So sorry to be late with a reply, but I'm grateful to see the terrific suggestion you received from SS. If your son is in public school, they have a legal obligation to be far more responsible and to provide an aide if needed.
I know a woman who fought successfully to be involved in the hiring decision for the aide who helps her daughter (who is also developmentally delayed) **and** this woman provide works with a pump trainer to do the training. Close coordination is needed.
Don't stop 'til you get results. You may need to bring strong pressure on the administrators, sicne they seem to be violating the law and are clearly jeopardizing the well-being of your child. That nurse seems very unprofessional.
Good luck with this. You simply must prevail.
Immediately go to the principal. If no help there, go to the superintendent of the district. If no help there, go to the school board. You should not tolerate that type of treatment for your child. You and your child have rights and the school nurse obviously isn't properly trained.
I suggest that you follow foxylady's advice. The school is beahving and handling this completely wrong.
If you would like to talk to communicate via email with a volunteer like myself, please copy and paste the below link into your browser.
This is completely unacceptable.
I had to post again to give you some more specific information. These school issues really get me going because I have come across some ignorant people as well when it comes to my son and his care at school. If taking the steps that foxylady gave you does not get the proper care for your son, do the following:
1. Call the school's district office and find out who the 504 Plan Coordinator is.
2. Type a letter requesting a 504 plan meeting. Make sure you say that you include something along these lines somewhere in your letter.......
I understand we need to go through the eligibility process; however, I would like to also write the 504 plan at this meeting which will include a comprehensive health care plan, therefore the appropriate personnel needs to be in attendance.
3. Make sure you CC the following:
US Dept of Education
Office of Civil Rights
Your state's Dept. of Education
(Mail this letter to the depts. above, as well as your school's disctrict office to the attention of the 504 Plan Coordinator - his or her name)
(Before mailing these, get a letter from your son's endocrinologist stating what your son needs while at school or type it yourself and request the doc's signature - he or she can revise it where needed)
At your 504 Plan Meeting bring with you the signed letter from your son's endocrinologist.
I understand that your son is in middle school whereas mine is in 5th grade, but I have made a One Page Instruction Sheet that gives basics on what to do based on Blood Sugar readings
Under 80 do this
Between 80 & such and such do this
Over 250 do this
In addition, I have made a one page sheet that tells some symptoms my son might experience when low and high and explains the immediate need for something with sugar in it when he is low and that low blood sugar left untreated can cause convulsions, loss of consciousness and death. This sheet also has a photo of my son on it. I have made sure this is given to anyone employed by the school or volunteers who might come in comtact with my son. Lunch staff, yard duties, etc.
Promise to stay in school? As if he asked for this disease and wants to get out of school. They do not know how high / low blood sugar makes your son feel. My sis also has type 1, so last yr. when I had a meeting with the nurse & principal because of a problem, I brought my sis with me, so they could hear an adult's perspective because sometimes people discredit (is that a word?) children /teens.
You can submit a form reiterating the info. about the school by going to that page - the link I gave in my earlier post and possibly we can get hooked up one on one because I volunteer there, as well.
They let him wander around? They obviously do not understand the severity of low blood sugar. You need a 504 Plan.
I forgot to mention...my son is also a pumper. He is 10-1/2 and has had diabetes for 7-1/2 yrs.
This year, although he has supplies in the health office and in the classroom, he is doing most of his testing in the classroom. He keeps his glucometer in his desk and I brough in a plastic container with a lid that has juice boxes, some peanutbutter crackers, sm. gel frostings, batterise for the pump, alcohol swabs, etc. In the nurse's office he has all of the above plus more lancets and a glucagon kit. There is not a "NURSE" onsite. There is a District Nurse who floats around to different schools. At school there is a Health Tech. The Health Tech once told me "I still say the Lows are better than the Highs" She is very educated, huh? The District Nurse says she trained her.
Ea. year I meet with my son's new teacher prior to the first day of school. I am not looking forward to middle school wherre he will have more teachers...ughh!
My son has a cell phone in his backpack that is turned off during the day, but if he had to he could call me. I have always told the school that if he ever says to call his mom, they need to do so. My son also carries a small tube of gel frosting in his pants / shorts pocket, so he has a sugar source with him at all times. He is still in elementary school so the backpacks stay right out in front of his class and the only other teacher he has is P.E.
Where do I start.
