Advice on school timing & school meal - Year 1

[girish84.kamble]

I need some advice on school time & school meal. What I want to understand

1. How insulin level school measures when someone with Type 1 is in school?
2. Do we need to follow school timing & schedule for Type 1 kid, in my case my daughter in Year 1 class.
   1. Reason I'm asking this is school meal time is 11:30 AM and then finish time is 3:00 PM , it almost took half an hour to reach home and get freshenup. So last meal of day would be around 4:00 PM which is almost 4 hours after lunch and we are very much worried about sugar/glucose level for that 3-4 hour gap.
3. I want to understand or know from experience person how they managing meals for kid during school days?

I'm sorry I may ask foolish questions here.
But we just come to know about my daughter's Type 1 situation and looking for any kind of help which may help us or support us during initial days.

Any feedback or comments would be very helpful.

Thank you,
Girish Kamble.

 

[Thebearcametoo]

My kid was older (8) when he got diabetes but even at that age there were still lots of snacks. I wouldn’t expect a year one child to go 4 hours between meals without snacking. Most parent I know will give snacks at pick up anyway as kids are in need by then. School may be advised to test BG every 2 hours or to go by behaviour. There will be a plan in place and snacks should be available for if needed anyway. Our paeds team worked on a rough timing of meals every 4 hours or so with a snack in between and supper.

Has your diabetes team been in to school yet? The team here does a lot of support and training for the school and communicates well with families about how things should be managed. It can take a little while to set up though so sometimes there’s a delay between diagnosis and when the school can deal with diabetes and a parent is expected to bridge the gap.

 

[Sally71]

Hello, and welcome to the forum.
I presume your daughter was only diagnosed recently? It’s quite hard in the beginning isn’t it. It does get easier though. Going back to school after diagnosis is scary.

There is no reason why your daughter shouldn’t follow the school routine. Diabetes is tough on children anyway, with all the finger pricking and injections they have to do, it makes them feel different from everyone else. If you make her eat her lunch at a different time then she’ll feel even more different. What insulins is she on? Usually a long acting one which you take once a day and a short acting one with meals. if she’s on this regime then it doesn’t matter exactly what time her meals are.

School staff will have to be trained on how to test her blood, what to do if she’s too low or too high, how to spot if she might be too low (behaviour changes etc), she must always have sugary snacks available in case she goes low, and staff will also have to know how to deliver her insulin. In England this is covered under the Equalities Act 2010, the school MUST provide members of staff who are willing to be trained on this (although it doesn’t have to be the class teacher). Your diabetes nurse should be able to help with this, they can go into the school and organise the training and get a care plan in place so that school staff know what to do.

Regarding the long gap, can you provide snacks for her? Or maybe test her when you come to pick her up and give her a snack then? At the primary school where I work it’s not uncommon to see children eating something as they walk home.

You may find that your daughter’s insulin requirements change when she’s on a different routine, my daughter was just one year older than yours when diagnosed and for a while we found she needed much less insulin on school days than she did at weekends and holidays. Talk to your medical team about how to adjust her doses.

Sorry if that’s a lot, I can understand why you are worried but it can be managed! Hope it helps 🙂

 

[girish84.kamble]

My kid was older (8) when he got diabetes but even at that age there were still lots of snacks. I wouldn’t expect a year one child to go 4 hours between meals without snacking. Most parent I know will give snacks at pick up anyway as kids are in need by then. School may be advised to test BG every 2 hours or to go by behaviour. There will be a plan in place and snacks should be available for if needed anyway. Our paeds team worked on a rough timing of meals every 4 hours or so with a snack in between and supper.

Has your diabetes team been in to school yet? The team here does a lot of support and training for the school and communicates well with families about how things should be managed. It can take a little while to set up though so sometimes there’s a delay between diagnosis and when the school can deal with diabetes and a parent is expected to bridge the gap.

Thank you so much for response.

We have been told we need to give her insulin before every meal or whenever she want's to eat, so that make us more worried as if in case we gave her some snack while return from school that may again increase her Glucose level?

There must be some snacks which are zero carb but you know how those kids are, they always want something yummy to eat. We are training her to eat salad/cucumber whenever she feed hungry so that would be one option for her but if you knows any other snacks which we can give as snacks either while return from school or whenever there is bit gap between two meals.

Once again, Thank you so much for you time !!

 

[Inka]

@girish84.kamble If your daughter’s blood sugar is dropping after school or at any other time between meals, she can eat a snack with carbs and without insulin. The carbs in the snack will raise her blood sugar a little and stop her going low.

