Thursday, March 28, 2013

School Daze

A while back I asked for advice on some school issues, and I was so thankful to everyone who replied.  Not only were your comments insightful, they left me feeling like I had some focus on the matter.

I finally did call up each school to try and set up an appointment, only the school we are not zoned for (which is the closer school) wouldn't even talk to me unless I called the district first.  Even then, they wouldn't know if they could enroll Elise until 1 week before school started.  Ummmm, no.  That's a deal breaker!

So we set up an appointment for the school we are zoned for, and took Elise.  I was a little wigged out by how secure the school is.  I mean, I understand (and am very saddened by) the need for it. But it makes me a little antsy being locked away from my kid that way.  Is it just me?

Anyway, we met with the nurse and the principal and were so impressed by what we saw.  We spent two hours asking questions, and felt pretty good about their answers.  The nurse is very business-like (but had great rapport with Elise), and is very, very pro-504 plan.  In fact, she said they had a T1 show up last year (he's no longer there) without one and they very quickly sat down with the parents to get one in place.

And the part that has us feeling pretty good about this being the school for Elise?  The nurse's brother is a type 1, who was dx'd at the age of 3.  He now lives with her and she helps care for him.

All through Elise's short schooling career, I feel like everything has just fallen into place; her first pre-school teacher had type 2. Her second teacher (who she also has for her last year of pre-school), has been amazing and does such a great job of taking care of her.  Our pre-school has worked with us to make sure we feel comfortable and Elise is safe.

And now the nurse in her new school has t1 experience.  Really, what more could I want?

I do have a few more questions as I start thinking about Elise's 504:
  • For those of you who pod, where do you keep the PDM?
  • Is it normal that you cannot just tell the nurse to make a change on the fly? Like cancelling a temp basal that you had started before your child left for school that morning?  It sounded like anything the nurse does (aside from straight-up bolusing, or correcting using the pumps suggestions), has to be approved by the doctor.
  • Can you put into the 504 that you have the final say in daily changes and the nurse doesn't have to contact the doctor for those?
If there's anything else you think is important, please let me know. I do plan on looking at sample 504s, but I'd like to know provisions that you guys think are the MOST important. 


  1. For our school, we have doctor's orders on file. The doctor's orders say "per parent" after every single instruction so YES, I make changes on the fly all the time. I would think that as long as you have something from your doctor stating this, you should be covered.

    When Ella was on the pod, at first we kept her PDM in the office. Then the Connecticut school shooting happened and I decided I wanted it on her body. She now carries all supplies (glucagon, cell phone, syringes, extra insulin vial, meter, strips, glucose, etc) in her backpack that goes with her to class. It goes under the teacher's desk and she takes it with her whenever she leaves the classroom. She leaves it in the health office after she gets checked/dosed during recess and then goes back to the health office after recess to bring it back to her classroom.

    The only reason I don't have her take it with her to recess is because I know she will lose/forget it on the playground.

  2. So glad to hear how this worked out for you guys! Nothing makes a D-Momma feel better than knowing her precious little one is being well taken care of out of her care! xoxo

  3. I love how the teacher has worked out perfectly for her every year! We have had very similar experiences with Natalie each year. Natalie is in a private school, so no 504 because no federal money is received. We do have Dr.'s orders on file and a very detailed log that goes to school every day which basically tells what to do in every circumstance. The teacher put Natalie's cubby on the side closest to the door, so when they have fire drills, etc, the teacher grabs her bag that always has snacks for her and Natalie can grab her backpack on the way out which has her PDM in it and always some emergency snacks too. Her PDM stays in the front pocket of her backpack where her daily log is kept in a sturdy folder. When she is checked at morning snack time her bg is recorded and the amount of insulin given on her log. Then her PDM goes right back in her backpack. Same for lunch time. She doesn't take it outside or to any other classes cause it is a very small school and the aide or teacher who does her diabetes care can always grab it and come to her. I think you should be able to add to the 504 that the Dr. has given you permission to make changes....or you will be making changes to that all the time. We have a much different situation, but I just write a note on the log with any different instructions for the day. I'd be happy to send you a copy of our log if you want as a starting point.

  4. Adam keeps his PDM in the health office. That is what works for us right now since he's only 6. I just don't trust him not to lose it (says the mom who has been looking for his new Dexcom receiver for a whole week with no luck!!)

    He has a separate box in the classroom for emergencies that has a One Touch meter, strips, lancet, juice, snacks, etc.

    We have our school orders written so that *I* can tell the nurse to make any changes - I think your doctor just has to sign off on each instance saying "per parent" That makes things so much easier, especially when they call and say, he's low, do you want me to give fewer carbs for lunch than he's actually eating? And I can just give them direction.

  5. and to clarify, our nurse has never had to call our doctor - all changes are made through me. :)

    I can email you a sample of our log sheet that we use each day!

  6. Joanne,
    I put our boys' PDMs in a travel case in their backpacks each day. They take it to the nurse, she sends it back. I have emergency #s in case they forget it at school, which has only happened twice. Not too bad for a year!
    I don't have any instructions regarding changes in the 504 plan. The doctor's order for the school states the "parent can make changes". So, I communicated daily via email regarding the day's numbers and if I have made any changes.
    I'm blessed to have an actual RN in the school who has Type she gets it and does well with my boys!

  7. Yes, it is true that a nurse will only follow doctor's orders, so much so, that if the correction factor changes lower, they will follow doctor's orders with the written higher correction... a fact to consider if the nurse would ever have to give correction by injection due to site failure. Do NOT write down ISF, ICRs or basals you have on the pump.... this way she will follow the pump that you program. We have always had notes from endo that they are to follow the parent's instructions regarding changes but this was questioned, ignored and basically the nurse claims they cannot follow parent's instructions only doctors. One of our school nurse's enforced this; many let us instruct our DD over the phone, with the phone on speaker and the nurse looking on. It seems we can have our child program the pump with the nurse overseeing but the nurse will not change anything without a doctor's order. The only thing we had to be careful with was correction by injection.... we would err on the side of caution. We were in communication via cellphone for every low blood sugar, for every lunch or other bolus. Elementary school great nurses; middle school a nightmare, highschool she self managed. In middle school the nurse tried to manage her even though she was self managed. Said nurse knew nothing. Sounds like you have found a real gem with the nurse with a Type 1 brother. You couldn't ask for a better situation. And, remember, there are always cell phones, LOL.


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