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[IPp] Strange request

Hi everyone,
I was wondering if those of you interested could read below.  It is a copy of 
the guidelines that I am giving to Matthew's school this week when we have 
our PPT meeting.  He currently has an IEP, but the school dropped the ball 
and admitted to me that they failed to add his medical to the current IEP.  
So if you feel like it, please read on and email me back with anything that I 
may have forgotten or if you don't agree with some of the things I have 
written. Thank you so much.
Sarah  (email @ redacted)
Mommy to Matthew age 5

Guidelines for Caring for Matthew Ashley

Bolus (es):
Give 1 unit per 20 grams of carbs
(take total amount of carbs and divide by 20 for exact bolus amount. EX:  
74grams divided by 20 = 3.7 bolus )

Correction Bolus:
Over 200: Add 0.5       Over 250: Add 0.8
Over 300: Add 1.1       Over 350: Add 1.3
Over 400: Add 1.6       If under 80, subtract 0.3

***Target blood sugar range is 80-180***

1.  Snacks
a.  Matthew is to have an afternoon snack with the rest of the class.  The 
snack will be provided by his mother and it will be labeled as afternoon 
snack in a see thru container.  The snack will also be labeled with the total 
amount of carbohydrates and the bolus amount that will be required upon 
completing the snack.  Upon completing the snack Matthew will need to be 
given a bolus in a location to be discussed at the PPT meeting, by a trained 
school nurse or aide.
 It is important that Matthew is watched to be sure that he completes the 
entire snack so that he is given the correct bolus amount.

2.  Lunch
a.  Lunch is at 11:30 daily.    
b.  Matthew is to go to the school nurse for a blood sugar check at 11:15 
daily and will be escorted to the nurse by another child or adult.  Upon 
completion of his lunch, he will then return to the nurse for a bolus. A note 
will be sent daily in Matthew's lunch box informing the nurse of the total 
amount of carbs in his lunch and the amount of bolus to give him.  If he does 
not complete his entire lunch, the nurse must call his mother to get a 
correction bolus.
c.  Matthew will need to be re-tested exactly two hours from the time he 
receives the bolus to be sure that his blood sugar is in target range.
d.  All blood glucose tests, bolus amounts, and total carbs eaten at lunch 
are to be recorded on a Log Sheet and given to Matthew's mother every Friday 
via Matthew's homework folder.
3.  Signs of Low Blood Sugar (hypoglycemia)
a.  Sweating
b.  Shakiness
c.  Pupils will be large
d.  Pale, moist skin
e.  Cold and clammy
f.  Extreme hunger
g.  Weakness/Dizziness
h.  Fatigue/tired
i.  Rapid pulse rate
j.  Shallow breathing
k.  Inability to concentrate
l.  Loss of coordination
m.  Loss of consciousness

Signs of High Blood Sugar (hyperglycemia)
a.  Weakness and Fatigue
b.  Frequent urination
c.  Excessive thirst
d.  Pupils are sometimes small
e.  Hyper
f.  Loss of appetite


   4.  Lunch Time Blood Sugars:
            Blood sugars 81 to 200      Matthew can go to lunch and 
                                                          Return to have a 
bolus after
                                                          He eats.

             Blood sugars 60 to 80              Matthew can go directly to 
            At lunch time                           Lunch.  However, when
                                                             He returns to 
have a bolus
                                                             It must be 
reduced by 0.3

            Under 60 at lunch time             Give Matthew a 4oz juice box
            Lunch time                              and send to lunch.  
Re-test blood                                                                 
                                                          Sugar immediately 
after he eats.
                                                          Call his mother 
with blood           
                                                              Sugar number 
and for the
bolus amount.  The   
                                                              Juice box is 
not counted as 
                                                               Part of his 
lunch carbs.
            Over 200 at lunch time             Matthew may go to lunch but    
                                                          He will need a 
correction bolus  
                                                          Amount.  Call his 
mother to
                                                              Verify correct 
bolus amount.

             Over 250                                 Test Matthew for 
Ketones and 
                                                           Allow access to 

                                                    Note:  Matthew may 
confuse being this 
                                                                   High with 
being low, since many 
                                                                   Of the 
symptoms are the same.

Following an episode of low blood sugar, it can take several hours to fully 
recover.  Hence, Matthew should not be expected to perform at optimal levels. 

5.   Low Blood Sugars other than at lunch time:

Blood sugars Less than 70 at any time other than lunch time
**Suspend the pump for 30 minutes
**Give a 4oz juice box and re-test in 30 minutes
**If blood sugars go up to target range, resume pump
**If blood sugars do not go up, give another 4oz. juice box and keep pump 
suspended for another 30 minutes.
Call Matthew's mother so that she is aware of the situation.

6.  High Blood Sugars above 250:
Take a correction bolus and re-test in one hour. (see above for correction 
If blood sugar is coming down, your all set
If blood sugar is NOT coming down or is going up, check for Ketones.
An insulin injection is required by syringe and the site needs to be changed. 
Call Matthew's mother immediately.

7.  Buying Lunch 
On days when Matthew will buy his lunch at school, his mother will send a 
note to school in the homework folder for his teacher to forward to the 
school nurse and email his teacher at school and at home informing her of 
what he can eat for lunch and  of the amount of carbs in the lunch and the 
amount of bolus to give him.  In the even that Matthew does not complete his 
entire lunch, please call Matthew's for the corrected bolus amount.

A teacher or other adult must supervise Matthew at lunch in the cafeteria to 
be sure that he has completed his entire lunch.   This is important because 
Matthew is given insulin according to the total amount of carbohydrates he 
has eaten.  If he is given too much or too little insulin it can be very 
dangerous to his health.

     8.  Wednesdays
On Wednesday, Matthew will need to go to the nurse right after physical 
education class so that he can have an extra blood sugar test.  This needs to 
be done before he can go out to recess, so that we can be sure his blood 
sugar is in range for him to go out to recess.  This test will count as the 
two hour after the lunch time bolus. With warmer weather this is important, 
since Matthew tends to sweat more.  A juice box or extra snack may need to be 
given if he is low. See above for treatment.
Any exercise out of the ordinary, the teacher will need to let the parent 
know so that accommodations can be made with either extra snacks or less 
insulin.  Such as field trips, extra recess time, etc.

       9.  School Nurse (Diane Mancuso) in the event of her absence:
Please notify Matthew's Mother in the event that the regular school nurse is 
absent.  The school must then provide a trained adult to administer his bolus 

      10.  Special Treats
The teacher will have to notify the parent ahead of time for Matthew to be 
able to enjoy a special treat.  The parent needs to know what special treat 
will be given and at what time.  A days notice would be appreciated.  A note 
to the other parents in the class should be sent home making them aware that 
there is a child with Diabetes in the class and that unplanned snacks make it 
difficult to maintain proper health and blood sugars for Matthew.

In the event that the teacher or school nurse is absent, they should have 
written instructions for the substitute on Matthew's needs and schedule.

All other teachers that will be working with Matthew must be informed on 
warning signs of low and high blood sugars and what do to if they suspect 
either. This is to include the physical education teacher, art teacher, 
librarian, music teacher, speech teacher, reading teacher, and most 
importantly the other teachers on duty out at recess.

      11.  Field Trips
In the event that Matthew's mother cannot attend a field trip, the school 
must provide an aide or have the school nurse attend to test Matthew and give 
his bolus.  His testing kit and Glucagon injection kit must be brought on the 
This is to include trips to Wolcott Forest.
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