The good thing about school is that she’ll behaving her lunch at a regular time each school day. You might therefore find a pattern to her blood sugars which will help you see if she needs a snack and at what time. She’ll probably also need a snack before PE, depending on her blood sugar and the activity. Again, these would be carb snacks without insulin.

 

[girish84.kamble]

Hello, and welcome to the forum.
I presume your daughter was only diagnosed recently? It’s quite hard in the beginning isn’t it. It does get easier though. Going back to school after diagnosis is scary.

There is no reason why your daughter shouldn’t follow the school routine. Diabetes is tough on children anyway, with all the finger pricking and injections they have to do, it makes them feel different from everyone else. If you make her eat her lunch at a different time then she’ll feel even more different. What insulins is she on? Usually a long acting one which you take once a day and a short acting one with meals. if she’s on this regime then it doesn’t matter exactly what time her meals are.

School staff will have to be trained on how to test her blood, what to do if she’s too low or too high, how to spot if she might be too low (behaviour changes etc), she must always have sugary snacks available in case she goes low, and staff will also have to know how to deliver her insulin. In England this is covered under the Equalities Act 2010, the school MUST provide members of staff who are willing to be trained on this (although it doesn’t have to be the class teacher). Your diabetes nurse should be able to help with this, they can go into the school and organise the training and get a care plan in place so that school staff know what to do.

Regarding the long gap, can you provide snacks for her? Or maybe test her when you come to pick her up and give her a snack then? At the primary school where I work it’s not uncommon to see children eating something as they walk home.

You may find that your daughter’s insulin requirements change when she’s on a different routine, my daughter was just one year older than yours when diagnosed and for a while we found she needed much less insulin on school days than she did at weekends and holidays. Talk to your medical team about how to adjust her doses.

Sorry if that’s a lot, I can understand why you are worried but it can be managed! Hope it helps 🙂

That's not at all lot ! its really so much informative and useful 🙂

My daughter diagnosed Type 1 few days back, during her summer holidays and now she will start her school which making us more worried. And yes going through Type 1 with her is horrible experience I pray to god no one would every go through that.

Diabatic team member told us about training/session they would have with school but they haven't come back to us after that so probably they will give more details on that coming week. Anyways I'll contact them to understand more on that process.

Regarding to snacks, we have been told to give her insulin before eating so I'm worried about giving her snacks without insulin, that may increase her glucose level? Offcourse we will check her glucose level before giving her snacks but still is it advisable to give snack without insulin?

My daughter is on Levemir which is long lasting and Novorapid ( before each meal ).
Thank you for sharing your experience.

We will contact Diabetes team to understand further on school routine.

 

[Inka]

Regarding to snacks, we have been told to give her insulin before eating so I'm worried about giving her snacks without insulin, that may increase her glucose level? Offcourse we will check her glucose level before giving her snacks but still is it advisable to give snack without insulin?

Yes, if she needs it. See my first post in this thread. Likewise, if she has a hypo, you give her glucose and carbs without insulin. If her blood sugar needs raising slightly, eg at playtime, mid-afternoon, before exercise, before bed, when hypo or approaching a hypo level, you give her glucose/carb snack without insulin. If you give her insulin with it, you’ll cancel out the effect of the carbs, making the snack useless as it won’t raise her blood sugar and she’ll be at risk of dropping too low.

@girish84.kamble A great book, often recommended here is:

Type 1 Diabetes in Children Adolescents and Young People by Ragnar Hanas

It’s good to refer to over time and it can be reassuring to have. There’s a lot to learn so my advice is that you pace yourself. Don’t worry about understanding everything at once. Get the basics going first.

 

[girish84.kamble]

@girish84.kamble If your daughter’s blood sugar is dropping after school or at any other time between meals, she can eat a snack with carbs and without insulin. The carbs in the snack will raise her blood sugar a little and stop her going low.

The good thing about school is that she’ll behaving her lunch at a regular time each school day. You might therefore find a pattern to her blood sugars which will help you see if she needs a snack and at what time. She’ll probably also need a snack before PE, depending on her blood sugar and the activity. Again, these would be carb snacks without insulin.

thank you so much , I think its quite helpful ..
So we can give her snacks while return from school and even though her sugar level go high anyways we measure her glucose and card from her meal at home and give her Insulin which would be anyways help on both carb she eat while return from school also meal she going have after school.

I think ( hope ) it must not that difficult & go well.
Thank you, thank you again for your thoughts.

I feel its worth joining Diabetes Community.

