Time Out!!

How to handle discipline?

We hadn't given it much thought. When Sawyer misbehaves, he is sent to his room for a seven-minute time-out. Sometimes, he spends that seven minutes cooling his jets in a chair. Either way, he isn't out of our site for very long.

So what happens when he misbehaves in school?

At the school my children attend, the elementary teachers have always placed the child in the hall, sometimes in a chair or at other times they sit on the floor outside the classroom door.

Alone.

Unsupervised.

I get a call from the school nurse one day. She had gone to Sawyer's classroom for some reason and noticed Sawyer in the hall. 

Alone.

He was being punished for some inappropriate behavior and I can understand the need for discipline in the classroom.


The nurse told me she noticed Sawyer seemed pale. She asked the teacher if she thought the same. The teacher told the nurse she was welcome to take Sawyer, which she did. She brought him down to her office and checked his blood glucose.


It was 50.


Perhaps some of Sawyer's misbehavior was due to his extreme low blood sugar. Who's to know for certain.  The fact is, another 20 mg lower and he could have had SERIOUS symptoms (confusion, rapid heartbeat, dizziness, sweating, shaking, violent outbursts) which untreated could have resulted in unconsciousness and seizures. 


...And he would have been alone. Nobody would have known that he was in danger.


Thank goodness the nurse happened by and noticed he didn't look quite himself.


Before that incident, I hadn't thought about how the teacher handled Sawyer's discipline. I was quite concerned that he had been left alone for any amount of time at all. 


Later that day I spoke with our wonderful diabetic nurse to report the incident of hypoglycemia in order to readjust Sawyer's treatment plan. I also shared concerns about the lack of supervision. She shared my concerns.  


I later called the school nurse and told her I wasn't comfortable with Sawyer being left alone for an extended period of time. (The class was watching a movie, and Sawyer was excluded from this event.) I explained that I wasn't against discipline, but the school would have to find another way to handle these situations with Sawyer. She agreed and since we decided Sawyer might come to enjoy going to the nurse's office and purposely misbehave to 'visit' her, the punishment needed to be a bit more severe. Since the principal's office was next to her's, we decided it would be better to have Sawyer go to the principal's office where the nurse would still be able to keep an eye on him.


When the teacher later called me to discuss Sawyer's behavior, I shared with her my concerns about the way Sawyer's situation was handled. She said she had also thought about this and agreed that Sawyer shouldn't be left alone again.


Everyone kept their heads and we worked it out as adults should. 


Although it freaked me out a little to think of what could have happened, I rejoiced that the worst hadn't happened. A very good lesson was learned at no cost to Sawyer, the school, or myself. I'm sure the school does not want the liability that would have accompanied a serious medical situation. They hadn't intended to put Sawyer into harms way and through this, we all got an education.


If your child is living with a chronic illness or disabling condition, it is very important to discuss disciplinary measures with your child's teacher, principal, and the school nurse. 


Of course, not everyone has a child who exhibits behavior that requires discipline, although what about other times when the child is alone? Perhaps a student is sent on an errand, is the last one in the gym locker room, or left behind on the playground. The absence of the student for an unreasonable amount of time should be taken seriously. Find out where they are, send someone to get them, or have someone stay behind for the child who is slower than others. 


It could save a life.

Bag of Hope

It's a lot to take in when your child is first diagnosed with type one diabetes. 

We've now adapted to the lifestyle change. We count the carbohydrates, we check the blood glucose, we administer shots. We've even dined out a couple of times. Nothing fancy, no, we're not up to dealing with a dining-in experience yet. We have done McDonald's and a few other 'to-go' deals. 

Sawyer has been terrific about checking in with the school nurse before gym class, lunch, and his bus ride home. He is accepting and understanding about not sneaking food...so far. 

The saddest moment for me was when Sawyer asked, "Am I ever going to get rid of diabetes?" 

Up until now, it was a virus or a flu from his point of view. It came, he takes some medicine, and then it goes away, like an ear infection or bronchitis.

I had to tell him that technically it won't go away. It's hard to tell a child something like that. The good news, I told him, is that it is treatable and researchers are close to developing a vaccine to combat the disease.

With all this adjustment and sad news, there was a bright spot to our days. 

I received a call from a diabetic nurse from the Juvenile Diabetes Research Foundation. Michelle had a gift for my son and she was willing to drive almost two hours to bring it to him. I told her she didn't have to do that and mailing it would be just fine. No, she wanted to come and visit us.

Michelle has had juvenile diabetes since she was two years old. I would guess her to be in her mid-thirties now. She is an inspiration. She has managed her diabetes well and has no complications from the disease. Complications such as blindness, kidney failure, heart disease, loss of limbs are just a few examples of the complications that can arise if diabetes goes untreated. 

