Thursday, August 12, 2010


Preface: The following post, like all material contained in this blog, is not intended as medical advice. In addition, I would like to THANK Joe's school for all that they have done in making school a safe environment for children with type 1 diabetes.

So, a lot of us D-Moms are talking about 504 Plans, educating school personnel...etc. This is Joe's 3rd school year with the public school system. When he started kindergarten 3 years ago there was a "weak" substitute school nurse system in place at his school and the district refused to delegate nursing tasks (which included EVERYTHING diabetes related...even checking a blood sugar and giving "life saving" sugar to treat a low). I told them that this was unacceptable. If the school nurse was gone, no one was in the building that could help my FIVE year old son check his blood sugar and/or treat a low by simply giving him sugar tablets. After graciously, but firmly presenting my case, the district provided incentives to "bump up" their pool of substitute nurses and this has been a non-issue since.

This, however, caused me to take pause....

and think.....

What would happen to Joe in a Lockdown Situation? If no other personnel are allowed to be trained on even simply giving him sugar...what if he was low and locked in a classroom due to an unsafe situation going down in the school. Is it acceptable to rely on a FIVE year old to take care of "D" on his own? Well I am 38 and I can barely handle it - so NO. This was not a safe situation. I realize we cannot ensure our children's' safety 100% of the time. We cannot forsee all the dangers that they will encounter. I could not, however, sit by and be "OK" with something that I could improve upon. I am not one to "panic" or "freak-out" over every last detail. Yes, there is only like a 0.001% chance that a Lockdown could happen here in Vermont at Joe's elementary school of all places. But hey...guess what? It did happen a few years ago. A school one town over had to Lockdown do to a gunman in the school. So it can happen even here in Vermont...and from what I have heard it happens much more frequently in schools throughout the country. I wasn't comfortable with Joe's situation.

So I changed it.

I have done all the education of the non-licensed medical personnel in Joe's school. They are allowed to perform blood glucose checks, treat lows, and administer Glucagon in Lockdown situations ONLY. They are not allowed to administer insulin and so you will notice if he is high, they are instructed to give non-carbohydrate fluids, but not insulin. I will have to sign a waiver stating that Joe is "independent" with his care in order for him to administer insulin, which I may consider doing this year. I wasn't ready to do that when he was five for obvious reasons.

Here is a procedure that I came up with:

First let me start by saying all of Joe's diabetes care is done in the Health Office. So this is why this plan is important to someone in his situation. It may be different for those of you that have the care being done in the classroom (we are moving to more "classroom-care" this year).

Emergency Preparedness Plan for J.M.'s
Diabetes Management

When will the Trained Non-Medical Personnel help J.M. with his diabetes management?
During times of In-Shelter Lockdown, Trained Diabetes Personnel will help the child with his/her diabetes care. Routine diabetes care (ie insulin administration/carb counting/etc) will be managed by the School Nurse or a parent. Parents must be notified if the School Nurse is not available for routine diabetes care.

What Tasks are to be performed: 1) Help/remind the child to check his/her blood sugar. 2) Help the child treat a low blood sugar. 3) Call parents or contact School Nurse for a blood sugar less than 70 or greater than 250. 4) Give Glucagon if the child is unconscious or having a seizure.


In-Shelter Lockdown:

1) Check or remind the child to check his/her blood sugar at the beginning of an In-Shelter Lockdown, if the child complains of or is showing signs of being low, and every 2 hours for the duration of the Lockdown.

  • If the child's blood sugar is less than 70 - see the "Treatment of Low Blood Sugar" procedure.

  • If the child's blood sugar is between 70 and 90, please give the child 1/2 of the granola bar provided.

  • If the child's blood sugar is greater than 250 - please notify the School Nurse and call parents immediately once the situation permits. Encourage the child to drink sugar-free fluids.
2) Please do not give the child food or fluids that contain carbohydrates during an In-Shelter Lockdown ... as he would need insulin to cover the food. (He may have the sugar/granola bar for the treatment of a low as outlined above).

3) If the child is unconscious or having a seizure - give the child Glucagon - see the "Glucagon Administration Instructions".

The above document is all well and fine you think...but how is it executed?

The 504 Plan: In Joe's 504 it states that he will have access to diabetes supplies and trained personnel during an In-Shelter Lockdown.

The Actual Mechanics of the Plan: There is a bag with a back-up glucometer, strips, batteries, sugar, granola bars, Glucagon, and one bottled water that "travels" with Joe's class. He always has access to the supplies and the classroom aid is trained to use the contents in the bag. I have a folder in the bag with short and simple instructions on everything I have taught. Treating a low and Glucagon Administration are laminated and placed on the front and the back of the folder and any additional information is placed in the folder. People feel more at ease knowing the information is there.

The "tattered folder" - the quick and dirty on treating a low with phone numbers (mine, my husband's and the Endocrinology Group)

Glucagon administration instructions on the other side of the folder

And there you have it...another "day-in-the-life"...what those of us with young type 1s need to do to ensure our children's safety.

SIDE NOTE: Please see other documents made for school in the side bar... general "d" info for the school, daily logs that travel back and forth between home and school, blood sugar check procedure etc. Please use any and all documents and tweak to your needs. I am soooo tired of us all having to "re-invent" the wheel. xoxo


Lorraine of "This is Caleb..." said...

You go girl!

We actually had a bomb scare in our school (before Caleb started there) and all the kids were sortof "locked down" at a local fire department. It's not something you think will ever happen, and it probably won't ever again happen here, but we're prepared if it does!

Wendy said...

THANK YOU SO MUCH! I'm going to throw some of this into our 504 too. This is really great information....thank you SO MUCH for sharing!!!!!! I love that you have so many helpful documents to share :)


htimm=) said...

Thanks so much for this post. I have the daunting task of writing my first 504 looming over me. I am trying not to let it overwhelm me but the truth is that it feels like I am standing in front of a giant mountain that I have to climb. With the advice and support from other D-moms like you, I can tackle this mountain head on!

Renata said...

This is AWESOME. I never went as far as thinking about a lockdown situation, but should have living in Dallas with the tornadoes. My youngest diabetic is 11 and I still go in and train the school teacher(s). He is going into High School next year and he has asked that I not go in and train everyone. So I am going back on doing the American 504 plan or a version there of. Since we have been in NZ I only have to do a very specific list and give it to his homeroom, aides, music, pe teachers after they have been trained. Nurses were still in schools when when my eldest diabetic was in school, so the 504 was simple. (for us anyhow)

I think this is pretty amazing. I wasn't going to post today, but if you don't mind I am going to repost your info for others to read.

Reyna said... are always welcome to re-post anything from me.

@ Wendy - THANKS...I just want to make things easier for everyone out there. It can be a huge task ensuring the safety of these children. Please use anything. I actually have a few other documents that I should add.

Shamae said...

Great!! I love this! Thanks. I think I will prob just incorporate this with Syd's 504 this year! you ROCK my world woman!

Melanie said...

Call me please my dear tomorrow if you can - i left a message earlier on your machine. I feel like htimm - very overwhelmed - and found out today there's no school nurse yet - unexpectedly and kathleen not here to help and guide me. I need help! Where do I begin?