
Diabetic Friends Action Network
Online Newsletter - March Edition (Children's Special)
(Delphi Custom Forum 255)

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This issue of The DFAN Diabetes Newsletter is devoted to
children.  I recently reached my tenth year of being a diabetic
and when I think back to all the experiences I've had during that
time I have to wonder what it would be like to have experienced
those same years as a child.  To be taken to the hospital and
told that you were almost in a coma because your blood glucose
levels were too high.  To be placed in the intensive care unit of
the hospital with all the machines and nurses watching over you. 
Facing a lifetime of taking insulin injections and sticking your
finger four or more times a day.  It's a lot for an adult to deal
with.  Imagine what it's like for a child.

Today children with diabetes have a lot more resources and
supplies available to them than at any other time in history. 
They might be on an insulin pump instead of taking injections
with a needle.  There are new lancets available that don't hurt
as much when they pierce the skin.  There are better insulins
available for them to use.  Needles are finer which makes it hurt
less when insulin has to be taken.

Although the "tools" of managing diabetes have gotten better,
diabetes also brings along a myriad of psychological issues.  A
child might blame themselves for having diabetes and have low
self esteem.  Or they might feel uneasy about letting their
friends know they have diabetes because they fear being treated
differently.  A child might not want to follow their diet plan
because they don't want people to know they're on a special diet.

All of this can lead to stress.  Yes, even children can get
stress.  It's important for the parent or guardian of a child
with diabetes to recognize that diabetes is a tough disease for
anyone who has it, including children.  It's no longer prudent to
thing that just because someone is under 18 they don't have
feelings and the same pain that adults have.

If you have a child with diabetes try to find a support group in
your area.  Having a group of peers their own age to speak with
might be very beneficial to a child with diabetes.  Knowing
they're not the only one with diabetes can also help the child. 
To know they're not alone with their confusion and fear can be

comforting.  If you can't find a support group for your child
you'll have to be a substitute.  Read as much as you can about
diabetes so you can have the correct information for them when
they come to you with a question.

The stories in this newsletter are for, by, or about children
with diabetes.  If you have a child with diabetes please read the
stories to or with them.  It might lead to a conversation that
you and your child might prosper from and enjoy.

Remember, this newsletter can't be produced without your stories. 
So please don't hesitate to send them to us.  No matter how
short, how long, how happy, or how angry they may be, we want to
see them and publish them in this newsletter.  We want to be
"real" and we can't do that without your story contributions.


******************ARTICLE************************
This is an interview I had with a young member of the DFAN Forum
on the Delphi Internet Service.  Dana is one of the youngest
members of our forum and agreed to tell us about her life with
diabetes.

What's your full name Dana?
Dana> Dana Leigh McCall Boltuch

And you're ten years old?
Dana> Yes.

How long have you had diabetes?
Dana> I had been sick for quite a few weeks before my fifth
birthday, but showed no ketones. Then a few days after my
birthday we tested again. Still no ketones. The next day we did
another test. Ketones. I was hospitalized that day. I've had
diabetes for 5 years.

Do you have any brothers and/or sisters?
Dana> I have a 6 year old brother.

Does he have diabetes?
Dana> No, so far as we know. Maybe he will, later in life.

What grade are you in Dana?
Dana> I just started fifth grade at the Upper Merion Area Middle
School. This is my first year at Middle School.

Are you the only child in your class with diabetes?
Dana> Yes, I am.

Do all your teachers know you have diabetes?
Dana> Yes, they do.

What about your friends?
Dana> Most of them already know, or if they don't, they notice my
bracelet and then ask what it is for.

Do you take anything special with you to school because of your
diabetes?
Dana> I carry glucose tablets in my bookbag, and drink a juice
box before gym, and I have juice in the nurse's office. I also
carry crackers in my backpack.

Do you have to inject insulin while you're in school?
Dana> No. Lunch is the one meal where I do not take a shot. If my
sugar is high, I either exercise or my Mom brings som6e insulin.

Have you ever had an insulin reaction while you were in school?
Dana> Yes, but I rarely display symptoms until I'm very low. And
the reactions are only occasional. I mean severe reactions are
occasional.

Is the food you eat for lunch different from everyone else's?
Dana> The answer would be no, except I am a picky eater. If it
weren't for that problem, I wouldn't eat much differently than
everyone else.

What's the biggest hassle your diabetes gives you while you're in
school?
Dana> Hmmmm... I guess if I have a low sugar in class, that is a
pain in the neck, because I have to interrupt class, have someone
else come with me to my locker, so they miss class, and i also
miss class. 

Does it bother you when your schoolmates ask you about your
diabetes?
Dana> No, not really. I just explain, and they accept the answer
and surprisingly know something about it, if they did not know I
had it. For instance a girl in my gym class asked me about my
bracelet, and i told her I had diabetes. She said "You mean you
can't have any sugar!? "I said "yes, not much"...etc.