Meeting someone who had good diabetes management and no complications was encouraging to a mom who recently learned that her son has a chronic disease. 

Michelle shared a little bit about diabetic treatment and also set mom (that's me) up with an endocrinologist (diabetic specialist). 

The Juvenile Diabetes Research Foundation has a program through which they deliver a bag of informational supplies and other items to a newly diagnosed child. Among the items was a book starring the Pink Panther. It is a child (and grandparent :) friendly book with valuable information on diabetes, how it happens, why it happens, and treatment options. It better informs family members about the importance of checking blood glucose levels, what can happen if sugars are too high or too low, and how different levels of activity can effect blood sugar levels.

Also in the backpack was 'Rufus the diabetic bear', along with his own book, "Rufus Comes Home", an endearing combination that offers support and education to the child and other family members. There was a DVD, information packets, and a carbohydrate counting book along with other literature on diabetes.

This does not replace the health of your child by any means, but it is nice to know that there are others out there who are supportive and care about what you are facing.

The Juvenile Diabetes Research Foundation is working to find a way to prevent, better treat, and cure type-1 diabetes. 


If you wish to donate to the research development through JDRF, you may do so through their Web site: https://www.jdrf.org/index.cfm?page_id=100903&sitereferer=100686

 

Our First Scare

They tell you it could happen. They give you literature about it. They show you videos about it. You know it could happen.

Then it does.

Now it's time to apply all you've learned.

Hypoglycemia.

This is not time for panic as every minute counts. Remember the signs? Shaky, muscle weakness, rapid heartbeat, sweaty, anxious, confusion, dizziness, and hunger.

It was after dinner. Sawyer went out to play for a while, nothing strenuous, just playing in a dirt pile we lovingly call 'Chia Pet'. He came in for a bath and was hanging out with his siblings reading a book. I was doing the same when he came into my room to tell me he was so dizzy and didn't know why.

I took him by the hand, armed with glucose tablets, and checked his blood glucose. It was a shocking 32!  It should never be under 70 mg/dl.

He rested his head on the counter. No! Don't go to sleep. I poured him some orange juice and told him to drink. He took a sip and told me he was hungry. "Can I have something to eat?" He asked. 

"Drink up, Sawyer." I wanted to get the juice into him before he passed out.

Sensing the urgency in my voice, he guzzled down the juice then we cuddled in a chair and waited the recommended twenty minutes before re-checking his blood glucose to make sure it had risen by 40 mg/dl.

I asked him what he'd been doing when this spell came on.

"I was playing with the cat and spinning around," he told me.

I imagine he felt like he must have been doing some serious spinning to feel that dizzy.
I doubt it had anything to do with playing with the cat.

When he started to snap out of it, he asked me if he'd drunk the juice. "I don't remember drinking it," he said.

"Yes you did," I told him.  Then he noticed his sneakers in the middle of the room. "I don't remember putting my shoes there," he said. He was confused.

Then I asked if he'd thought playing with the cat and spinning around had made him dizzy.  He thought about what I'd asked then said, "I just couldn't think," he said.

That's a seven-year-old's way of relaying that he'd been confused. 

I spoke with his older sister later who told me he hadn't been playing with the cat. He'd been reading a book.

"I was coming down the stairs and I got so dizzy," Sawyer said. "I thought I should go tell mom about it."

Good call. As confused as he was, he was able to get to me and let me know that something was not right.

His blood glucose came up more that 40 mg/dl. He was back to his old self, playing with his siblings and raising a raucous.

A good sound.


**Treatments for low blood sugar include:

1/2 cup fruit juice
2 tbsp. raisins
3 graham cracker squares
5 vanilla wafers
1/4 cup sherbet
1 cup of skim or 1% milk
1/2 cup regular Jell-O
1/2 cup of regular pop
1 small tube of cake mate frosting
1 tbsp. honey
1 tbsp. maple syrup
1 tbsp. jelly
3 BD brand glucose tablets
4 Dex brand glucose tablest
1 Insta-Glucose tube.

Check Blood Glucose after 15-20 minutes to make sure it has risen 40 mg/dl. If it has not, re-treat until blood sugar rises appropriately.

** I chose to administer a glass of orange juice because it works quickly and I didn't have to worry if he would be able to chew properly. As the blood sugar level drops, muscle coordination can diminish.

The Emotional Side

So, how are you doing?

Let's face it, this is a real blow. It hit me like a lead Zeppelin fallen from the clear-blue sky and onto my head. It happened so fast there was no preparation. My little boy was healthy one moment and chronically ill the next. 


I looked at him and sadness filled my heart. It was my fault. I had done this. I had given it to him. How could I live with myself knowing I had passed this disease on to my son?


