managing Director of Diapoint, Pam Durant, shares her experience as the mother a teenage son who was diagnosed with Type 1 Diabetes at 20 months old.
Pam was also a healthcare manager for 25+ years, and is a certified Wellness and Lifestyle Medicine coach. She is passionate about showing people how to not just survive, but thrive.
If you are interested in appearing as a guest, please email us at info@diapointme.com. We would love to hear your story and your connection to diabetes.
For more information about our work visit us at diapointme.com and follow us on Facebook, Twitter and Instagram @DiapointME.
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