Risk assessment

[Docb]

@sunnyday @H.L.M. Thank you for clarifying the issues surrounding the child in that they do not show any obvious signs that their blood glucose is high or low and I can appreciate how that complicates your approach to a risk assessment. We have several teachers on the forum but I do not know if they have any children in their care with that problem.

It seems to me that the biggest risk you face is that the child gets to the point of becoming suddenly very ill because their blood glucose level has gone very low or very high.

To mitigate against that risk I'm guessing that you will need procedures in place to monitor their blood glucose and the circumstances when you need to react to the readings you are seeing. Setting those out need the input from the diabetes nurse and the parents. Thankfully you seem to have a good relationship with both so it should be possible to devise something workable. I'm also guessing that you should have in place a backstop procedure in the event that the child gets suddenly very ill. You do not want to be thinking (panicking) on your feet if, heaven forbid, that happens.

If nothing else, you have introduced the forum to the wider use of the term "asymptomatic" diabetes. Thinking about it, I often see T1's talking about their "lack of hypo awareness" on the forum which I guess is the traditional way of expressing the same thing and a term much more familiar with forum members. As @JJay says, it is most often used in referring to T2 diabetes where high blood glucose is not accompanied by any symptoms.

Let us know how you get on with your risk assessment. Your experience will be of value to others facing the same issue.

 

[Robin]

If nothing else, you have introduced the forum to the wider use of the term "asymptomatic" diabetes

I’m not sure the phrase ‘Asymptomatic Diabetes' is used in the sense of not having hypo symptoms. If you Google 'Asymptomatic Diabetes' (which I did, at the OP's suggestion) you only get stuff about the Honeymoon period, and the onset of diabetes before any of the common symptoms appear (thirst, etc). If you Google 'Asymptomatic Hypoglycaemia' you do get stuff relating to Hypo awareness. It’s an important distinction.
I'm glad we’ve pinned down what the problem is, though, now, which usually happens after a few posts and a bit of discussion and clarification.

 

[Inka]

Asymptomatic diabetes is usually used in relation to Type 2, or forms of MODY. I’ve never heard it used in relation to hypo and hyper unawareness. Perhaps this phrase was used as a kind of simplification by the team/parents when explaining to the nursery? When it’s used in relation to paediatric diabetes, it generally means MODY.

Anyway, hypo unawareness is very common in young children as they’re not yet able to distinguish hypo feelings themselves. Even if they can sometimes, the assumption always is that they can’t be relied on to. So, all risk assessments would make that presumption for safety.

 

[sunnyday]

Does that sound familiar @sunnyday

Does the child have no symptoms or ‘warning signs’ of hypos?

no warning at all

 

[sunnyday]

I’m not sure the phrase ‘Asymptomatic Diabetes' is used in the sense of not having hypo symptoms. If you Google 'Asymptomatic Diabetes' (which I did, at the OP's suggestion) you only get stuff about the Honeymoon period, and the onset of diabetes before any of the common symptoms appear (thirst, etc). If you Google 'Asymptomatic Hypoglycaemia' you do get stuff relating to Hypo awareness. It’s an important distinction.
I'm glad we’ve pinned down what the problem is, though, now, which usually happens after a few posts and a bit of discussion and clarification.

thank you

 

[sunnyday]

Which would be of more concern, potentally, than having symptoms.
Questions i would want to ask are...

Do they have a insulin pump?
Do they wear a continous glucose monitor (cgm eg libre, dexcom) and would your staff have ecess to see this ( i would say this would be crucial to keep them safe)
Do they have hypo symptoms/ how do they show others they are going low?

yes, yes and no

 

[sunnyday]

@sunnyday @H.L.M. Thank you for clarifying the issues surrounding the child in that they do not show any obvious signs that their blood glucose is high or low and I can appreciate how that complicates your approach to a risk assessment. We have several teachers on the forum but I do not know if they have any children in their care with that problem.

It seems to me that the biggest risk you face is that the child gets to the point of becoming suddenly very ill because their blood glucose level has gone very low or very high.

To mitigate against that risk I'm guessing that you will need procedures in place to monitor their blood glucose and the circumstances when you need to react to the readings you are seeing. Setting those out need the input from the diabetes nurse and the parents. Thankfully you seem to have a good relationship with both so it should be possible to devise something workable. I'm also guessing that you should have in place a backstop procedure in the event that the child gets suddenly very ill. You do not want to be thinking (panicking) on your feet if, heaven forbid, that happens.

If nothing else, you have introduced the forum to the wider use of the term "asymptomatic" diabetes. Thinking about it, I often see T1's talking about their "lack of hypo awareness" on the forum which I guess is the traditional way of expressing the same thing and a term much more familiar with forum members. As @JJay says, it is most often used in referring to T2 diabetes where high blood glucose is not accompanied by any symptoms.

Let us know how you get on with your risk assessment. Your experience will be of value to others facing the same issue.

