Getting pump week into school.advice wanted

So despite my begging for an appointment three months ago for a pump start up, our doctor refused to schedule it until after my daughter’s late July appointment where we ordered her pump… So that means she will be starting her pump a week into her school year starting. She is twelve and was diagnosed about fifteen months ago. She is extremely independent and receives very little supervision at school. But I want her teachers to actually check her meter the first few weeks she is on the pump, knowing how intense and easily things can go wrong at first. She does recognize when she is high or low, I worry she might not be aggressive in her treatment, (insulin or sugar) if she is busy and doesn’t want to stand out. She usually is great, I just worry …so do I just tell the teachers to keep an eye on her behavior, or do I ask them to look at her meter? She wants no assistance.

I'm not sure if a teacher would be willing to check her meter... it's beyond their expertise and the school might have liability issues.  Definitely check with the teacher first.  Just as a safety precaution it's smart for your daughter to tell her teachers on the first day of school that she has type 1 diabetes and if she acts oddly the teacher should get her to eat/drink some sugar and then call the school nurse or you.  Your daughter also needs to let her teachers know she may need to eat in class to treat a low.  I was diagnosed at age 4 and did this every year of school; it wasn't a big deal and my teachers were always cool about it.  I never had a low in class that was so severe I needed help.

Your daughter will have highs and lows during her first week with a pump.  Most doctors/diabetes educators will start your daughter out with a standard basal rate (that's the base rate of insulin the pump delivers) of .5 or 1.0 units an hour.  Then when your daughter has highs and lows the doctor will adjust the basal rate based on those numbers.  Ideally a person will fast a lot for those first days or eat low carb so the basal rate can be set accurately.  I started out with a 1.0 unit an hour setting, but after trial and error found my body needs 6 different rates throughout the day.  They currently are between .4 and 1.4 units an hour, but I still have to adjust them occasionally.  Growth spurts, stress levels, adding exercise, gaining weight, eating differently, can all require basal adjustments.  

For the first month with a pump your daughter will have to test a lot and log the results and be ready to treat the inevitable lows and highs.  If she can't handle this on her own, she needs to do it under your supervision.  That's way too much to ask of a teacher or anyone else who isn't a diabetes expert or medical professional.

Starting back to school usually affects blood sugar, between the excitement and schedule change from summer.  You will be able to get her started on the pump in the first few weeks of school, but I think it will be a smoother transition if you wait until Fall Break or at least a 3-day weekend.  When I got my pump I'd had diabetes more than 20 years and was adept at adjusting my own insulin.  But there were constant basal changes needed in that first week and I also had to make lifestyle changes, like figuring out which clothes were pump-friendly, getting used to sleeping with the pump, and doing the first site changes.  It took about  a week to adjust.  

If you don't have it, get John Walsh's book "Pumping Insulin."  It's a great resource that I've used for the 12 years I've had a pump.

When my 5 yr old started the pump, the first week was with saline - went thru all the motions as if the pump was functioning w/insulin.  That may help with some of the unknown.  Our lives are pretty much the same year round so it didn't matter if we started at the beginning of school, a Monday, a Friday...wasn't really the issue.  We decided that the pump was going to be our method of insulin delivery so we just went for it!  Best of a bad situation, but it has made the daily treatment more effective and efficient!  Good Luck!  PS  We love the Animas Ping, hope her's works out well for her!

I'm working on a similar issue with my 12 almost 13 year old who was diagnosed almost 2 years ago. She just has to check in with the health office at lunch time. They are not necessarily trained on the pump, but there are a few diabetics at the school, so they are very aware of her needs. We are fortunate in that the health officers are respectful of my daughters wishes and allow her to do it on her own, they just observe and take notes.

As far as the teachers, they probably won't be able to help monitor her pump due to time constraints. Instead, I requested that each teacher have a small stock of juice boxes on hand for lows. I supply them and they just keep them in a drawer with her name on them. Its peace of mind for me. I bet your school would even make an exception to the "no cell phone" rule and allow her to text you between classes, at least while she gets the hang of it.

We waited too long to start the process, so now her estimated pump start is 3 weeks after school starts. I dread having to wake her up twice in the middle of the night during school year, even if its just til we get used to it. But I guess there's no perfect timing for anything!

So Kendra, am I understanding that your daughter is starting her pump this fall too?  Let's connect.  Mary is 12, diagnosed 15 months ago.  Ready for a pump.  I am dreading the waking her up at night.  We only have to do that once a week or so now, depends on how her day has been.   I am a teacher and go back to work the same day as her school starts.  Then two weeks into it, she gets her pump started.   My job is intense, I can't even use the bathroom half the time, so I dread having to stop and answer her calls, but I will do what it takes to make it smooth for her.  Her school is pretty cool with whatever we ask, but they don't have anyone trained in the building, except for glucagon training.  So she is on her own, but they will call me if they need to.  Let me know about your daughter and her start up.  Good luck!

My daughter has been on the pump for 5 months now and she starts kindergarten in 3 weeks.  I was (and still am) very concerned about the oversight as she is so young and still requires help with all of the steps as well as someone to recognize lows as she is not always aware, yet.

If you haven't already put a 504 plan in place, it is something you might consider.  JDRF has a great School Advisory Kit which provides a lot of great information for addressing the various concerns.  They also give a sample 504 and suggestions as to common recommendations for accomodations that should be made for your child.  I'm not sure if you are in the US, but if your child is and is in public school then based on input from you and your medical care team you are entitled to get the necessary accomodations for your daughter.

Our 504 includes even simple things, but important, such as requiring all classrooms our daughter will be in to have emergency juice/snacks on hand (provided by me).  Any staff that will be directly responsible for her care is trained in signs/symptoms of highs and lows.  She needs to be allowed to use the restroom whenever necessary, have water available to her at all times, be provided a place inside or just outside the classroom to check her sugar.  She is never to be sent to the nurse unaccompanied if low BG is suspected.  If her BG is above 250 or below 80 she can reschedule any exams.  And so on.  

Check out the JDRF site it may give you some guidance on what things you can have in place for her that won't interfere with her wanting to do it on her own, but at the same time have the tools there for when she does need them.

this is our second year at school with T1D.  Last year I made a 504 from the website and brought it in to talk with the school about.  Wow.  The principal freaked, did not want one!    So me, being new at all this, let it go.  But she got all we needed, basically.   This year is a new, still to be announced, principal.  I did not do a 504, but the nurse has been really on top of stuff, except she isn't at the school.   So it is up to the teachers.  She is training, but not each teacher, my daughter has 5-6 different ones a day, on glucagon.  But not really on the highs/lows spotting, etc.  So it is frustrating.  All I really want is someone to actually look at her meter once or twice a day and see if she is in range.   But then I am told, they aren't trained, etc.  Well, if I write below 60 is  a problem, above 300, a problem, call me, even a ten year old could handle that.   I dunno.  Just frustrated.  And she is so against my asking them to look at her meter.  So I will just be in touch.  Fortunately, two of her main teachers have had my other children so I feel comfortable with them.