How do you think your Mom and Dad have accepted that you have
diabetes?
Dana> mmmmmmmm....toughie!   I think that they have taken it very
well, although sometimes I worry my Mom a little bit with my
sugars, I think. 

There might be a lot of kids who read this interview and need
help with coping with their diabetes...what advice would you give
them?

Dana> The advice that I would give them is to make sure that
people know that you have diabetes, and know how to care for you
in an emergency, but don't draw attention to it. If asked about
it, I just answer the questions with out confusing people too
much. If I am asked to go into detail, I do, but not every single
little thing. I also will give this advise: Deal with the
diabetes, but once you have it under control, go on living and
don't let it get you down!

********************ARTICLE********************
D* at School, The Time of Diagnosis
by Rebecca Stanley

    I am a teacher at a small private school in San 
Francisco, and I'd like to tell you about a very special 
girl, Allison, and how we dealt with the diagnosis of 
Diabetes at school.

    It was the end of October when she was suddenly absent 
from school.  On Nov 1st, she came in late with her mother. 
When I saw her, I picked her up, and gave her a hug, and 
asked why she had been absent.  She told me she had been in 
the hospital.  One of the other teachers then said to me 
"Allison has diabetes." All I could do was hug her hard as 
the tears sprung to my eyes and I envisioned the difficult 
times ahead.

     Her Mom left her Halloween candy at school, for me to 
share with her classmates.  I sat them down, and explained 
that Allison was sharing her candy with them because she has 
diabetes and couldn't eat all that candy.  I told them that 
it was a disease she would always have, but that they 
couldn't catch it from her.  That she wouldn't be any 
different than before, except that she couldn't eat very 
much sugar and would need extra snacks.

During the next couple of days I found that I had a 
sixth sense about diabetes.  One day early on illustrates 
this well.  Allison's mom came that day at lunch, tested 
her, and gave her a shot.  She didn't eat much lunch, 
because she wasn't hungry, and went and played.  At the end 
of the walk back to school she told us she felt tired, and 
kind of funny.  That's when I took over.
    
I took her in to the kitchen and pulled out her lunch. I 
gave her the yogurt and sandwich after which she felt 
better.  It turned out to be exactly what she needed, her 
mom later told me.  This did a lot for my confidence in 
dealing with diabetes at school.

Over the next few days I was introduced to blood glucose 
monitoring and the signs of low and high blood sugar 
reactions, and how to deal with them.  Allison tested daily 
at school, and lot of teachers got a lot less squeamish 
about blood!
     
None of the other children treated Allison differently, 
and they never got jealous of the extra snacks and getting 
to leave class at the odd times to test, or if she felt low. 
    
We all got a lot more comfortable, since we learned how 
to read the simple chart her mother gave us.  A blood glucose
reading of less than 80 meant LOW, over 180 meant HIGH.  Once we
had dealt with  some lows and highs we became confident that 
dealing with Allison's diabetes at school would not be a 
problem.


********************ARTICLE********************
Getting Ready for School Beyond Buying Notebooks and Erasers
by Laurie Nelson 

We had a head start getting to know the teachers, when my
daughter began Kindergarten 4 years ago. She had just finished a
week at ADA Daypoint Camp and discovered that her enthusiastic
camp counselor would, in a couple weeks, be her student teacher
for the year. Both were excited because they would each know 
someone going into a new situation. As parents,we were excited
and a little relieved to know that our daughter would have a
teacher who also had diabetes.
  
As school grew closer, I called the school district to inform the
district nurse that we had special needs and that we would like
to meet with her, the Kindergarten teacher, and the "health
clerk" who managed the health office before school began (It's a
good idea to include the gym teacher, if possible). 
We had no problem setting up the meeting for the week before
school started. I began checking different sources for ideas and
suggestions to prepare for the meeting. Besides gathering
information from ADA and JDF publications, I turned to some
helpful people on the PRODIGY bulletin boards. The ideas that
follow have been fine-tuned over 3 years to meet {our} specific
needs. Use them as a guideline and make adjustments where you
need.

After calling the school and setting up the appointment with the
teachers and nurses, the next call was to the school bus company.
If you child will ride a bus, it is important to make sure the
bus company and the driver know about your child's diabetes.
Inform them that he/she may need to have an occasional snack
while on the bus to maintain a proper glucose level. Ask if you
can supply a quick-acting glucose treatment that can stay on
board the bus in case of an emergency. Find out the pick-up and
drop-off times for your child so you can begin a similar schedule
at least a week before school starts. That way you may be able to
find problems with your child's schedule that lead to high or low
blood sugars.

When meeting with the teachers and nurses, find out about
scheduled snacks, lunchtime, gym class and recess. Our teachers
are usually working on their scheduling that week before school
and have been willing to make small changes in their schedule to
meet our needs. Again, begin changing your child's schedule 
ahead of time to prepare for things like waking up earlier and
different mealtimes. (With our daughter, everything was at least
an hour earlier. One year lunch was so early she needed 2
afternoon snacks).
  
