Help Type 1 diabetic and lunch

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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.

 

Specializes in School Nursing.

I have a TD1 1st grader. We do FSBS 3 times daily per MD orders. The first FSBS check the student will bring in a card that states what she will be eating for lunch. I copy this on a red index card so that she is able to show the cafeteria staff what she can eat that day. This card is made by the parent due to me providing the lunch calendar for the month to her. At the lunch FSBS and insulin administration we calculate the carbs she will eat and then admin according to her diabetic care plan. She will then return to lunch so she can eat. I have 3 UDCAs and 1 is a monitor in the cafeteria. She encourages and notifies me if the student did not eat her lunch. Also, if it is a lunch from home the parent will provide a index card with the carbs calculated (I recheck) and follow according to diabetic care plan of administration for insulin. 

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Specializes in ICU, ED.

Hi. I have template for management and action plan if you like I can send it through to you. Also, is the student on insulin pump or multiple injections? Because they are two completely different management and action plan. 

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Specializes in Med-surg/school nursing.
On 3/20/2021 at 7:01 PM, peaceful2100 said:

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. 

 

sounds like things are going OK. my own type 1 kiddo is in 2nd grade and dx in pre-k. we have frequent convos about what he wants packed in his lunch. we don't do the lunch line because it just has always seemed easier with his pickiness, food allergies, and diabetes to pack lunches. one day that may change. he gets dosed before meals but within the first few months after dx we dosed after until we were able to help him understand the importance of finishing what he says he will eat. we keep fast and complex carbs in the nurses office for him as a back up. one time a yogurt tube burst inside his lunch box all over his other food so the nurse had to grab stuff from his supplies to make up for it quickly because he had been dosed not realizing his lunch was ruined (we don't pack yogurt tubes anymore). another time he also suddenly decided he hated his main food item in his lunch (he had taken it for an entire year straight because that is what he said he wanted). he also has ocd so he likes things to be the same for long periods of time but something in his little brain changed and said I hate that food and its disgusting now. so again his nurse had to quickly make up the carbs because he had been dosed not knowing he was going to do that. thankfully stuff like that doesn't happen super often and he usually finishes his food. 

Good luck to you and your new type 1! 

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On 3/23/2021 at 5:42 PM, Alexandra28 said:

Hi. I have template for management and action plan if you like I can send it through to you. Also, is the student on insulin pump or multiple injections? Because they are two completely different management and action plan. 

She is on insulin pump. 

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Specializes in ICU, ED.

Okay. I have got the management and action plan for insulin pump. Let me know where you want me to send it. ☺️

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Specializes in School nursing.

Of note, all my kids with T1D have a line in their medication orders that allows the school nurse to adjust insulin +/- 20%. I find this very helpful when I have newly diagnosed T1D kids - they can be all over the map sometimes with BG numbers (especially if their diagnosis aligns with puberty).

I typically dose before if it is a kid that is reliable eater, after if not. I talk with parent to find out which works better. I've had parents that pack lunch and a note with all the carb counts on it, those that do school lunch, and some that let the kids buy chips at 7-11 and don't carb count with their child consistently at home (that is another long story).

I work with slightly older kids and honestly that picky eating - it doesn't change when the kid is 13. While I wish I could convince a T1D that chips and soda are NOT a proper meal, when that is what they are allowed to eat at home, it is a harder battle. I'm still fighting it, but also at least teaching the student how to carb count for chips and soda to cover properly. 

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Hi, you've already gotten so many great answers. I personally have worked at all grade levels. So for elementary, with a new type 1, I would prefer the student eat in my office for a while with the parent's permission. Of course, the older kids would be taught to come to check the level and tell me on the lunch menu I have printed, what they would choose. Then I would follow-up with often. 

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Specializes in pediatrics, school nursing.

Not sure if this will be helpful for anyone, but if you can get your cafeteria / food services manager on board, our district created a shared Google spreadsheet with all of the breakfast/snack/lunch carb counts on it so we can reference the lunch calendar and know ahead of time what the carb count is! Our cafe staff also do a great job of letting everyone in the school know if there are changes (meaning an entire meal is subbed out) and the manager usually calls me if she sees my T1D is getting school lunch or if there's a minor change (say orange slices instead of apple). 

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