Low blood sugars have been frequent around here lately. My daughter seems to go through a streak of them every fall, but the implications are getting harder to manage. Missing class time in 7th grade is much different than it is in 3rd.
Our current in-school low blood sugar protocol is this: She checks in the classroom to confirm she's low and is escorted to the nurse by a classmate. She has a juice box and waits 10 minutes. She rechecks and if she's back in range she heads back to class. Usually, one juice box perks her back up, but she's had a few 2 box lows lately.
Nobody's comfortable with her wandering back up to class at 53, hoping that second juice will kick in. So there she sits with the nurse. The nurse, as we all know, is lovely. But she's not accredited to teach geometry, or geography, or grammar.
So when 4:00 homework time rolls around, I'm called upon for help. I'm able to help with English. Geography is easy enough with the textbook at hand, and it's interesting. Geometry? Forget it. Helping with math homework consists of me sitting near her, muttering encouraging words while she reads the textbook out loud until she figures it out.
Fortunately she's a smart kid, and can catch up pretty quickly. But it's frustrating for both of us. The question is, can we make it so she doesn't have to?
Obviously we're tackling the low blood sugar issue. No matter when they happen, sticky low blood sugars shouldn't happen on a regular basis. Adjustments are underway.
But I'm also wondering about our low-at-school game plan. What could we do so that she misses less class time when this does happen?
As usual, sitting here writing has brought ideas to mind, some of them pretty obvious. Like when she tests in class and she's 58, she should drink the juice she has with her on her way to the nurse, not wait until she gets there. And maybe we need to talk with the nurse about whether any lows could be treated by my daughter in the classroom. For her, some lows are very functional lows at which she can drink juice and keep doing what she's doing. During others, she feels much safer taking a time-out in the company of a caregiver. How to quantify or describe this on a 504 plan, I'm not sure.
Any other ideas or suggestions which will keep me from (re?)learning more geometry or algebra are most welcome.
Here's a sentence you won't read often:
Twice in a the span of a week, my daughter has ended up in the nurse's office with a low blood sugar and I think it's because of her breakfast cereal.
You see, breakfast cereals are notorious for causing high blood sugars, not low. Also, blood sugar tends to spike in the morning, making any breakfast carbs harder to cover with enough insulin. So I'd say these may be the first 2 times in 7+ years of school my daughter has ended up in the nurse's office low before 10 a.m.
Our tactic for combating post-breakfast highs has worked well of late. A few years ago, a registered dietitian at our clinic suggested trying cereals with 5 or more grams of fiber per serving, which would slow the digestion of the cereal and thereby even out the spike. Occasional experiments with old favorites like Cheerios and Kix prove that the extra fiber in the new choices really does help.
In her quest to reduce breakfast boredom, my daughter spotted a new cereal in what might be referred to as the 'healthy' aisle of our grocery store. We enjoy other cereals of the same brand, so we picked up a box.
This cereal has 6 grams of fiber per serving, the same as several others my daughter eats. The serving size, and the number of carbs per serving are comparable. The same almond milk is added. The first time she ate it she needed 2 juices to get her back to class.
Several days of her usual breakfast foods and standard post-breakfast blood sugar results went by, and then she tried again.
Despite mediocre reviews the first time around of both flavor and chew-a-bility with braces, she had a bowl of the new many-grained flakes this morning. Already suspicious of last week's low, we subtracted a handful of carbs from the total per serving, and she ate 3 slices of my peach which we never covered. Again she ended up with the nurse and a blood sugar of 58.
I guess if she really loved this cereal, I'd put on my scientist cap and try to figure out what was going on here. Instead, I'll finish the box (which will require lots of peach slices for flavor) and we'll move on.
My daughter came home from school with a gleam in her eye. Something special had happened and she couldn't wait to tell me what it was.
"This is for you mom," she said before giving me a huge hug.
"It's from Mrs. Elementary School Nurse."
"She was at the middle school today?"
