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March 10, 2002

Hypoglycemia, School and Daycare

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Question from :

I am a nurse and am raising three grandchildren, one of whom has severe hypoglycemia, and I have several questions:

No one has any classes for him to learn how to eat, how to monitor his blood sugar, etc., because he is does have diabetes.
He cannot go to summer camp because of his specialized diet, and diabetes camps will not accept him because he does have diabetes and on insulin.
I cannot find materials geared for a child to read about his disorder which is so much like diabetes because there are none.
Teachers still give him candy and do not assist him with his diet, but they will not allow him to test his blood sugars because he does have diabetes.

Can you please tell me why?

Answer:

I cannot understand why you can’t get the help you need to put a meal plan in place. The pediatric dietitians I’ve worked with are very comfortable in outlining a diet and providing materials for you to read and learn from. For most (but not all patients) with hypoglycemia, a common dietary approach is what you have alluded to: decreased refined and “simple sugars” (i.e. table sugar, juice, candy, fruit) and increased complex carbohydrates (i.e. starches, rice, pasta, potatoes). Sometimes extra protein helps, but there are specific conditions in which increased protein may exacerbate hypoglycemia. If there is family history of this, it may be wise to have specific testing done for mild increases in insulin. Sometimes this must be done with a lengthy 12-36 hour fast in the hospital. One form of inherited excess insulin can be screen with measurement of ammonia in blood.

I often will instruct patients in home glucose monitoring, as if they had diabetes. The school should be able to follow doctor’s orders/instructions. You may only need to check glucose levels before meals, and bedtime, and whenever there is a suspicion of “a spell” of hypoglycemia. Teacher’s should accommodate. Ask for a 504 plan written by your grandson’s doctor to provide specific instructions at school and ask for a mature, adult conversation with the principal, teacher, and school (or district) nurse to find some common and middle ground. Everyone’s effort should be in the well-being of this child. Certainly a teacher’s job is to teach (and they don’t want added responsibilities if they can help it), but a child can’t learn very well if he has hypoglycemia.

I am surprised that summer camps are not more accommodating. Ask the director whether or not they’d accommodate a vegetarian, or for religious reasons, someone who does not eat pork, or for someone who was allergic to certain foods, like eggs. If the answer is yes, then I’d think they should be able to provide complex carbs, limit simple sugars, etc. Is your grandson on some other type of a diet? I do not think that it is unreasonable to expect a diabetes camp to not accept a child who does not have diabetes. They probably have limited resources and a waiting list to get in with a limited number of bunks.

DS

[Editor’s comment: Even though your grandson does not have diabetes, these same laws apply. See The Law, Schools, and Your Child with Diabetes]

SS]