Arnu

If its decided that this child should be home from school then it sounds as though the parents can't be responsible enough to make sure she's doing work so its probably best for the school to aprove someone to go to the home an hour or two a day to make sure this child is doing her work. As much as everyone wants this child to not contaminate others you need to get the MD on board, if he's not yet. Do you have permission to call the MD? If not, that should be the first step, or having the mother bring in a note from the MD. The school won't approve a tutor for home without that.

Doesn't matter what the school wants, its what the MD says. If he says that he can be in school, then the school can not keep him out. We had a student with an active infection (not c-diff) but contageous, and one that would require special gowning in the hospital setting, but the MD said they were absolutely NOT to be out of school. The school really wanted him out of school but their hands were tied because the MD said no way.

We use the precision xtra ketone meter all the time. MUCH easier than urine strips. The strips are expensive, but so worth it. Plus most insurance companies cover them now.

Its important what his dr's think. just because his parents don't want him in school that doesn't mean the school needs to provide teachers and tutors for home. If the Dr. writes a note or calls the school saying he's NOT to be in school for X amount of days and those days surpass the 'limit' and a tutor is needed THEN the school should provide it, not just on what the parents want. I've never delt with C-diff so I can't really comment on c-diff in a school setting.

In order for them to request a home tutor they would first need a dr's note saying he's not to be at school and I believe it has to be so many days that they are out for a tutor to happen. Wouldn't the principal be the one to organize all this (once the note is brought in and you are informed).

You can not MAKE the parents go. Its against section 504, while the child is at school its the school responsibility to make sure his needs are met, that includes field trips and extra curricular/afterschool activities.

I'm not understanding why this mother came at you like that? Is she blaming you, or the school for the lice? maybe have a talk with the principal on the best way to handle this particular parent in the future, because I'm sure you'll hear from miss lovely again.

I think the mother overreacted. It sounds as though everything was done right, there were no s/s of a head injury, you called the parent--its HER job to make sure the numbers are correct, not her older child's job! Any parent that comes is yelling and not willing to hear you out is clearly over reacting.

Taking it slightly off topic here, but Flare, why don't you like to delegate glucagon (not sure what state you are in or what the law reads at). But you can't over dose on glucagon, its just like an epi pen, its life saving. Of course you do need to mix it, which can be scary. Hopefully the 'pen' version will be out soon so they'll be a few clicks rather than fiddling with a vial and syringe.

If you are in a public school someone that is fully trained in diabetes care MUST be on that field trip with the student. At 12 he may be doing most of his own care, but someone must be fully trained incase of an emergency. I would think on an overnight field trip they'd require a nurse anyway, just incase something happens with ANY of the children.

I hate to say it, but the teen years are tough, very very tough. I would be very careful to keep my calm with her. If numbers are high DON'T ask in an accusing tone if she snuck something, or ate extra food. Depending on how long she's had diabetes she may simple need a break. Not sure how much help she gets at home, but at 17, probably not much. She needs someone to understand, to help, to listen. She definitely doesn't need someone to be on her all the time. She has plenty of people like that. Our job is to make sure she's safe and doing what needs to be done. But, in this case, do it with as much compassion as possible. Diabetes is such a tough disease, many people don't realize that. Is there any other disease in the world where the person who has it is totally responsible for keeping themself healthy? Adjusting their 'medication'? Is there any other disease that is knocking on your door 24hrs a day, 7 days a week? To a teenage (and most kids) the day to day gets old fast. So you are right. Right now she could probably care less. And that is so dangerous for her in the long run. Good luck.

Glad you are getting more comfortable. I totally understand now why she's coming to see you. There is a lot to learn with pumps, insulin and type 1 diabetes in general. I have several kids in my school. Plus my friend has a child with type 1, who happens to be friends with my daughter, so she sleeps over a lot.

If its 'snack time' she can certaintly eat the snack. 182 is perfectly fine for her to have a snack. She shouldn't be kept from doing what everyone else is doing. Now, being 17, do they actually have a snack time? Is it breakfast? Begin on a pump allows freedom, one of those freedoms is not having to eat on a schedule, so she doesn't HAVE to eat a snack, unless low, but she also shouldn't be excluded if its something everyone else is doing at that time, regardless of her blood sugar level. The pump is programed with all her personal information. Her carb ratios, her correction factor, her basal rates and her blood sugar targets. This is different from every person and it may be different on a day to day basis. You can not stack insulin while using an insulin pump (unless your pump isn't programed right). The pump keeps track of the corrections you are giving. If she was 300, and it gave her 10u, she checked again in 30min (which isn't even time to even see a difference as most insulin don't start working for 20-30min, so checking in 30min isn't going to give you useful information) and her bg was 330, the pump will NOT give her another 10u.. it may not give her any, depending on her correction factor. ALso, the difference between 300 and a 330 is nothing, its well within the 20% margin of error that is allowed with blood glucose meters. There should be no restriction on gym unless there are large ketones present. Make sure she's drinking plenty of water during that time. She may not feel well and will likely be very thirsty. Is this student newly diagnosed? If not, at age 17, I would think she'd be doing most of this on her own.