 

[Inka]

thank you so much , I think its quite helpful ..
So we can give her snacks while return from school and even though her sugar level go high anyways we measure her glucose and card from her meal at home and give her Insulin which would be anyways help on both carb she eat while return from school also meal she going have after school.

I think ( hope ) it must not that difficult & go well.
Thank you, thank you again for your thoughts.

I feel its worth joining Diabetes Community.

I’m not sure you’ve fully understood, so I’ll give an example. All the numbers below are examples only:

A child’s blood sugar is 6 before lunch. That’s great. They take their insulin and eat their lunch. 2 hours after lunch, their blood sugar is 9. That’s fine. However, 3 and 1/2 hours after lunch, their blood sugar has dropped to 4.2. Although this isn’t quite a hypo, they have a small carb snack without insulin. These extra carbs stop them going too low. Before their evening meal, their blood sugar is 7.2. They take their normal insulin and eat their evening meal. They do not have to think about the snack. All the little carb snack did was nudge the blood sugar a little higher so that the child didn’t go too low before their evening meal.

Another child’s blood sugar is 7 before lunch. They take their insulin and eat their lunch. 2hrs after lunch, their blood sugar is 10. Just before they’re about to leave school, their blood sugar is 8. That’s ok. They do not need a snack with a blood sugar of 8. They get home by car in 10 minutes and their blood sugar is 7.8 (no snack needed). They have their evening meal and insulin as normal.

Carb snacks without insulin are used to raise the blood glucose a little to stop it from going too low.

 

[Sally71]

That's not at all lot ! its really so much informative and useful 🙂

My daughter diagnosed Type 1 few days back, during her summer holidays and now she will start her school which making us more worried. And yes going through Type 1 with her is horrible experience I pray to god no one would every go through that.

Diabatic team member told us about training/session they would have with school but they haven't come back to us after that so probably they will give more details on that coming week. Anyways I'll contact them to understand more on that process.

Regarding to snacks, we have been told to give her insulin before eating so I'm worried about giving her snacks without insulin, that may increase her glucose level? Offcourse we will check her glucose level before giving her snacks but still is it advisable to give snack without insulin?

My daughter is on Levemir which is long lasting and Novorapid ( before each meal ).
Thank you for sharing your experience.

We will contact Diabetes team to understand further on school routine.

Snacks which would have no effect on blood sugar would be things like Peperami, mini babybel cheese, olives, carrot sticks, and we’ve also just discovered salted popcorn - it does contain carbohydrate but because it’s puffed up and mostly consists of air, it hardly weighs anything and you can eat a bag of it before you‘ve consumed enough carbohydrate to make a difference to your blood sugar!
So you could give your daughter something like that without any insulin and it won’t make her go high, and then let her have a cake or something like that for her pudding after dinner, when you are able to inject for it, so that she doesn’t have to miss out completely on the treats.

However, if your daughter is walking home from school that may lower her blood sugar, in which case a snack containing 10-20g carbs without insulin wouldn’t hurt her, it would balance out the drop when she’s walking. This would be something like a couple of plain biscuits or a packet of crisps. Or a piece of fruit if you prefer something healthier for her. Also, if her blood sugars are a bit on the low side before you set off then a snack like that would be good for her. Instead of waiting for her to go too low and then feeding her glucose, give her some carbs in the form of a more pleasant snack before you set off and then hopefully she won’t go low.

Have you been taught to carb count yet? I’m guessing not, this means you learn to work out how much carbohydrate is in whatever your daughter is eating and then you inject the correct amount of insulin for that amount of carbohydrate. This then makes it much easier to balance insulin with meals and keep blood sugars a bit steadier. As she is so newly diagnosed you may not have been told this yet, they don’t like to overwhelm you with too much information at once. With time you will learn to judge how much carbohydrate is in the food that your daughter eats.

You have a lot of learning to do and for the first few weeks at school you will just have to keep trying different things to see what works best, then eventually you will find a routine that works for you and life will start to become a lot easier!

 

[girish84.kamble]

Snacks which would have no effect on blood sugar would be things like Peperami, mini babybel cheese, olives, carrot sticks, and we’ve also just discovered salted popcorn - it does contain carbohydrate but because it’s puffed up and mostly consists of air, it hardly weighs anything and you can eat a bag of it before you‘ve consumed enough carbohydrate to make a difference to your blood sugar!
So you could give your daughter something like that, and then let her have a cake or something like that for her pudding after dinner, when you are able to inject for it, so that she doesn’t have to miss out completely on the treats.

