Implementing a Diabetes Care Plan
So you have written a fantastic, concise, comprehensive Care Plan for your T1D child at school… now what?
The next step may be to figure out how to put that plan into action by sitting down with your primary contact at your child’s school (this may be a teacher, the principal, the school nurse, a teaching assistant, or a combination of these people). At this meeting you could discuss: Who will do what and when? Where will supplies be stored, where will your child check her blood glucose? What structures and procedures need to be created at school to keep your child safe and available for learning? What do you need to do from home to keep things running as they should?
Planning the Day
A good place to start is with the existing school schedule. School staff can tell you what a typical day may look like, including when recess, lunch and physical education classes occur, as well as any other day-to-day events that may affect your child’s blood glucose. At our school meeting, I jotted these times and events on a blank piece of paper so I could visualize the structure of the day and the time between significant events.
You may need to construct more than one template if your child’s school schedule changes from day to day (Phys. Ed happens at a different time on MWF than on TR, for example; or the schedule runs in a 6-day cycle, where timing on Day1 is different from Day2, etc).
Next you may want to figure out where your child’s blood glucose may be in question, and, therefore, when blood glucose checks are best conducted.
When Might Problems Occur
You may then want to take a second look at a typical day, walking through it in your mind to anticipate when trouble spots may occur. When and where might your child need access to her monitor? When might she need to take a low treatment? Where could necessary supplies be stored for ease of access? Once you have identified potential issues, discuss possible solutions with school staff.
You may also want to consider where your child could be when he experiences a low, so that low treatments may be stored at that location. Perhaps there could be a “stash” in the gym, the library, or the main office (with locations known by key adults, as well as your child).
Often the most important factor for successful diabetes management at school is the quality of communication between home and school. In order for you to troubleshoot and adjust procedures effectively as needed, there needs to be a reliable system for parents to communicate with school staff, and for the school to communicate with home. This may include a written communication system, such as the Agenda booklets that many schools use for all of their students, as well as a verbal communication system when needed: Which phone number does the school call if they need to contact you quickly? Who should you contact at the school, and how do you get a hold of them? Some students with diabetes have their own cell phone with which they may communicate directly with their parents if they need support during the school day (you may choose to establish a rule that this phone is to be used for diabetes-related issues ONLY). Some parents and teachers text each other on their cell phones. Others use email. There are many options for communication – the key is discussing with school staff which option seems most appropriate in your situation.
In order to track blood glucose patterns during the school day, you (or the school, for record-keeping reasons) may want to keep a log of when blood glucose checks were done, and what the result was. If this is the case, you may want to discuss who will be responsible for writing in this log, how often it will be reviewed, and how you will be able to access it when needed. (Will it go home every day in your child’s backpack? Will it be an online record?) This record may be less important if your child wears an insulin pump with integrated blood glucose meter, as the pump history will automatically keep a record of blood glucose checks and insulin delivered.
To communicate the carbohydrate content of snacks and lunches brought from home, we have found it useful to stick a carb label on food containers, or in our son’s blood glucose meter (where he will need it right after his pre-lunch BG check, to input the lunch carbs into his pump). Whether you count the carbs for your child, or your child counts his own carbs, a label is a convenient reminder of the carb content. Large dot stickers (like those often used for pricing at garage sales) are handy – just jot the number of grams of carbs and stick one on each food item. Or rectangular file labels, which are the medium of choice in our home, can be preprinted with:
Preprinted File Labels Containing:
For a printable carb label template:Carb Stickers For School Snacks and Lunches
Fine-Tuning the Plan
Now that you have a day-to-day plan implemented, you may find that there are some unanticipated issues within your child’s school day. You may find that you have to fine-tune the initial plan to better suit the new realities of which you have become aware. Both parents and school staff should feel comfortable with bringing forward their observations and suggestions – either at a pre-arranged semi-formal meeting time, or through any of the day-to-day communication channels you already have in place (text, phone, email, agenda books).
It’s okay if things don’t work as well as you planned initially. Through a continuing process of communication and fine-tuning, your child’s school days are bound to improve over time.
The above information was reviewed for content accuracy by clinical staff of the Alberta Children’s Hospital Diabetes Clinic.
This material has been developed from sources that we believe are accurate, however, as the field of medicine (in particular as it applies to diabetes) is rapidly evolving, the information should not be relied upon, as it is designed for informational purposes only. It should not be used in place of medical advice, instruction and/or treatment. If you have specific questions, please consult your doctor or appropriate health care professional.
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