If its that much lower I'd stay where I was, unless there is a reason you really need to move along.

We hold onto expired epi pens and expired glucagon for training purposes.

Most of the parents of special needs children, whether its physical, congnitive or medical, are the best and most helpful parents I've ever delt with.

I agree, jeans are OK. I don't wear scrubs to school anyway, but always dress professional, nice, clean and neat.

Does he have MD orders in place saying he can self care? Children that age do NOT want to be different. Having to stop by the nurse is being different. Having to 'check in' is being different. I'd encourage you to 1, make sure you have MD orders stating he can self care and 2, open communications with mom. I wouldn't get any social workers involved just yet. Typically parents of kids with type 1 diabetes are very knowledgable. 10 years old is young, but its not unheard of for self care with diabetes. I have several kids that age that do self care. They do, however, have protocol in place that if things go haywire with hypo/hyperglycemia I do step in. I would encourage you to keep the lines of communications open with mom and the child, be as gentle as possible with mom, nonaccusatory as possible. Like I said before, I would not notify any social worker at this time, unless there is evidence of neglect.

Purple scubs, it could work.. it would take care of a lot of the issues with cross contamination and such. One thing a lot of the districts don't understand is that they have to provide what the other kids are having.. if its a ham and cheese sandwich, pretzels, fruit a cookie and milk they can't give the child with the gluten issues the ham and cheese with no bread.. they have to provide equal.. chicken nuggets, rice, mac n cheese, it would be made gluten free.. These things aren't hard to do, infact there are some great companies out there. Bell and Evans has great chicken nuggets/patties.. Amy's makes wonderful mac n cheese that is frozen so its pretty simple. It can be easily done, you have to have people that are willing to take it on and to completely understand it. Just a crumb can send kids with celiac into a tail spin for a week.. Its not anaphlactic, but its affects the entire body and over time it can lead to cancers if gluten is continuously consumed.

If it was a child that I excluded then its an excused absence. I don't see how the principal can say 'you can't be here but the absent counts against you'. Thats ridiculous.

In our district we do have children that have celiac, one that has celiac and type 1 diabetes. Celiac is considered a disability and is covered under the ADA. Its a disability that is covered under a 504 and accomidations MUST be made through a cafeteria IF the parents want the child to have school lunch. The school can not make the family pay the difference of the gluten free foods. If they are receiving free meals then the gluten free meals will be free as well. Its extremely important to work with this family to provide gluten free lunches if thats what they want and need. A family strapped for money is going to have an extremely hard time getting gluten free foods for their child because they are so much more expensive. One of the kids in our district really wanted to be able to get the hot lunch. He just felt so different (child also has type 1 diabetes) and didn't want to be any more different by having to bring in his lunch everyday. The mom worked very closely with the kitchen staff, explained cross contamination to them, which is a huge issue. Its not as difficult as you would think it would be. On the days where the lunch would be hard to do gluten free he will bring in a lunch from home. Mom goes over the menu with the child for the month, they send the menu in at the beginning of the month to the lunch cordinator so they can go over how everything will be done. Mom does supply the school with certain things, bagels for pizzas, and the bread the child likes the most. He's picky about his types of breads, so mom provides the specific kinds he like, it wasn't something she was made to do but rather she wanted to do, have a good relationship with the kitchen staff and to provide her child with some of the things he really likes. They keep gluten free cookies/pretzels/breads/chicken nuggets/patties/noodles/ on hand as well as a few treats for those days the other kids get treats.. all fruits/veggies/milk are gluten free, so its usually the main meal that needs substituting. If the child and family really want him to have school lunch its best to work with that family to provide that. These kids feel so different to begin with these 'little' things make a huge difference.

For those that are making the parents come to school (which is illegal, the school MUST provide someone to take care of that child while they are at school, making the parent come in is wrong). What happens when there is an emergency? Do non medical people know how to deal with low blood sugar, what about high blood sugar, or a hypo that makes the child pass out, what about glucagon? Not have a TDP in a school where a nurse just simply isn't avaliable is scary.

504 isn't for a learning disability, the requirement isn't about the effects of the disability on learning (thats an IEP). Its about the disability having an effect on one or major life activities such as walking, talking, breathing, seeing, hearing, eating (celiac disease and allergies), the endocrine system (diabetes) to name a few.

Teen years are very hard. How long has this child has diabetes? Do his parents help him at all? For his doctor and parents to basically give up on him is sad and frustrating. This child doesn't need ultimatums, he doesn't need threats, he needs someone to understand. Threatening to suspend a child over not doing blood sugar checks is out of line. Is that even legal? In our district that never would happen. I think you need to gain his trust and start with baby steps, no threats. He's a teenager, maybe he resents the fact that he has to go to the nurse in the first place? Maybe work out a plan with him stopping in the office in the middle of the day to let you know what his bg is. say before lunch, if he's checking else where he can peak his head in an say '135' or whatever he is. I'm sure he's holding some resentment. Diabetes is very difficult, most people don't understand that. Its constantly there. Sitting down and having a heart to heart with any teen that is having a difficult time will go a long way. You're on there side, to help them, not to control them and certainty not to threaten them. Good luck.