High BG's at lunchtime at school?

My son, Leo, was diagnosed with Type 1 at age 2 1/2. He is now 5 and headed to Kindergarten at a private school this year and we a bit nervous. We are currently working on a testing plan for the school and I have a question about lunches. If Leo's blood sugar is high before a meal, we usually wait a certain amount of time after we bolus before he begins eating. But I'm not sure how to handle this at lunchtime at school, where there is a limited amount of time to eat before going out to recess. I'm wondering what other parents do? We are of course hoping he'll be in range, but what if he isn't??  I mean if he came in really high and was supposed to wait 20 or even 25 minutes, what do we do? I don't want him to sit there and watch everyone eat and then head out to recess while he sits and waits. On the other hand, I certainly don't want him eating his carbs before giving the insulin time to work... Suggestions?

Sometimes ideal diabetes care doesn't fit well into real life and you just have to do the best you can. It's okay to just take the insulin and then eat right away.  Maybe you could recommend he start eating anything low carb first.  Or maybe he could test 20 min. before lunch to correct any problem in advance.  Don't stress about this, whatever you decide to do will be okay.

Not sure this will make you feel better, but I was a diabetic kid in kindergarten before glucose meters or pumps or multiple daily injections existed.  My blood sugar was probably sky high through most of my early schooling.  I did fine in school and went on to get a college degree.  Everything worked out fine.

I now have a son who just started kindergarten.  He's loving it and I hope your son loves school too and has a great time.   Take care.

-Jenna

I try to follow a few basic rules for dealing with food when BG is high (> 175).  The first thing we do is use the pump to do a correction for the high #, plus the carbs which are planned for the meal.  Then, if at all possible, I try to get my daughter to go for a walk, do jumping jacks, or some form of light exercise to help the insulin work faster.  We will typically wait up to 30-60 minutes before eating any new carbs, depending on how high she is.  If she is over 200, we almost completely restrict any new carbs until her #'s are in range again, otherwise we are constantly chasing corrections.

So, a shorter solution for you at school lunchtime is to include an alternate meal of only protein, or perhaps ask the school administrator to make sure Leo does not eat any fast acting carbs if his BG is too high.  Pasta is a good source of slow-acting carbs and a much better alternative than bread if BG is high.  Not always practical, but still an option.

The advice I give most often, which has worked very well for us is to know the glycemic levels of all the foods your child eats most often.  And, to always pre-bolus at least 15 minutes or more, depending upon current BG numbers and the type of food to be consumed.  It works well for us, but took a lot of trial and error to figure out.

Hi. It’s wonderful reading responses. I always learn so much! As a third grade teacher in a public school, I can tell u that lunch flies by! Our 35 minute lunchtimes are usually ten minutes to eat and 15 minutes for recess. The other ten minutes manages to quickly disappear with the sock that is always mysteriously missing! One amazing thing abt our school is that we have a full time nurse. She actually discovered that my child had diabetes!

Sorry - not finished… I like Jenna’s idea of checking 20 minutes before lunch - then the correction can be made and a bolus - and Leo can eat on time. I also like Michael’s ideas of packing a protein lunch or pasta instead of bread, which he said is a slow acting carb. I must admit that with my son, we correct at eating time, and usually enter abt half the carbs he’s going to eat, as he often doesn’t finish a meal. If he continues to eat, we give more insulin via pump. His sugars run higher than we’d like - but he’s very active, athletic and has a good A1C.

Thank you all for your replies! They all provide much to think about. I suspect there will be a bit of trial and error before we find something that works for him. I do like the idea of having him start on carb free foods first.

My son's school is really good about working with us. We had a meeting with all of the staff that would be working with him this year and went over everything from his ratios to what his symptoms are for his highs and lows. They allow him extra time to eat if needed. Luckily he has recess right before lunch, so he can run off his highs. If he's low, they send him to lunch early.

hi, my son is diagnosed two months ago, his endo told us to get him on the pump as soon as he is ready. he is 41/2, just starting JK in Sept. we are seriously thinking about getting him on the pump but can't figure out how to give him insulin during the school time. Can't I get some advices from you?

Weide-

Pumps use base rates of insulin (basal) and extra insulin to cover food and correct highs (bolus).  

If the school has a nurse or someone else who can be educated to give insulin with the pump, then ideal is to have your son test his blood and take an extra bolus dose to correct and cover the carbs he'll eat at lunch.

Over time your son will become adept at dosing his insulin to correct and carb count, but he'll still need adult supervision with this for a few more years.  

Another option, if your son will have a set schedule and if he usually eats all of his lunch, is to program the extra lunch insulin into his basal rate.  So at 11:30am or whenever he eats lunch, his basal rate will increase to 4 units or whatever it will take to cover lunch.  The danger of this is that the insulin is there, so if he's low before lunch or doesn't eat all of his meal then it will cause a low.  But it can be pretty effective.  

There's a great book called "Pumping Insulin" by John Walsh that you'll find helpful in making the decision about when you son is ready for the pump.

Take care.  -Jenna

great thanks, that is very helpful. I will look for this book,

does he need to give insulin during the snack time, he usually has one snack in the morning and another snack in the afternoon. We are trying to figure out how we can allocate the human resources