As ussual, I had an information session with the teachers before the first day of school. I explained Mr T’s break time routine. He was to:
- wash his hands,
- go behind the teachers' desk where his “D stuff” was kept and check his number (BG),
- get his lunch box with a write / wipe-off tablet,
- choose the food he is going to eat,
- record the carbs and the BG on the tablet,
- enter those two numbers into the pump and deliver the suggested amount of insulin
- write the amount of insulin delivered on the tablet,
- READY to join the others in eating as the break starts.
Luckily, he communicated with us, complained about the delay and asked for a solution. I do want to nourish that approach in him: there is a problem, let's find a solution. I do not want him growing up thinking: “you see, diabetes stopped me from playing with my friends during break time at school”. I am also glad the teachers saw what he would be missing out on and we were able to make a plan that works. ten minutes head start was just a solution.
Anyway, back to year three. Mr T is joining his friends in time, at the beginning of the break and all is fine….for a while. Then, occasionally, his blood sugar would be unexplainably high at lunch or as I pick him up after school. As usual, I put my D1 detective hat on and try to figure out what went wrong based on a few clues : was it air in the line, is the infusion site getting old, what did he actually eat ?
I consult the tablet where Mr T records his BG, carbs and insulin. I check the pump history for boluses and raid the lunch box. It helps if I can remember what I actually packed in the lunch box that morning, but luckily Mr T’s memory is much better than mine. We chat about what he ate, when, and usually the solution presents it self. “Oh, mom, after I had a sandwich which I bolused for I was still hungry so I had crackers too”.
Of course, it is all normal – he was hungry, the lunch box was in front of him, he needed more – he just needs to bolus again. That is our new challenge – getting him to remember to bolus for additional food, right there, in front of the other kids sitting and eating. Not that he is shy, or doesn’t want his friends to see – they all see him do that just before lunch anyway. It is just such a busy time, eating, chatting and planning what games to play next.
Who would think of another bolus. I understand, but it is very, very important and not good for him to go high like that often and to develop the habit of, “I can eat and not bolus, nothing happens”. So, the following solutions were offered :
Solution one : remember to bolus for additional food if it has carbs.
Solution two : choose carbs free food, and you do not have to bolus.
I had to make it clear that not bolusing and therefore going high is not good for him and that if he cannot remember to do it I’ll have to make a plan to come to school at lunch and bolus for him. It was not meant as a threat, but as a firm statement that it HAS to be done – by him or me.
It worked !
He has remembered to bolus additionally for the first time the other day. It is a small, first step in the right direction. We’ll see what happens tomorrow.....