Interesting timing of this post. My son was diagnosed with Type 1 diabetes two years ago at age 13. I homeschool my children. Always have, and always will. But sometimes it is not easy, since I am also a student in nursing school
. However, this evening before I saw your post I was thinking how good I have it in that I don’t have to deal with the school system and 504 plans. It has made homeschooling worth it! I say this with kindness, if you want to see what parents of children with diabetes go through, not only with the crapfest that is T1D, but dealing with their schools
, check out the ChildrenWithDiabetes.com forums.
“She always wants to know his IOB (Insulin on Board) numbers when he is low and to be nice the aide usually writes that down (I was covering for the aide that day as she was absent). But I've been told by the pump manufacturer and the doctor and the nurse handling his case that this is not important or necessary.”
OMG!!! Is all that I can say! IOB means that the pump is still going to give him insulin!! If he is low and there is IOB he is going to go lower!
From CWD website:
Insulin On Board (IOB)
Insulin on board is probably the most valuable feature in the latest smart pumps. When insulin is administered via a bolus from the pump, it has a timeframe where it can effectively lower blood sugars. For example, if a 10 unit bolus is given the first hour, 30% is used up in the body (minus 3 units leaving 7 units still working in the body), the second hour another 30 % (minus another 2.1 units leaving 4.9 units still working in the body) and the third hour another 30% (minus 1.4 units leaving 3.4 units still working in the body) and finally the fourth hour the last 10% (minus .3 units leaving 2.97 units still working in the body).
The only problem with this analogy is that not everyone fits this profile. Like basal rates, not everyone have the same rates in a 24-hour period. The latest smart pumps have adjustable time frames to accommodate these differences. Some individuals may set their insulin on board feature at 3.5 hours or 5 hours rather than 4 hours as mentioned in the example above. One way to see what works best for each individual is to check blood sugars each hour after giving a bolus to see how blood sugars react.
Stacking of Insulin
Before the insulin on board feature was available, many individuals would have a high blood sugar (i.e., 250 mg/dl) 1-2 hours after eating (postprandial) and consistently give a correction bolus to bring their blood sugar down to a normal range. The problem with this technique is not accounting for the insulin on board in the body and often going low by overcorrecting. Now, after inputting a blood sugar of 250 into the pump, the pump will account for the insulin on board and possibly suggest a different correction bolus, which will help avoid a low blood sugar. For example, a person who has a target of 100 mg/dl and an insulin sensitivity factor of 50 (1 unit of insulin will drop the blood sugar 50 points) in the example above would normally give a correction bolus of 3 units to get to 100 mg/dl. Now, using the insulin on board feature on the pump, the pump may only suggest 1 unit based on how much insulin is still working in the body rather than 3 units.
Insulin on board calculation can also work when a blood sugar is only 95 mg/dl an hour or two after eating. It is common for blood sugars to rise 60-80 points higher than the pre- meal blood glucose reading even when a correct dose is given. If a blood sugar is taken 90 minutes after eating showing a 95mg/dl that may be a red flag knowing it is common for levels to go up somewhat after eating. Looking at the insulin on board feature on the pump may show 4 units still working in the body, which may indicate the need for carbohydrates to head off a low blood sugar.
She shadows him to keep him alive. As he gets older she will loosen the reigns. My ds does most of his own care, but puberty is wreaking havoc on his BG numbers. These are things you don’t learn in nursing school. The pediatric endocrinologist and the certified diabetes educator haven’t taught me diddly compared to other parents in the trenches. You sound like a caring and competent school nurse. Sadly there are some that aren't and that is why parents of Type 1 diabetics become anal retentive.