However, if your daughter is walking home from school that may lower her blood sugar, in which case a snack containing 10-20g carbs without insulin wouldn’t hurt her, it would balance out the drop when she’s walking. This would be something like a couple of plain biscuits or a packet of crisps. Or a piece of fruit if you prefer something healthier for her. Also, if her blood sugars are a bit on the low side before you set off then a snack like that would be good for her. Instead of waiting for her to go too low and then feeding her glucose, give her some carbs in the form of a more pleasant snack before you set off and then hopefully she won’t go low.

Have you been taught to carb count yet? I’m guessing not, this means you learn to work out how much carbohydrate is in whatever your daughter is eating and then you inject the correct amount of insulin for that amount of carbohydrate. This then makes it much easier to balance insulin with meals and keep blood sugars a bit steadier. As she is so newly diagnosed you may not have been told this yet, they don’t like to overwhelm you with too much information at once. With time you will learn to judge how much carbohydrate is in the food that your daughter eats.

You have a lot of learning to do and for the first few weeks at school you will just have to keep trying different things to see what works best, then eventually you will find a routine that works for you and life will start to become a lot easie

I’m not sure you’ve fully understood, so I’ll give an example. All the numbers below are examples only:

A child’s blood sugar is 6 before lunch. That’s great. They take their insulin and eat their lunch. 2 hours after lunch, their blood sugar is 9. That’s fine. However, 3 and 1/2 hours after lunch, their blood sugar has dropped to 4.2. Although this isn’t quite a hypo, they have a small carb snack without insulin. These extra carbs stop them going too low. Before their evening meal, their blood sugar is 7.2. They take their normal insulin and eat their evening meal. They do not have to think about the snack. All the little carb snack did was nudge the blood sugar a little higher so that the child didn’t go too low before their evening meal.

Another child’s blood sugar is 7 before lunch. They take their insulin and eat their lunch. 2hrs after lunch, their blood sugar is 10. Just before they’re about to leave school, their blood sugar is 8. That’s ok. They do not need a snack with a blood sugar of 8. They get home by car in 10 minutes and their blood sugar is 7.8 (no snack needed). They have their evening meal and insulin as normal.

Carb snacks without insulin are used to raise the blood glucose a little to stop it from going too low.

Got your point!! Thanks for explaining with numbers it makes more sense.

Thank you.

 

[girish84.kamble]

Snacks which would have no effect on blood sugar would be things like Peperami, mini babybel cheese, olives, carrot sticks, and we’ve also just discovered salted popcorn - it does contain carbohydrate but because it’s puffed up and mostly consists of air, it hardly weighs anything and you can eat a bag of it before you‘ve consumed enough carbohydrate to make a difference to your blood sugar!
So you could give your daughter something like that without any insulin and it won’t make her go high, and then let her have a cake or something like that for her pudding after dinner, when you are able to inject for it, so that she doesn’t have to miss out completely on the treats.

However, if your daughter is walking home from school that may lower her blood sugar, in which case a snack containing 10-20g carbs without insulin wouldn’t hurt her, it would balance out the drop when she’s walking. This would be something like a couple of plain biscuits or a packet of crisps. Or a piece of fruit if you prefer something healthier for her. Also, if her blood sugars are a bit on the low side before you set off then a snack like that would be good for her. Instead of waiting for her to go too low and then feeding her glucose, give her some carbs in the form of a more pleasant snack before you set off and then hopefully she won’t go low.

Have you been taught to carb count yet? I’m guessing not, this means you learn to work out how much carbohydrate is in whatever your daughter is eating and then you inject the correct amount of insulin for that amount of carbohydrate. This then makes it much easier to balance insulin with meals and keep blood sugars a bit steadier. As she is so newly diagnosed you may not have been told this yet, they don’t like to overwhelm you with too much information at once. With time you will learn to judge how much carbohydrate is in the food that your daughter eats.

You have a lot of learning to do and for the first few weeks at school you will just have to keep trying different things to see what works best, then eventually you will find a routine that works for you and life will start to become a lot easier!

A perfect explanation, this is what I was looking for.
Thank you millions!!

Have gone through all comments and those are really good and informative.

@Sally71 : You are ⭐ !!

 

[Sally71]

A perfect explanation, this is what I was looking for.
Thank you millions!!

Have gone through all comments and those are really good and informative.

@Sally71 : You are ⭐ !!

Only trying to help, I was just like you once, confused and scared and trying to learn how to deal with things I’d never had to think about before.

If it makes you feel any better, my daughter is 17 now and just gets on with it on her own, I don’t think she can remember not having diabetes, it’s just a normal part of who she is and it doesn’t stop her from doing anything. Your daughter will be like that one day too