Help Type 1 diabetic and lunch

[peaceful2100, BSN, RN]

Help! My school is returning to in person next week. I have a newly diagnosed type 1 diabetic who is 3rd grader.

I worked in high school mostly. When I was in elementary before I never had a young diabetic.

I know to follow school orders, always communicate with Mom, and Dr office if need be.

However, lunch time? Do you go to the students and watch what they eat, or do you have them come to you? How do you handle that. I want to be sure she is getting the proper insulin amount at lunch time of course.

I told Mom she needs to be sure to send snacks and extra snacks for days when she don’t like lunch.

Mom told me she is a very finicky eater and sometimes will not eat at home so that makes me super nervous about her being at school and possibly not eating.

Any tips/suggestions please share.

Thank you.

 

My 2nd grader with T1D was allowed to eat first and then he came to me with everything he had eaten so I could calculate his insulin.  He saved all wrappers and mom would make a list of carb count. I would touch base with mom and ask her what her plan is for lunch and snacks.  He had his "diabetes bag" that had his glucagon, 2 mini juice boxes that had 15 g carbs and a peanut butter and crackers pack.  It also had all his supplies.  That travelled everywhere he went in the building.  I made sure to always have updated orders and a diabetes management plan from his endo.

[Incognito-lpn]

There is a first grader who is T1D at my school. He has an insulin pump. I go to the cafeteria when lunch begins to check BS. Then go back after he finishes. I have all nutrition info or all wrappers are saved and administer insulin with his pump. He is picky and doesn’t finish so I wait until he is done eating. All employees in the cafe know not to throw his things away. 
     I suggest that you tell mom to pack things she knows her child will eat in case  she does not like the school lunches. 
Good luck! 

[peaceful2100, BSN, RN]

Thank you.

I definitely told Mom I strongly suggest packing a lunch for her since she is so finicky. However, Mom said there are times she just can’t get her to eat, and that makes me really nervous too. 
 

I told Mom she needs to send juice and glucagon too.

I have purchased some juice and some snacks just in case Mom forgets. 
 

Hopefully Mom is responsible. 

[nursetlm, ADN]

My first grader tells me ahead of time what she plans on eating (I have school menu) and I dose her 10 minutes prior to eating.  We do the same for her snack.  If she doesn't eat something she said she was going to- we make up the difference in my office.  It works for us. 

[schoolnurseadmin]

I had one in MS and he would bring his lunch box in to show me what he had eaten as he was known to not finish.  He was dosed prior to eating.

[k1p1ssk, BSN, RN]

My 4th grader and I discuss what he will eat ahead of time, and dose per his orders right at snack & lunch. It helps that his mom is the lunch monitor for his grade right now, so he has been focusing on eating under her eye rather than socializing and he hasn't been dropping low post-lunch as a result. If his CGM alarms during the day, his teacher will text me or call and I just head up to the classroom and treat & monitor from there so he doesn't miss class-time, and that works out super well. (This was pre-established with his & his mom's input prior to him starting in-person. If he wanted the privacy of the office, he would have that privilege in a heartbeat).

[stlrn]

I have 3 in my school.  If buying lunch then they bring their lunch to the nurse office to let me know what they’re eating and we dose before they eat. If they bring lunch then they still come before lunch and we dose according to the carb count mom has written down.  Occasionally one doesn’t finish lunch (maybe talking too much) so they come sit in my office to finish.  This rarely happens because then they’re late for recess.  Luckily we have a monitor in the office so their BS displays all day. Each kid brings their snack daily. They come to the office prior to eating it to dose.  Each kiddo has their own stash brought from home of either glucose tabs, juice, pb crackers, etc that is always kept in our office for times they go low.  

[AdobeRN]

I have a kinder that doesn't always eat everything -I will check BG before lunch and dose insulin after she has eaten.  If she is buying her lunch (only buys on pizza day once a week so makes it easy for me), I will escort thru the line to see what she chooses, figure out carbs, set my watch alarm to return in 25 minutes to see what she has eaten, then dose her insulin.  If she has brought her own lunch she will stop by my office on the way to cafe, mom has written carbs on sticky note inside lunch box - I glance at what she has, we check BG and I send her on the way.  She will return with her lunch box -she has been instructed to not throw anything away, just put everything back in lunch box and we toss in my office after I have figured out what she has eaten.  Time consuming but this works for us and mom is happy.  

[Flare, ASN, BSN]

I think the dose first / eat first is very dependent on the child.  Mostly my student have been good eaters and I have been able to dose them based on what they are planning on having and supplementing if something happens between insulin delivery and last bite.  I find that makes it  easier and the kids more compliant in returning, as they often "forget" to come back for their dose when it's time for recess.  A picky, finicky NEW diabetic, though... I would say that tray checks and returns are necessary until this becomes more routine and you can get an idea of eating habits.  Have the child take a very active role in their own care as often as possible.  Soon enough calculating carbs and the testing and injection process will become second nature to them, and that makes it so much easier.

[raebabelvn, LVN]

My T1D is a 1st grader. I'm in constant communication with the family. He brings a lunch and the carb count is usually done. However, I'll know ahead of time if he's grabbing something from the hot lunch line so I can calculate carbs ahead of time. He comes to me and I do a finger stick, and then dose him. He has an aide with him to make sure he eats everything. A few years back I had a 5th grader T1D. It was about the same process... parents did carb count for me, and I did it if she got hot lunch. I checked her BG and dosed appropriately. She was good about finishing her food. 

[peaceful2100, BSN, RN]

First week went really well. She is only there 2 days a week for now. As the kids are Hybrid. Group A comes 2 days and Group B come 2 days.

I am impressed with how much she knows and how well she is handling this. 

She is very picky, but Mom brought lunchables to keep in my office refrigerator for her.

I don’t feel that is an ideal lunch though, but it is what it is.

Mom also brought granola cereal bars to keep in my office for breakfast.

School orders say dose before eating so I have no choice, but to follow the orders.