We do have a 504 plan( it worked beautifully in elementary school) that states they are not to let him go anywhere by himeself when he is low. They told me last year it is not possible for them to know where every student is at any given moment? SCARY! I did go to the principal then the superintent of our district and you know what he said to me.. You'll have to excuse me I don't know much about this diabetes stuff . He had plenty of time to prepare for our meeting. I have meet with the 504 coordinator as well, he was at all those meetings( NO HELP). He is securely in the pocket of the district . As for the nurse she is only there one day a week and I told the VP I would rather she had no contact with my son. They didn't even think what she said was neccesarily a bad thing ugh! He has 6 teachers this year and one said to me the other day that he will be over this party soon and that will be good,when he is regular? what the $%#@& does that mean? Educated ,I think not! They treat me like I don't know what the heck I am doing , " all the other diabetic we have had in the school don't seem to have all these highs/lows. I swear some of his flucuation is because he knows No one there has a clue and if there is a big problem he's #%&$#$@( up a creek with no paddle). He carries a cell phone,gluometer,carbs. I feel like I am always fighting up hill with this district. Who can I get to come to my next 504 so I can rely to them the importance of his 504 and this disease. I just sent his teachers and VP this.
I got this from JDRF I beleive. I just want them to take this serious.
Teachers and School Personnel
Dante Rucker is different than other diabetics you may know. He is
on a regimen of Intensive Insulin Therapy and uses Insulin Pump.
Please take the time to read this information. Therapeutic strategies
for diabetes are changing rapidly and it is important that individuals
supervising young people afflicted with diabetes be aware of the
nature of the disease, the treatment as well as the problems that can
occur on a daily basis. Some of the material covered is technical;
however, I have tried to present it in a non-technical fashion. Much
of the information presented is applicable to other children (and
adults) with diabetes.
What is an Insulin Pump?
An Insulin Pump is a miniaturized version of the
device you see in hospital movies attached to a pole those meters bags
of "liquid stuff" into the patient's I.V. An Insulin Pump contains a
large syringe filled with insulin, a computer that allows the user to
time and adjust the administration of insulin to their bodies, and a
small motor to drive the syringe. Attached to the end of the syringe
is a sterile tube (infusion line) fitted with a needle which is
inserted into the soft tissue of the lower abdomen. The entire fluid
system (needle, infusion line, and syringe) must be changed every few
days to maintain a sterile environment and avoid infection at the
infusion site on the abdomen.
Diabetes Explained: Dante suffers from Insulin Dependent
Diabetes Mellitus (IDDM) also known as Type 1 Diabetes or Juvenile
Diabetes. IDDM is an AUTOIMMUNE disease that destroys the cells in
the pancreas that produce the hormone insulin which is required to
metabolize glucose (blood sugar) and provide energy for cells in the
body. People afflicted with IDDM produce no insulin whatsoever.
Approximately one million people in the United States suffer from
IDDM. Dante will be afflicted
with this disease until there is a cure. Another 10 to 12 million people
suffer from Type 2 (adult
onset) diabetes where the pancreas fails to produce enough insulin.
Type 2 diabetes is a 'different' disease with symptoms and
complications that are similar to Type 1 diabetes. Type 2 diabetics
can sometimes control their disease with diet alone or with the help
of oral medications.
Problems Associated with Diabetes
HIGH BLOOD SUGAR Without insulin the body cannot use glucose and
shifts from metabolizing carbohydrate (glucose) to metabolizing fat
for energy. This shift is accompanied by elevated blood sugar levels
(hyperglycemia) and normal, acidic by-products of fat metabolism
known as ketones. When fat is
the main energy source, ketones
accumulate and move the body's electrolyte balance into the acidic
range, causing excessive urination and dehydration as the body tries
to reestablish its acid balance by excreting the ketones. This life
threatening condition is known as diabetic ketoacidosis (DKA). Total
interruption of insulin to a person with IDDM can result in DKA within
4 to 8 hours.
Regular blood sugar testing can detect elevated blood
sugar levels and the onset of DKA and timely action can be taken to
prevent problems from occurring.