Thank you for your advice and help. I've done lots of risk assessments for various situations in the past but this is the first one for a health issue in a pre school child. I wasn't sure where to start and appreciate you helping me to unpick it

 

[H.L.M]

@sunnyday @H.L.M. Thank you for clarifying the issues surrounding the child in that they do not show any obvious signs that their blood glucose is high or low and I can appreciate how that complicates your approach to a risk assessment. We have several teachers on the forum but I do not know if they have any children in their care with that problem.

It seems to me that the biggest risk you face is that the child gets to the point of becoming suddenly very ill because their blood glucose level has gone very low or very high.

To mitigate against that risk I'm guessing that you will need procedures in place to monitor their blood glucose and the circumstances when you need to react to the readings you are seeing. Setting those out need the input from the diabetes nurse and the parents. Thankfully you seem to have a good relationship with both so it should be possible to devise something workable. I'm also guessing that you should have in place a backstop procedure in the event that the child gets suddenly very ill. You do not want to be thinking (panicking) on your feet if, heaven forbid, that happens.

If nothing else, you have introduced the forum to the wider use of the term "asymptomatic" diabetes. Thinking about it, I often see T1's talking about their "lack of hypo awareness" on the forum which I guess is the traditional way of expressing the same thing and a term much more familiar with forum members. As @JJay says, it is most often used in referring to T2 diabetes where high blood glucose is not accompanied by any symptoms.

Let us know how you get on with your risk assessment. Your experience will be of value to others facing the same issue.

Thank you @Docb for your understanding and helpful reply. We are all working really closely with the parents and where possible the diabetes Nurse. The child in question is 3 but was diagnosed when they were 1. We have daily reports with the parents and they are on call throughout the day, the risk assessment was suggested to us by an outside practitioner who isn't fully aware of the child's needs or diagnosis. Because the child is young and doesn't show any signs and every day is a different scenario we just couldn't find a starting point for the risk assessment.

 

[Docb]

No problem, @H.L.M and @sunnyday - I spent most of my life in the nuclear industry where writing safety cases (posh risk assessments) became second nature. They are important because it gives you the opportunity to think through stuff and either avoid a problem or have a plan in place if bad things happen, when you are facing something where you cannot call on past experience to do the right thing without lots of time to think.

My other thought is that you keep it simple, just like (I hope) the other risk assessments you have written. When you have written it, pass it somebody who knows nothing about the situation to read. If it makes sense to them, then you will have cracked it!

 

[sunnyday]

No problem, @H.L.M and @sunnyday - I spent most of my life in the nuclear industry where writing safety cases (posh risk assessments) became second nature. They are important because it gives you the opportunity to think through stuff and either avoid a problem or have a plan in place if bad things happen, when you are facing something where you cannot call on past experience to do the right thing without lots of time to think.

My other thought is that you keep it simple, just like (I hope) the other risk assessments you have written. When you have written it, pass it somebody who knows nothing about the situation to read. If it makes sense to them, then you will have cracked it!

thank you

 

[mitchsi]

@sunnyday @H.L.M is there a reason why you couldn’t have access to the child’s CGM alarms, the app and access to it can be granted to anyone with the right smartphone ideally the child’s smartphone where you’d have it in the teachers possession. If you don’t have access I can’t see how the child would be safe in school.
That’s got to be one of the 1st consideration in terms of detecting an out of limits condition and then it’s what response is appropriate and what do you have to correct the out of limit condition (glucagon, insulin, sweets etc…)
Monitoring, detecting an issue, treating the issue, safety features for when the normal process breaks down (eg smart phone battery dies or is forgotten, hypo meds forgotten etc…) these I guess have all been thought through?
Are you able to share what you’ve come up with?

 

[everydayupsanddowns]

Because the child is young and doesn't show any signs and every day is a different scenario we just couldn't find a starting point for the risk assessment.

Hopefully it is beginning to become clearer now.

Factors which can increase the risk of hypoglycaemia can include things like being more active than usual (exercise, sports, dance, even exuberant play), missing meals, snacks or parts of meals or snacks (particularly where carbohydrates have been counted and insulin has been administered.

Even things like emotional states, excitement, warmer weather can have an impact.

There’s a general write up about hypo symptoms and treatments here which you might find helpful

What is a hypo (hypoglycaemia)?

A hypo is when your blood sugar level, also called blood glucose level, drops too low. This is usually below 4mmol/l. A hypo, also called hypoglycaemia, can happen quickly. So it’s important to always have hypo treatments with you. It's also important to know what the signs are and how to treat...

www.diabetes.org.uk

 

[sunnyday]

Hopefully it is beginning to become clearer now.

Factors which can increase the risk of hypoglycaemia can include things like being more active than usual (exercise, sports, dance, even exuberant play), missing meals, snacks or parts of meals or snacks (particularly where carbohydrates have been counted and insulin has been administered.

Even things like emotional states, excitement, warmer weather can have an impact.

There’s a general write up about hypo symptoms and treatments here which you might find helpful

What is a hypo (hypoglycaemia)?

A hypo is when your blood sugar level, also called blood glucose level, drops too low. This is usually below 4mmol/l. A hypo, also called hypoglycaemia, can happen quickly. So it’s important to always have hypo treatments with you. It's also important to know what the signs are and how to treat...

www.diabetes.org.uk

thank you for this