# [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 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
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
Correction
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
water

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
bolus)
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.

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
amounts.

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
trip.
This is to include trips to Wolcott Forest.
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