April 7, 2002
School and Daycare
Question from Clio, Minnesota, USA:
I assist in the care of two children with type 1 diabetes at an elementary school, and we have a seven year old little girl who seems to run very high numbers (250-350 mg/dl [13.9-19.4 mmol/L]) most of the time when check before lunch.Sometimes when she comes into school in the morning, she complains of feeling dizzy — and her numbers at that time have been over 300-500 mg/dl [16.7-27.8 mmol/L]. When asked what she ate for breakfast, she is most likely to reply, PopTarts, ChocoDonuts Cereal or Strawberry Toaster Strudel. Her snacks at school tend to be cookies or candy bars (albeit snack sized). We are concerned with the child’s health and well-being, as well as our liability in this matter, but her mother seems to think that this situation is fine and that we should not be concerned with her numbers or what she is eating. Do you have any advice for us?
Answer:
My advice is simple. Please ask the mother if you may speak with the child’s physician. The mother will need to provide written permission for this. Your rationale is clear and should not seem as any form of subterfuge. You must care for the child at school, and you need guidance and orders as to a number of possibilities including when to check glucose, when, if ever, to consider giving extra insulin or glucagon, when to check for ketones.
Depending on the child’s diabetes care plan and meal plan, then the snacks may indeed be sanctioned by her healthcare team (although, frankly it would surprise me somewhat). It would be helpful to know whether the child is followed by a pediatric diabetes team and/or pediatric endocrinologist.
DS
