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RE: [IPp] First week of school & @#$#$#@^%#@ Nurses!

If your doctor signed the IHCP then they are considered doctor's orders. The
school doesn't need something separate from that. We have our endo sign our
504 plan each year.

> Monday AM, school started at 7:25 and his blood sugars had been
> surprisingly
> good at 6:15 even though he'd still been awake at 12:30 being upset.
> At 8:30 the hospital faxed me the signed Health Care Plan I'd completed.
> I faxed it to the school.    Unfortunately,  at 9AM I was paged by my son
> with blood sugars of 339.    Then the nurse called and complained
> she didn't
> have dr. orders.

IMHO, based on what you have written (I wasn't there), it doesn't seem that
the nurse was out of line. She doesn't deal with diabetes every day and it's
your job to educate (not berate) her on a daily basis and help her see what
is right for your son. I don't disagree with a little more control by the
school the first week or two of classes. Our kids are going to be high and
low the first couple of weeks. Your going to be doing basal/ratio changes
due to the new schedule. Things are going to be changing alot the first
couple of weeks.

The schools have to protect themselves legally. They are required by law to
make accommodations and they (most of the time) live by the letter of that
law, not the spirit of it. If your 504/IHCP says he tests at 8:30, then they
are going to want him to test at 8:30 every day. Does your son have a watch
with alarms? If not, I highly recommend one.

I know I'm being the devil's advocate here, but you will get further with
the school (who sounds like they are more than willing to make
accommodations) by being THEIR advocate as well. Helping them help you,
rather than fighting them and being rude ("repeatedly requesting the she
please shut up").

> As I'm repeatedly requesting that she please shut up and put him on the
> phone,
> she instead hands the phone to the 7th grade principal who conviently had
> just walked down the hallway.   She then proceeds to tell me that he's
> obviously not prepared for self-care in the classroom, didn't know what to
> do,
> and had forgotten to test at 8:30 instead of 9  (big deal!!!)
> and will need
> to do
> all blood sugar readings in the nurses office for a few months.

I am surprised that the school accepted the liability to calculate the
boluses. Not many schools (districts) will do that. Again, I think you are
being a little hard on the nurse. Again, she doesn't deal with this every
day, and doesn't know your "rules." I also think that her adding the two
numbers together is not a "mess up", it's not like she calculated the wrong
amount. You just wanted two boluses so you could see the numbers later, and
a verbal request is not likely to be remembered by someone who deals with
hundreds of kids a day, especially on the first day of school. You can't
just change the "rules" on them like that. And it won't do you any good to
get upset about it.

>  Nurses messed up
> helping him
> calculate his lunchtime correction and bolus.   He did the calculations
> correctly,  but she then added up both answers and told him to punch that
> in as one normal bolus.   My verbal orders to them that AM had said to do
> separate correction bolus, so I could identify it later from the pump for
> logging,
> and then to do a Dual Wave bolus for lunch when eating pizza.

I agree with the nurse here. Again, it's a liability issue. Whenever you
son's bolus ratio's or corrections (times and ratios) change, you will need
to either change the IHCP or an easier method, to add an addendum with the
change, signed by the doctor. I know that we make these kinds of decisions
every day, we change basals, we adjust bolus ratios, correction ratios,
determine what times our kids should test, etc. But this is not the job of
the school nurse. And she (the nurse) can only do what the 504/IHCP says she
can do. If you IHCP says correct over 250, that is what she is legally
allowed to do. Make her like easier by keeping your 504/IHCP up-to-date.

> Today,  he was 84 at home,  but then 284 two hours later, and
> spent the day
> between 214 and 275.   They did the correction right, the bolus
> right,  but
> then called to complain that he shouldn't have done a correction unless
> he was over 250 (their plan they wrote last year).    She wanted NEW
> Dr. orders if he was to do corrections at a lower number.

Try to work with the school rather than fighting with the school and you
will have a much easier time of it.

I speak from experience. I can tell you horror stories of my own, and I have
learned that playing the game will get you much, much further than fighting
against them.

Take a deep breath and remind yourself that you have accommodations for your
son. Your son IS allowed to test in the classroom. Your school nurse is
willing to calculate corrections and basals. You have SOOOOO much more than
many parents do. Your glass looks half full (not half empty) from over here.

Putting on my fire resistant cloak,

Mom to Tarek, age 10, IDDM, dx 11-16-1998
Pumping DTron since 1-12-2001
Denver, Colorado
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