"Yeah...she was subbing! Mrs. Middle School Nurse is still sick."
The grin was from ear to ear and I shared the excitement. Mrs. Elementary School nurse holds a very special place in both of our hearts. She semi-retired as my daughter finished third grade and they'd only seen each other once since then.
To every child at the school she was a competent, kind and gentle presence when they needed help. She'd often say, "For six hours a day, I'm like a mother to 200 children," and that's how she did her job.
To us, she was all of that and so much more. To be like a mother to my child was a lot to ask, and it was a lot to trust someone else to do.
My daughter was the first child with diabetes Mrs. Elementary School Nurse had cared for. She jumped right in, spending hours with me learning the details of what my child would need done in the nurse's office, and of what needed to be shared with the rest of the school's staff. She listened well, asked lots of questions, and considered us a team coming up with the best plan together. Probably most importantly to me, she had my phone number plastered all over the office (and quickly memorized) so that we could consult over any question or concern. She advocated for my daughter several times when I brought her stories of staff confusion over things like having enough time to eat lunch, or needing a buddy for a nurse's office trip. Over the years, we spoke regularly and got to know each other very well.
To my daughter, she truly became like family. They made up songs about blood sugar checking. They had oft-retold stories like the one about the time my daughter squeezed her finger and got blood on Mrs. Elementary School Nurse's white shirt. They shared stories about their lives, families, and weekends.
When she left the elementary school, there were tears from all three of us.
There are so many stories of things going awry when school and diabetes get put together. We've had a few of those ourselves. So we'll be forever thankful that in those first terrifying years of elementary school we were blessed with an amazing nurse. Her competent care eased my mind every day. The love with which she provided it added a special and lasting bond.
For the first time, diabetes wasn't a big back to school issue here.
All of the forms from the endocrinologist were filled out, signed and turned in to the nurse in June.
There were no treatment or equipment changes over the summer to educate the school staff about.
We packed up the bag of supplies and checked it twice.
It's been our tradition to drop off the supplies a day or two before school starts. This visit has always included at least a quick check-in with the nurse and until 6th grade with teachers as well. We go over any changes from the previous year and answer any questions.
This year we had only one free morning during the two days when staff were in the building for meetings and setting up. We learned the nurse might not be available when we arrived. She was not. We left the well-labeled bag in the office. We missed saying 'hello' and exchanging pleasantries about the summer. Otherwise we had no concerns about not meeting face to face.
The nurse has not yet needed to call home.
Reports are good about lunch. She's sitting with friends of her choice, and she's finishing in time to go outside with everyone else.
There have been no classroom-related diabetes concerns.
This appears to be a non-story until it's put in perspective.
Seven years ago this same girl started Kindergarten. The preparation was extensive. We spent hours in the nurse's office reviewing every detail of the care she needed. We met with every teacher who would come in contact with my daughter. The nurse, my daughter and I took turns quelling each other's anxieties. My daughter was tiny and needed help with every aspect of her care. She needed staff to watch for signs of low blood sugars, and to make sure she was eating all of her food, and that she wasn't accepting food from others. The other elementary school years were progressively easier, but we still had an annual meeting with the primary teacher and the nurse.
Two years ago we spent time settling in to the middle school. There was a new nurse. My daughter encountered a minimum of seven teachers every day. There was a new lunchroom to navigate and a new schedule to adapt to. It took time and energy develop a good diabetes routine and a good working relationship with the new set of staff. Last year was certainly simpler, but a few things had changed and we spent a little time in the health office making sure we were on the same page.
It's amazing to look back and realize how much my daughter has learned to do for herself in the past seven years. She needs significantly less hands-on help from the school nurse or her teachers. It's reassuring to see how our hard work building relationships with and communicating with the schools has paid off. We have a thorough 504 plan, an excellent nurse, and a staff who has been well-educated by that nurse.
We don't know what next year will bring; and I'm sure the high school transition will bring its own collection of tasks and challenges. Right now, I'm just going to be grateful that this year's start was easy.