Here are some questions to think about asking the staff:

-Has your child's teacher had any experience with Type I
diabetes?

-How frequent is Diabetes in the school and district?

-Does the school have a glucose testing meter? Is your child
familiar with it?  Can the school nurse help with necessary
training? Or can you have your RN Certified Diabetes Educator or
pharmacy help? Does your doctor need to write a prescription for
the test strips?

-Who is responsible for its maintenance of the battery in the
meter? 

-Where will your child be testing? Is he /she able to test and
interpret the results without help or does your child need
supervision? What are the school's policies about testing in the
classroom? Can they be changed to meet your needs and desires?

-Is it possible to keep a supply of snacks in the classroom? We
found it was easier to send a box of crackers and a box of
fruitsnacks with our daughter to keep in her room. The teachers
have been willing to give up a small amount of space in their
cupboards.

-If your young child doesn't tell time, can the teacher help by
reminding your child about snack? We bought our daughter a
wristwatch with an alarm and set it for afternoon snacktime.

-Can your child get milk from the cafeteria during the day? We
keep track of the number of days our daughter has extra milk and
write one monthly check to pay for it.

Pack a box of diabetes supplies to keep in the Health Office
(sick bay). Ours  includes:

   Blood glucose test strips
   Lancets
   Lancet device (finger poker)
   Cotton balls
   Urine ketone test strips
   Glucagon with 2 syringes rubberbanded
    to the box (don't tape them on
    because the tape peels off the
    syringe markings!)
   Treatment for hypoglycemia (sugar
    cubes, glucose tablets, gel glucose
    -or gel frosting in a tube)
   Protein and starch snack (crackers
    and cheese or peanut butter)
   Pencil and paper (or record book) to
    record the day's test results to
    take home daily.

I typed up an outline with MY rules and expectations and make
copies for everyone at the meeting. We read through them together
and discuss any questions that come up. Our sheet is set up like
this:

Child's name
Teacher and grade
Date (last updated)

Emergency phone numbers: mine, my
 husband's, a neighbor, the endocrinologist, and our family
 physician.

1) (Child) needs to test:
 -daily before lunch
 -if symptomatic for low blood sugar*
 -when ill
 -before boarding the bus if any snack
   is forgotten.
*If symptomatic, check blood sugar in classroom rather than
sending her to the Health Office for test OR have her escorted to
the Health Office by an adult.

2) Normal blood glucose levels for
   (child) are ____-____ mg/dL.

3) Symptoms of low blood glucose (hypo- glycemia) are:
 -shaky
 -pale
 -quiet/personality change
 -weak
 -headache

4) Symptoms of high blood glucose (hyper
 -glycemia) are:
 -headache
 -stomach ache
 -frequent urination
 -thirsty

5) If blood sugar is:
 Below 80 mg/dL:give treatment of (# of
 tabs) Follow in 10-15 minutes with
 (protein &  starch snack)  OR regular
  lunch.
  Call Parent.
  In case (child) may become incoherent or pass out due to low
blood sugar, Call 911. Give glucagon by injection and/or place
small amount of gel-glucose in between cheek and gum. Lay on her
side. Call Parent.
-Over ___mg/dL: continue with regular
  activities

-Over ___mg/dL: may need to use the rest

-room more often and may be thirsty for water. This is one way
for the body to dilute the high amounts of sugar in the blood and
is an important self-regulating factor.


 -Over ___mg/dL: test urine for ketones.
  a) If positive, restrict physical
     activity and call parent. Recheck
     ketones in 1-2 hours. Call Parent.
  b) If negative, may continue with
     regular activities.

6) Mealtimes:
 -(breakdown each meal, ie. 9:30am snack
  is 1 starch, lunch is...etc.)

*It is important for (child) to finish all of his/her lunch.
Staff should encourage her to eat at a rate to keep up with her
class. However, if she does not finish before the class is
excused for recess, she needs to stay in the cafeteria longer to
complete her lunch. 

7) Illness:
 -Test blood sugar
 -Test urine for ketones
 -Call Parent

8) Let parent know when there are about
  5 blood or urine test strips left in
  jar to allow enough time to reorder
  from pharmacy. For each new bottle of
  strips used, the _____ monitor must be
  recalibrated. (For now, my child needs
   help with this procedure).

  I also made a Diabetes Flow Sheet. In an emergency it is
helpful to have every step charted out in an easy diagram, rather
than having to scan a sheet to determine the procedure. Our
School District Nurse was so impressed with it, she made copies
and sent them around to the health offices of the other schools.
Again, thanks to a helpful person on Prodigy.

  Again, these are just some ideas to prepare your family for the
upcoming school year. If you meet with any opposition at school
with your child's health care, work your way up the ladder.
Contact the supervisors, the principal of the school, the ADA and
JDF and your child's doctor. As our doctor explained it to us,
most schools would rather bend over backwards to accommodate our
families than to be in the media because of an avoidable 911
call.

I sincerely hope that these ideas help ease your family into a
successful school year.

                   
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