The blame game. What mom hasn't done it? Everything bad and evil in the world that befalls our child is put on us, not by us alone but also by society. 


Why didn't you catch this sooner? Why didn't you test him earlier? Why did you let him eat maple syrup? (See 'The Beginning')


As I let my thoughts pour from the wellsprings of my heart during a visit with my chiropractor, he reminded me that diabetes isn't contagious. He also told me not to do this to myself, that I hadn't given my son diabetes. He also expressed his sorrow at the news and told me things would be fine.

He was right. Things would be fine. 


In that moment I realized that what was done was done. The important thing to do now was be a rock for my child and teach him the appropriate way of managing his condition. 


I had my moment of weakness. I allowed myself five minutes to cry while Sawyer wasn't in my presence. Sawyer needed me to be strong for him.  Allowing him to see me cry would only create in him a sense of guilt. Children often carry the burden of their parents sadness, whatever the cause. I didn't want Sawyer to feel he was the source of any sadness in my life. Although his lifestyle would be under construction the prognosis was good. 


A smile, a hug, and praise for his good attitude goes a long way. He is facing this like a champion and I am proud of him.  

As we face this together, I hope I can make him proud of me too.

School Involvement

My son loves school and I wanted to get him back into his normal routine as soon as possible. 

He felt fine and I wanted him to have a sense of normalcy and not feel isolated because of his illness. He needed to know he was the same little boy he was a few days ago only better, healthier. I packed up his testing kit, strips, needles, insulin, and orders from his pediatric endocrinologist and took him to school.

The fact is, he can live a fairly normal life with proper care and continual monitoring of his blood sugar. It'll will be a labor of love for sure, but definitely worth it.

My husband and I paid a visit to the school nurse and informed her of Sawyer's situation and gave her the instructions that we'd received less than 24 hours ago. There is a period of adjustment in getting his sugars stabilized and knowing how much insulin will work for him. 


With his blood sugars in the sixties at lunch time, we worked out a plan with the nurse to schedule a snack for Sawyer in the morning. He still had lows and had to have treatment. The scary thing was he had no hypoglycemic symptoms. 


Generally, a person who is experiencing low blood glucose will exhibit symptoms such as shakiness, rapid heartbeat, sweating, dizziness, anxiousness, hunger, blurry vision, weakness or fatigue, headache and irritability. When this occurs, the person will need to check their blood glucose. If it is under 70 and they are not unconscious, they should be given 4 ounces of fruit juice, 4-5 pieces of hard candy, or 3-4 glucose tablets. After twenty minutes their blood sugar should be re-checked. It should have increased by 40 points. If not, treatment must be repeated. NEVER give food or drink to anyone who is unconscious. If you do not have access or training on how to administer Glucagon, call 911 immediately.

I learned through this experience that there is legislation that protects children with disabilities from discrimination at school, both public and private, and daycare facilities. (This excludes religious schools who do not receive federal funding).

According to Section 504 of the Rehabilitation Act of 1973, "Students with disabilities have a right to a 'free, appropriate public education' without discrimination." Additionally, children in private schools and day care centers fall under this umbrella of protection. These rights are protected by the federal civil rights and education law.


We didn't experience any troubles with our school and, in fact learned that the nurse took the initiative to consult with the principal and trained the high school nurse on the procedures necessary in the event of her absence. She also spent time researching information, on her own time, to get up to speed with his treatment and administration of shots. (Thank you for caring!! ♥) Nurses Rock!!

Section 504 "protects individuals with disabilities against discrimination in any program or activity receiving federal financial assistant." 
Parents have the right to develop a Section 504 plan with their child's school. School's failure to comply with the law can cost them federal funding.
Parents/guardians of a child with a qualifying disability have the right to meet with school staff and administrators to explain the condition at one meeting and put together a plan that best suits the need of their child. Section 504 ensures the child's right to participate in all activities without feeling 'different' from his classmates.

Your child spends most of his/her time under the care of the school. It is vital to maintain close contact with the school nurse and those who will be caring for him/her when you can't. It is a relationship that will benefit your child and their overall well-being.




More information regarding your child's civil rights can be found at the Web site of the U.S. Department of Education, Office of Civil Rights: www.ed.gov or toll free at 1-800-421-3481. 




*Photo courtesy of cuddlebugs.onslow.org
**Information obtained form American Diabetes Association and "Safe at School" pamphlet

The Diagnosis

My life seems surreal to me.

Everything that is happening must be just a dream that I will awaken from. I'm going through the motions not really taking in that this is our life now.

We spent seven hours in the emergency room the night we rushed Sawyer to the hospital, waiting and not knowing what would happen next.

