From Lawrence, Kansas, USA:
Recently, a five year old child in our child care center was diagnosed with type 1 diabetes, and we are not getting much information from the parent other than we need to check her blood sugar at 10:00 am to see if she needs a snack. This morning when I checked, it was 97 mg/dl [5.4 mmol/L], so I did not give her a snack. Forty minutes later, she was sitting a looking tired, I checked it again and it had gone to 28 mg/dl [1.6 mmol/L]. I gave her apple juice with a graham cracker and she then seemed okay. I am getting very vague answers from the parent about what her food needs are. I have gotten her sugar free fruits, but all her mother tells me is she needs 4 to 5 carbohydrates at each meal. I am not comfortable and certainly do not want to do anything that would be harmful to the child. Are there guidelines that would apply across the board as to what we need to do for a child with type 1 diabetes?
Your e- mail presents an important question. First of all, a blood sugar of 28 mg/dl (1.6 mmol) is dangerously low. Had you not been observant and given this child juice and a cracker, she might have gone on to a seizure and even to some permanent damage. A normal blood sugar just a short while before suggests that the Regular insulin dose in the morning was inappropriately large for the 'carbs' in the meal. All of this also suggests that the mother is not very clear about the principles of blood sugar control which is in turn probably because she has not had enough instruction. This raises a number of issues which at this remove we can't be of much help with.
However, especially under these circumstances, you would be entitled to insist on a School Health Plan even if you are not Federally funded. This would specify your responsibilities much more exactly.
[Editor's comment: Please see: Diabetes Management at School. This on-line guide provides an outline for schools to use in designing a diabetes management program including a ample School Health Plan. The specific roles and actions that various staff need to perform are identified and supporting materials are included. Each page can be displayed in a format that is easy to print so you can use this as your diabetes management plan. SS]
Original posting 8 Jan 2002
Posted to School and Daycare
Last Updated: Tuesday April 06, 2010 15:09:30
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