Sunday, September 9, 2012

1st Grade - It Takes A Village

Natalie has been back to school for a couple weeks now and her Omnipod is working out great so far!  She is really enjoying eating a carb snack in the morning rather than the peanuts and cheese she had every day last year.  I know when the first birthday treats show up she will love enjoying the treat with all her classmates rather than bringing it home as well.

I met with her 1st grade teacher, Mrs. Gray, and the nurse, before school started to train them how to check her BG and administer insulin using the PDM.  The nurse is only there one day a week and our beloved Mrs. Gray who handled Natalie's care last year agreed to do the majority of her care again although she is not in her class this year.  Just knowing that everything went so well last year made this meeting quite a breeze.  Really, the PDM walks you through everything step by step so everyone was pretty excited about how easy it is to use.  After checking BG, it asks you "Do you want to eat now?" and you press yes or no, enter the carbs, and it calculates how much insulin she should get.  Mrs. Gray has a now adult daughter with T1D and she uses expired glucagons to practice mixing and drawing it up in a syringe.  (Glucagon is used in an emergency if she were to pass out from a low blood sugar.)  I thought that was a great idea so I brought one of our expired ones (thankfully we have never had to use that scary red box) and we practiced with it.  Everything is more fun with Mrs. Gray (yes, even practicing glucagon!) and I was quite surprised with just how easy it was. I have been scared to death of that thing for 2 years and now feel less intimidated.  I have a sheet in the school binder that explains simply how to mix the glucagon and Mrs. Gray said if our girl passes out she is not going to get the binder to read how to do it!  Ha ha...she always knows how to put everyone at ease.  Natalie's 1st grade teacher has grown up with a knowledge of T1D because her Mother has been living with T1D since the age of 14.  When we pulled out the glucagon she said, "Oh yeah, I've had to give that to my Mom a couple times."  Now, I don't like that she had to administer it to her Mom because she passed out, but really how great that she has actually done it before!  I don't anticipate Natalie needing it but it does give me an extra sense of comfort knowing she is in class all day with someone who is very capable of administering it if necessary. Her teacher also has gestational diabetes so she checks her BG throughout the day too. She will be on maternity leave for 4 weeks, but we will deal with that when the time comes! The other 1st grade teacher will be on maternity leave right before her, so it is quite a year for 1st grade!   Isn't it amazing to think how God is using these two people and their different experiences with T1D to now help and care for Natalie?  It makes me wonder how God will use this later in Natalie's life to help someone else. 

The plan for the school day is that Natalie grabs her backpack (which holds her PDM and daily log) and walks with a buddy across the gym to Mrs. Gray.  Mrs. Gray checks her BG and administers insulin for her morning snack.  Then at lunch time Mrs. Gray comes to her and checks her BG and gives insulin for lunch.  Mrs. Gray still works the lunch room so she is always able to keep an eye on Natalie and make sure she eats everything (which has NEVER been a problem for her).  Since the pod is still so new and we are trying to get a good routine down she is also checked in the afternoon before recess.  Mrs. Gray checked her the first couple days and then her teacher took it upon herself to check her!  I came into the classroom early that day and Natalie and her teacher were huddled together at her desk and she had just checked her BG.  I can't tell you how heart warming that was to see her teacher take the time to do that and go above and beyond in caring for my daughter.  She said she had just checked and Natalie's BG was 80, and she asked Natalie "So what do we now?"  Natalie said "I think I probably need to eat something."  (Her teacher knew what to do, she was just confirming.)  Her teacher was so excited that she checked Natalie's BG.  It was very sweet.  She has checked her every day since in the afternoon and handled what type of snack or none at all to give her just perfectly.  It brings tears to my eyes to see in action all the details I have been nervous about falling into place perfectly.  When will I ever learn that God has a perfect plan for Natalie and He continues to provide a way for her to attend this wonderful school?!

The second day of school I read the book "Taking Diabetes to School" to the class.  About half the kids were in her class last year, so it was good to be able to talk about the pod and her new way of managing diabetes to everyone.  It was really fun to change the wording in the book yet again and say "Natalie USED to get shots, but now she has a pump!"  Natalie got a big smile on her face for that part.  I sent a letter home with the parents again as well.  I wondered if it was really necessary to send the letter this time, but I am glad that I did.  Several Moms new to the class told me how much they appreciated the letter and that it was very informative.  So maybe I'll send it every year!  It's a great way to educate others and raise awareness.  Another Mom told me she had gestational diabetes with her past pregnancies and she would be more than happy to check Natalie's blood sugar if ever needed and to be trained on using her PDM.  Another Mom that was helping in the class one morning said she is a nurse and would keep an eye on Natalie and could help her if needed as well.  So many in the village willing to come along and help Natalie and the team caring for her! 

The first week I only went in twice to oversee the BG check and insulin dosing.  It is just SO easy to work the PDM and Mrs. Gray had it down in no time!  The first day, Mrs. Gray and I were not quick enough with the BG check and Natalie even huffed at Mrs. Gray and said "this is taking forreeeever."  Just another sign of my girl becoming more and more confident, so we'll take her attitude every once in a while. 

I was concerned about the timing of fruit break and lunch because we are not used to giving insulin in between meals.  She gets her breakfast insulin by 7am, snack at 9:15am and lunch at 11:15am.  That is a lot of overlapping insulin (since insulin continues to work for 3 hours).  It took a couple days to figure it out, but right now what is working for her is that at snack time she is dosed for her snack at a higher ratio than normal (1/18) and NOT corrected if her BG is high.  Then at lunch she is dosed also at a higher than normal ratio (1/18) but this time if her BG is high it is corrected.  If her BG is below her target number we let the pdm do the reverse correction and she gets less insulin.  The CDE suggested we change her breakfast ratio from 1/15 to 1/12.  Changing carb ratios bothers me so much for some reason.  Knowing she continues to have to receive more insulin per carb just scares me.  I am trying to accept this and realize this is just what her body needs.  Anyway, this ratio change has been easier to accept because it has actually worked wonderfully and I think we might have actually striked the dreaded breakfast strike!  Most days at school she has been around 150-200 2 hours post breakfast and then still in range at lunch time.  We are not seeing any significant low BG with this routine so I am happy with it, actually I am quite thrilled with it.