LOW BLOOD SUGAR Without an adequate supply of carbohydrate to
support immediate metabolic requirements, a diabetic may experience
low blood sugar (hypoglycemia). The symptoms of mild low blood sugar
may include among other things; tremors, tingling, palpitations,
sweating, anxiety, shivering, dizziness, confusion headache, speech
impairment, drowsiness, weakness, hunger, and blurred vision. Severe
low blood sugar is associated with impaired cognitive function that
results directly from brain glucose deprivation and may lead to
unresponsiveness, coma, or seizure. The changes mentioned above may
go unnoticed by a casual observer,
however, the person experiencing
low blood sugar can usually recognize and treat the symptoms without
outside help. Because symptoms of low blood sugar can rapidly
progress from moderate to severe if untreated, a person experiencing
these symptoms should not be left alone until action is taken and his
blood sugar levels are raised.
Known Long Term Problems Associated with Diabetes
and Long Term Elevated Blood Sugar Levels
Diabetic Retinopathy the deterioration and
destruction of small blood
vessels in the retina leading
to loss of vision. The
leading cause of blindness in
the United States
Proteinuria and elevated levels of protein
Nephropathy in the bloodstream
damaging the kidneys and
other organs. The leading
cause of kidney failure in
the United States.
Neuropathy damage to the nervous system
resulting in the loss of
sensation in the skin and
extremities. Combined with
the effects of
vascular complications, the
leading cause of amputations
in the United
Cardiovascular and damage to capillaries,
Peripheral Vascular increased risk of stroke,
Complications ischemic heart death, and
Any or all of these complications may appear in as little as five
years if blood sugar levels are not maintained at near normal levels.
Example: a 20 year old Diabetic has just undergone
eye surgery to forestall damage to her retinas (both of them)
caused by Diabetic Retinopathy.
Treatment of IDDM
For years, most diabetics have taken two and sometimes
three injections a day of insulin to control their blood
and manage their diabetes. With this level of control it is almost
impossible to maintain near normal blood sugar levels and the onset of
long term complications is inevitable. Since 1923 it has been
Recommended by endocronologists that blood sugar levels be maintained as
close to normal as possible. It was not until 1993, however, that it was
unequivocally demonstrated by the conclusion of the 10-year
Diabetes Control and Complications Trial (DCCT) that
sugar management can dramatically reduce the risks and complications
of diabetes. The trial consisted of 9000 patient years of observation
of one group of patients on intensive insulin therapy and another
group using the conventional 2 to 3 shots a day. The results of the
trial demonstrated for the intensive therapy group a 76 percent
reduction in the risk of development of retinopathy, a 54%
in incidence of nephropathy (kidney disease), a 60% reduction in
Incidence of neuropathy, a 34% reduction in the development of high
cholesterol, and a 41% reduction in the risk for heart attack and
The intensive therapy group used two methods to control their blood
1) Multiple Daily Injections (MDI) consisting of three
or more injections of insulin combined with regular
testing of their blood glucose levels;
2) and Continuous Subcutaneous Insulin Infusion (CSII or
more simply - new technology in the form of an Insulin
Pump) combined with regular blood glucose testing.
"Intensive Therapy" is just now emerging onto the clinical scene with
the publishing in 1994 of the results from the DCCT.
Example: When a friend went to diabetes camp in 1994 there were
300 kids and 30 to 40 counselors. Only one counselor had an
Pump. The summer of 1995 the camp participants counted 3 pumpers (one
counselor, the friend and one other kid).
Conventional insulin therapy practiced by most diabetics requires
testing blood sugar 5 or 6 times a day and the periodic injection
of a long and a short acting insulin. Meals and exercise must be
carefully controlled and timed to
match their body's insulin uptake
and energy needs. The most noticeable element of this type of
management is the periodic snacks required to maintain adequate blood
Insulin Pump users test their blood sugar 4 to 8 times a day and
program their Insulin Pump to provide a continuous small drip of
insulin that matches their body's background (fasting)
requirements (this is called the "Basal Rate"). In addition, pumpers
program their pumps as needed to provide the exact amount of insulin
to match the food they eat at the time that it is consumed (this is
called a "Bolus"). The management effect of an Insulin Pump can be
approximated by using MDI (multiple daily injections) and frequent
blood sugar testing, however, MDI to achieve intensive therapy is
more rigorous and difficult to maintain (especially for a kid).
