If you have found this blog, saying Welcome does not really seem appropriate. I know you wish you weren't surfing the internet for diabetes. I felt the same.

A big part of me wishes I were not writing about diabetes, nor did I anticipate to become so opinionated or informed on the subject, but it happened. In 2010, my son was diagnosed with Type 1 Diabetes.

It wasn't really part of the plan… Correction - it was not part of the plan, but it happened. It is not always easy, but I think we are all doing okay, and I hope we continue to do so.

Why the Middle East? I happen to live in Dubai. I don't think that living in the Middle East makes mine or my son's diabetic experience any more unique or challenging than it does elsewhere in the developed world.

I hope you stick around, or read something you like. Feel free to comment and join the conversation, subscribe or follow this blog by liking the Facebook page Diapoint.

Please note: This blog does not give medical advice. I am opinionated, and I share my experiences, but the first rule of diabetes is to follow up with your doctor and/or nurse educator about your care, diagnosis or medication. If you do not have a medical practitioner that is helping you find your way through this crazy world, then do not give up until you find the right one.

Tuesday, August 30, 2016

Back to School with Diabetes - Directives & Supplies

When I meet with the nurses and home room teacher the week before school, I also make sure I take the first draft of my son's medical directives as well as emergency snack boxes. 

The medical directives are what the nurses will follow in regards to my child's care - daily insulin doses, what to do in extreme high and low blood sugar situations and other emergencies. At our school, only nurses are allowed to administer medications. I am fine with this. Just note that not all schools always have a school nurse available, so it is important to educate everyone that will be helping your child manage their diabetes.

I strongly suggest you have a written document with the exact protocol you want them to follow. Every diabetic is different, and every day each of those diabetics blood sugar will be different. No way is a general understanding of diabetes enough. This is not a one size fits all disease. 

You should complete this document with your child's physician. Or, if you have been around the diabetes block a few times, complete as much of it as you can and then review it with the physician to make any updates or suggestions before you take it to school.

I call it a working draft. It should be as complete as possible by the first day of school, but also know that you may find that due to your child's body's response to the schedule some things may need to be tweaked. And be sure, your child is going to grow throughout the year. So just as they will need new shoes soon, you may find one day they wake up and suddenly need more insulin.  

For the last several years, I have used the American Diabetes Association (ADA) Diabetic Medical Management Plan as a template for my child's details. It is nine pages long, but do not let the length scare you. The first time I used this five years ago, it really got me thinking about our diabetes management and things I did not consider when he was in nursery. I have actually added more information to this document  since then as I have suggestions for various blood sugar levels and activities now that I know my son's response to certain things. I am sure there are also other similar documents from other countries available on the internet. So if you find something that works for you and your child, use it!

And make sure that after you review every page of this with your child's caretakers at school that all of you sign it. Yes, this is formal, but it seals your mutual agreement about how your child will be cared for. 

Now on to emergency snack boxes. These are not the "Hey, I think I'm hungry" kind of snack boxes. I take one box of several juices and snacks to keep in each classroom where my son will be. This includes his home room and everything from the music room to PE class. In addition to these, he also has a large box of snacks and a comprehensive box of medical supplies in the nurses office. For medical supplies think daily care, and also emergencies. 

God forbid, if there were ever a lock down at his school, hopefully this would be enough. Each teacher who has one of these boxes in their classroom is trained about when to use them and how. I put a short summary on the lid of the box, and the nurses include a huge insert with their emergency phone number. 

In the US, where lock downs are more probable, many Type 1 children carry a bag of supplies with them everywhere they go. Always. Including the bathroom. But why? If there were an emergency and a Type 1 child was pulled into a random classroom, they may end up in a situation with no access to any supplies. This is a huge risk for a Type 1. If a Type 1 was running low and could not get to a fast acting sugar for several minutes, a half hour, an hour??? 

That is a scary thought as a parent. Because of what I see happening in my country, I am honestly considering that my son carry glucose tabs in his pocket always. Our children here are so innocent to the subject of such violence at school, that I cringe at the thought. But lock downs can also occur for things like routine fire drills.

Too an American an approach? Perhaps. Too much? Maybe. Unnecessary? I hope it would be unnecessary always, and if my time is ever wasted on something in my life, then let it be this.  I used to work in a hospital and dealt with risk management. There is a reason for risk management. Accidents and events do happen. Many are often out of our control, and the only thing you can do is try to prepare. In previous school years, the nurses are grateful for these boxes because it saves time. They can treat a low blood sugar on the spot, and not have to run back to the health office to get a fast acting sugar. If the supplies get low, just refill.

Below is our image of this year's boxes. My son shot this with my camera. There you see juice for severe lows, chocolate milk for mild lows, snack bars, raisins, fruit and vegetable purees among other things that will not go bad. You definitely want fast acting sugar in your boxes to treat lows. It does not have to be in the form of juice. Use what you would customarily use at home. 