Natalie still makes me walk her in every day rather than dropping her off in the carpool line. Now that they do the pledges as an entire school (rather than in their individual classes) before going to their classroom, I also have to do all three pledges (American & Christian flag and Bible) before she allows me to tell her goodbye with our ritual of kisses and hugs. Now, don't get me wrong I am very patriotic and thrilled that they do all the pledges at her school every single day. I LOVE seeing her stand with her hand over her heart and hear her sweet little voice recite the pledges. I just would rather sneak out a little earlier and get on with my day! I guess when she is 21, I will remember these precious days! She decided I have to walk her in every day until she is in 8th grade.

She is in the same class as her buddy Cole from last year. I always meant to do a post about the two of them, so will still have to do that! They don't seem to be as interested in each other this year, which is just fine with Eddie! I am glad to see Natalie being independent and speaking up for herself as well. It took a little bit of time last year before she was comfortable and we could really rely on her to tell the teachers when she felt low.   This year, she already told her teacher the first week when she felt low and the LIBRARIAN the second week! That is huge that she told one of her extra teachers. Now she also reminds her teacher, "It's 2 o'clock, aren't you going to check me?"

Natalie has been doing a really good job recently of checking her own BG "all by myself".  She has always been able to tell anyone how to do it, but she still had some trouble with the "sucking up the blood" part.  She would then get frustrated so we didn't force it.  The PDM is much easier for her to use especially since it takes a smaller drop of blood.  Our goal was that she could check on her own by the end of the school year, so she is ahead of the plan! 

I will admit my anxiety has been at an all new level with this pod.  I was really feeling anxious the first week of school.  I have been so afraid of her pod falling off at school or her going high because the pod isn't working and I just didn't feel ready to send her to school with that pod attached to her body!  I was pretty anxious the first couple of days, but when I saw all the people in the village taking care of her and how smoothly it went the first week, I have felt much more relaxed.  So if the pod falls off or she is high they will call me and we will deal with it.  I feel so confident in the teachers that are taking care of her and it is kind of nice to have a little break knowing she is in such loving and capable hands while at school.  I feel a little guilty about enjoying a break.  I'm trying to make myself rest a little in the afternoon, because the nights have been pretty rough for me.  We are checking her a lot more than when she was on shots.  Depending on her BG, we are sometimes checking every 2 hours through the night.  Now I am just as worried about the highs not being treated since she has started to develop ketones so quickly a couple times.  While on shots, I could always count on the lantus to still bring her BG down some. 

Now I'd like to brag on my smarty pants girl about something unrelated to T1D.  She was tested on an extensive list of sight words and she was able to read the sight words up to a 4th-5th grade level!  So she has tested out of her sight words for the entire year already!  Is it weird that I kind of feel disappointed that I am missing out on studying sight words with her?? 

As for another smarty pants, Mrs. Gray noticed that when she tests Natalie's BG using the PDM it is not asking "use for bolus calcs" per my instructions on the daily log.  I could have sworn that it always asked that when checking BG, but we frequently use her old meter and manually enter her BG and it definitely asks at that time.  So after calling Insulet they initially told me it will only ask that if her BG is above her target BG, if below it will not.  I checked when she was high and it still did not ask so I called Insulet back.  This time they told me that it should only ask when going through the Home page and selecting "Bolus".  They said my PDM is correct when it gives the option of "Done" or "Next" after checking BG on the PDM.  I also posted this question in the Omnipod group on facebook, and I am getting varied responses.  Since we do NOT want her BG corrected if high at snack time, we must go back to the home page and bring her BG up that way and THEN it asks "use for bolus calcs".  So podders, go check your child's BG using the PDM and tell me if it says "use for bolus calcs" or if it gives the option of "done" or "next".  I just want to make sure nothing is wrong with my pdm and I give the appropriate instructions for school...although Mrs. Gray already has it figured out no problem! 

1st day of school:


 
Big hugs because they aren't at the same school this year:
 


Enjoying her snack at school (her buddy Cole is right across from her):



Natalie's new case that holds her PDM:




5 comments:

  1. I went to a private Christian school until 8th grade and I wondered how they would have dealt with my diabetes had I been diagnosed back then. I hope it would be how your school is handling it! Sounds like they are doing a great job!

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  2. First off...I am so glad that things are going well at school! Praise for that!!

    And second, I have to laugh at our kiddos being so parallel yet AGAIN. Adam also tested out of all of his sight words and is reading at a 4th grade level. Those two smarty pants!! Diabetes ain't got nothing on those two!!

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  3. Wow what an incredible team you have working together with cheerful hearts for Natalie's well being. You hear so many horror stories that it's wonderful to hear a very positive experience for all :)
    And of course Natalie is adorable, she sounds so similar to Ethan in her quest for independence, it must be this age!

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  4. Sounds like you have your DUCKS in a ROW...and so does the school. Mrs. Gray is a GEM.

    Oy vey on all those pledges though!!!

    And I bet Nat will be bolusing herself in no time...Joe could not stand how slow the school nurse was and started his own bolusing in K-garten. But of course.

    xo

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  5. oh my goodness its so much info!!!! Im excited to learn more about the pump/pod.. but it still makes me so nervous!!

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