What's Normal Blood sugar levels for a non-diabetic fall in the 80 to
120 range. Glycosylated hemoglobin levels ( a measure of average blood
sugar levels over a three month period) for a non-diabetic average
around 5%. For a diabetic, consistently maintaining near normal blood
levels of 170 or below on a day-in day-out basis will produce a
Glycosylated hemoglobin level of around 7% and a reduced incidence of
complications as demonstrated by the DCCT. At Dante's last check up his
hba1c was 7.1 (very good). In the course of a day, a Diabetic in "good
control" may have blood sugar levels that swing from 50 to almost 200 with
the teenage years this is almost impossible. The body's blood sugar
servomechanism does not work and is replaced by machines; i.e., a
Glucometer, Insulin Pump, and the brain of the patient to close the servo
loop in real time. Blood sugar control for a diabetic is analogous to
steering a car on a Winding road from the back seat with two long rubber
bands attached to the steering wheel while
watching the road through the wrong end of a telescope.
What does this mean for you as a teacher or office staff??? Now that
you've read all about what can go wrong, what happens on a day to day
basis? Usually everything works OK and Dante takes care of
problems that develop. Diabetics need the people around them to
aware that they may suffer from low blood sugar and need
assistance to correct a SEVERE low blood sugar or simply your patience
and indulgence until they can correct a MILD low blood sugar. On the
average, diabetics suffer a reaction which requires the assistance of
others a couple of times a year or less. However, not to get
complacent, moderate low blood sugars can and often do occur on a
daily basis. Diabetics on intensive therapy
on the average suffer 50%
more low blood sugar reactions. Dante suffers 2 to 5 mild
reactions a week which he has always caught and corrected himself.
Someday this will not be the case and that is why the people around
him must constantly be vigilant in the event that he needs your
ABOUT your child
name Dante Rucker
Address 432 Briggs ct
PARENTS: Desmond & Christine
WORK PHONE 622-3700/521-3601
DOCTORS Dr. Maney 783-7109
HOSPITAL UC Davis
If Dante is in need of medical treatment it is IMPORTANT that
the medical team be aware that she is an "Insulin Dependent Diabetic".
It is common practice for emergency rooms to give patients fluids and
glucose which is not necessarily a good idea for diabetics.
YOU Dante can usually tell when he/she is LOW and will
NEED test and correct blood sugar levels as needed
TO however, if he appears shaky or upset when there
KNOW is no apparent good reason ASK IF HE/SHE IS LOW
THIS AND ENCOURAGE HIM/HER TO TEST BLOOD SUGAR LEVELS. IF YOU
SUSPECT LOW BLOOD SUGAR, DO NOT LEAVE HIM/HER BY ALONE OR
ALLOW HIM/HER TO GO OFF ALONE WITHOUT
Physical exercise is not appropriate when Dante's blood sugar
levels are below 80 or above 150. He can correct a low blood sugar
in 10 to 20 minutes using fast acting carbs but should have food
containing carbohydrate for long term correction. High blood sugars
can be aggravated by exercise and may take several hours after
insulin infusion to return to acceptable levels.
Dante can usually correct high blood sugar levels in
anticipation of a meal within an hour using an accelerated bolus.
However, if he/she uses an accelerated bolus to lower blood sugar levels
there is an increased risk for low blood sugar, he MUST eat within
the appropriate time frame to avoid a subsequent severe low blood
sugar level and insulin
In the event Dante experiences a severe insulin reaction (low
blood sugar), he carries in his pack the following items.
1) 20 grams of carbohydrates take 20 grams of fast acting
carbohydrates( fruit snack, juice- he
needs sugar) Have him call home after he
has walked to office with a buddy. He
can eat two or three snacks if he is
low . Make
sure his tester comes to the
office with him. Make sure the office
knows he is low and waiting for me. He
should never walk alone when low.
3) Cell Phone Call 911 Call 911 and notify responding team that
he is a diabetic on a pump then call
Sports and Exercise
Physical activity increases the body's need for
glucose and lowers blood glucose levels (as long as there is adequate
insulin). Most ordinary exercise that is not strenuous or prolonged
does not require any particular action on the part of the diabetic
person. Prolonged physical activity such as marathon runs, or other
activities that extend more than an hour, AND PARTICULARLY Running,
require the intake of additional energy (glucose). Dante
burns an extra 10 grams of carbohydrate an hour while swimming. You
may see Dante munching on a cracker or other snack before or
during exercise. This is normal.
Thank you for taking the time to read this and help Dante. Please feel free
to contact me if you have any questions.
Desmond and Christine Rucker