With the exception of a quick fix for a mild low during a class, hopefully all these boxes return back full at the end of the year.

Have a safe, healthy year!

Tuesday, August 23, 2016

Back to School with Diabetes - The Before School Meeting

School starts next week!

All teachers and nurses are back to my son's school today. That does not give me much time to connect with them and my son's newly assigned teacher to give them the Type 1 highlights before school starts.

Anticipating this, I sent an email to the nurses last week requesting a meeting with them and my son's home room teacher. In some cases you may have to be persistent and follow up. It is not that they do not want to meet with you, but they have many meetings in those days and are quite busy. Never be afraid to follow up or call to set a time.

I use this meeting to start the year off with open communication. It is informative, but it is equally important to enforce the message that I want to work with them and make their life easy so they can focus on the job of teaching.

For the nurses, we review all medication doses, snack timings, blood sugar checks and emergency protocols among other things. It is also important to note that my son is in the 3rd grade. If you have a high school student, the student will play a bigger role in their care. However, it is still good to request a meeting before school starts - particularly if diagnosis is new, or you are at a new school.

When meeting with the teacher, I suggest that a school nurse also join. At that time I review the basics of what Type 1 is, and how we treat it. Having the nurse there also helps open the dialogue for how they may manage certain situations with the teacher. Based on your experience, you may have ideas or suggestions for them, so do not be afraid to share your thoughts.

I typically use a template for this discussion. For example, this Guideline for Schools, I found from Australia is a good place to start. I do suggest to read everything word for word. I use various guidelines as an outline and I take the best of their information that is relevant for me here and include things specific to my son and his care.

Other guidelines to consider can be found at Diabetes UK or at this American site, The National Institute of Diabetes and Digestive and Kidney Diseases.

There is a lot of information out there, and it can be overwhelming - for both you and the school staff. I use this information as a foundation and edit it when it comes to specifics for my son and his treatment. Every diabetic is different. For example, the way one child reacts to, or feels a low blood sugar is not the same as another. Be sure to highlight information specific to your diabetic.

It is also important to note that Type 1 school guidelines often include legal information specific to a country. It may not always be relevant for you, so update it to be in alignment with your location.

I typically focus on the following topics with the teacher and nurse:
  • What is Diabetes, and the difference between Type 1 and Type 2
  • Hypo and Hyper Glycemia. What is the difference, signs and why are they important?
  • DKA (Ketoacidosis). It is likely that a DKA would be managed at home on a sick day, but I still explain what this means as it is critical, and could happen at school.
  • How the teacher can help. (This is essentially, the expectations and support your child needs to function as a normal child in the classroom)
  • Diabetic Emergencies
  • Other topics. For example, depending on the age of the child, you may want to discuss discipline, what to do during tests, field trips or other things.
  • Thank them. Thank them all for their time and encourage them to reach out to me if they have any questions.
  • Note any action items. Do they need any more information or supplies from you? Do you need more information from them?
So far this has kicked off every year to a good start. Things are never 100% sorted after this meeting.  And let's face it, if you are a caretaker you know these are just the highlights when it comes to diabetes management. But it is a start!

Have a great school year everyone!

Stay tuned. Up Next on the Blog: Directives for medical management at school and "lock down" boxes.

Wednesday, August 17, 2016

Back to School With Type 1

School starts in just less than two weeks!

After a busy summer full of travel and learning more about our diabetes it is time to get ready for school. Of course that includes buying the next size in the school uniform we outgrew, shoes that fit, pencils, paper and all that good stuff.

For a child with Type 1, back to school means so much more. 

It is full of a myriad of medical supplies and snacks that must be strategically placed throughout the school, educating the school health staff and teachers on what it means to be a Type 1 Diabetic, how and when to use those supplies, and how they can help ensure your child's safety at school, advocating for your child to administration if there is no support available, new carb:insulin ratios, basal rates if you are pumping, and insulin doses if you are injecting to match the new school schedule, after school activities and all of those things I just mentioned must be considered in the context of the activity and with their coaches, if your child rides the bus what to you do, how do you manage school parties and those dreaded carb loads, depending on their age how do you get them to become more independent in managing their diabetes at school, if they are not independent yet how do you manage play dates and activities, this and more.. plus any anxiety or stress your child might have, and probably more for the caretaker that goes with all of that.... 

Read the above run-on paragraph three times out loud without taking a breath and you get a small idea of the heavy weight carried when sending a Type 1 back to school, or off to school for the first time. And those are just the highlights!

It is stressful, but with a lot of planning, work and advocating it can go well. Sometimes really well.

Over the next several days as I prepare to send my Type 1 back to school I will share the tools, links and other things I do to try to manage all of those things and more.

Even though I have done it a few times, I am still not mentally ready to tackle it just yet. But it has to be done. 

So as you recover from reading that paragraph three times without taking a breath, take a deep breath now and let's recall the beautiful days of summer just one more time before we begin..