My son Gregory has finally started school. His first school year in Kindergarten, or I would say half year as his diagnosis with T1D held us back a bit.
Me and my wife are a bit stressed as we don’t know if it will be feasible to manage his diabetes at school.
How will I manage my child’s diabetes at school?
- Will there be a school nurse every day to give him his bolus?
- Will the teacher treat his lows?
- Will the school principal allow him to have his Nightscout phone near him?
- What if the CGM sensor fails during school?
- Who will give glucagon if needed?
- Will we as parents be ready to react in case of an emergency?
These are few of our major concerns that kept our minds spinning day and night. One extra thing that caused extra problems is that we live in Belgium and our 2.5 year old son does not speak any French at all (yet) in order to communicate with his teacher. We took a big breath… we will make it.
We had a meeting with the school principal, the teacher and the school nurse. We were surprised about the willingness to support us; everything went well until we were asked what we shall do in case the nurse was absent due to sick leave, annual leave or force majeure.
There was no backup nurse so we had two options:
- Let Gregory alone at school with only having his teacher treating his low BGs, but noone to take the responsibility to count the carbs or bolus him. That would definitely end up in severe High BGs.
- Skip these school days and keep him home until the nurse returns.
We decided to let him start school and meanwhile we would try to figure out something that could make diabetes school management easier.
Medtronic 640G Insulin Pump
Medtronic 640G is one of the well known and broadly sold pumps in the market having the nice feature to suspend insulin delivery when Low blood glucose is predicted.
Guardian 3 CGM
Gregory is wearing a Guardian 3 Continuous Glucose Sensor (CGM) which checks his Blood Glucose (BG) every 5 minutes and sends the BG values directly to the pump. Then the pump’s algorithm uses the BG values and makes a prediction. If the prediction is a low BG (<70mg/dl) then the pump suspends insulin delivery. That would either prevent a low or cause a less severe one.
Nightscout (CGM in the Cloud)
The school principal kindly stood by us and allowed Gregory to have a mobile phone always next to him. His Android phone was equipped with:
- 600 Series Uploader. A GitHub app that could read and transmit BG values from the pump to the Cloud via Contour Next Link 2.4 USB. The device is connected to the mobile phone via a short OTG USB cable. The app then uploads the blood glucose values along with Carelink treatments entered via the pump (carbs, bolus, bolus wizard data, basals, profiles, corrections etc) directly to Gregory’s Nightscout.
- xDrip+. One of the major diabetes management apps. You can find it in GitHub too. It can process the BG values input from “600 Series Uploader” and create custom alarms much louder than the pump ones. It has lots of other features but I solely used it for better alarms and also further upload Gregory’s data to Tidepool.org.
First day at kindergarten
First day was stressful but when better than expected. Gregory had a couple of lows but were successfully managed by his teacher.
In total he had a snack and lunch. The nurse met Gregory at class after his lunch to check how much carbs he ate and give the corresponding bolus.
Carb counting during school
That’s a big challenge. We had two options:
The nurse could go before lunch to check the portion and carbs. Then go after lunch to check how much Gregory has eaten, count the carbs and give the bolus. That was too much of work for the nurse and she had to take care of hundreds of children in her area of responsibility. So we skipped this option.
The nurse could go before lunch, check carbs and give a prebolus. That was too risky though as we didn’t know if he would eat the whole portion and then end up with insulin overdose.
What we finally did:
- We took a photo of his snack/lunch before school. Snack was prepared at home every day so we could easily calculate the carbs of each portion. We used his mobile phone to take the photo.
- The nurse went to Gregory after lunch, she checked the leftovers from his food and she compared with the photo we had already taken with his cell phone. That way she could count the carbs easier.
- To make the nurse’s life much easier, we had a small daily calendar in his bag, where we were writing what food he was going to eat and how many carbs it had.
Day stats