He was finally seen by nurses who inserted an IV and got him started on fluids. This process brings down the blood sugar levels without doing it so fast that it shocks his system. Once they had it down some, they gave him some insulin.

It was 1:30 in the morning when we finally got Sawyer to a room. There was one pull out bed in the room. Barely able to keep our eyes open, I zonked out on the bed while my husband went to a lounge and did some office work.

There is no such thing as sleeping in at a hospital. Awake at 6 am like usual, I got up and took Sawyer to the play room that he'd been told about the night before. The thought of this playroom held his interest all through the night and he was not disappointed.

We still hadn't seen the doctor. We were tired, stressed, and in the dark about what was going on. Our pediatrician's office back home had told us it would be one night at the hospital and now the nurses were telling us two. We hadn't prepared for that. We had obligations at home.

The staff of nurses and diabetic counselors were excellent. They got us through six hours of diabetic training in that one day. They were doing everything in their power to get us out that day.

We practiced checking blood sugar levels by poking our fingers and reading the meter. We learned how to formulate how much insulin to give to Sawyer by adding the carbs he would be eating at his meal. This number is then added to another number for 'correction' of blood sugar over 250. Also, we had to learn how to administer a shot. There was a video about what to do in the event of an insulin reaction. Scary stuff right there. If this ever happens to Sawyer we are now equipped with a shot for the life threatening situation. In fact, we couldn't leave the hospital until we had a Glucagon kit.

It was lunch time before we met with the pediatric endrocrinologist. She informed us that Sawyer has type 1 diabetes. Treatment is four shots a day; one long acting insulin and one short acting three times a day before meals.

Diabetes is an expensive disease to maintain. Not only is insulin needed, but also the needles to administer it, test strips for the testing machine, lancets, alcohol wipes, ketone strips, regular doctor follow-ups, and enough healthy food on hand to ensure a consistently well-balanced blood sugar.

My mind was reeling. And still is.

Armed with information on the disease, medication, and a network of support we left the hospital in hopes of doing a good job keeping Sawyer healthy.

So far, it's been going well. Sawyer's blood sugars have been well under control and we're getting pretty good with a needle.

Sawyer wants to have an active role in his own care. He reminds me to check his sugar at 3 am, he can poke his own finger and check his sugar, and he knows he cannot have a snack higher than 10 carbs without an injection.

I'd say he's adjusted quicker than his parents.


...Next Time...Getting the school on board with Sawyer's treatment.

The Beginning

It came on suddenly. Nothing could have prepared us for what was about to take place in our son's body. There wasn't anything we could have done to prevent it. As much as we love him and do our best to protect him from the evils of this world, this attack came through the back door.
The word I have hated my entire life, diabetes, hit home with it's attack on my seven-year-old son.
It began with frequent trips to the bathroom and a constant thirst. This is a boy who we had to remind to drink his required intake of water. A child who rarely had to run to the restroom. Suddenly, he is saying, "I'm thirsty" on a continual basis.
I'm no stranger to diabetes. I grew up with a grandmother who had the disease and had spent time in the hospital. Then my father (not grandma's boy, but on the other side of the family altogether) ended up sick and in the hospital where he was diagnosed with diabetes. Again in high school, my best-friend had what they once called 'Juvenile diabetes'.
In October of 2007 I was also diagnosed with the disease.
As if this wasn't enough it made another appearance in my life.
Last week, Easter Sunday, I noticed my son's incessant thirst was profound. He drank from the drinking fountain until I had to intervene and tell him there was a line waiting to get a drink. I asked him if he had to go to the bathroom before we left church and he said he didn't have to go. Five minutes down the road he said he had to go and couldn't hold it.
When we got home, I used my blood testing kit to check his sugar. I almost hit the floor when I saw the number. 519.
No. No. This can't be. Not my little boy. Hadn't he just turned seven only a month ago? He's too young, yet in the back of my mind I knew my little guy's life was about to change as was the entire family's.
I put a call in to his pediatrician and the nurse practitioner quickly returned my phone call. First, she asked if my test strips were old. Uh, no. I have to purchase them every month. Hmm. Well what has he eaten? I told her he had waffles for breakfast. Oh, that must be it, she says. All that sugar in the maple syrup. Why, I don't even allow it in my house.
Okay, so now I feel the guilt of letting my children have maple syrup. How could I be such a horrible mom and bring that poison into my home.
I question the high blood sugar number of 519. Shouldn't a non-diabetic be able to process that waffle and maple syrup? It had been over 3 hours since he'd eaten.
Oh, that's normal, she tells me. It can be that high in a non-diabetic after eating that high carb maple syrup.
Funny. My husband can eat two cinnamon rolls and be 114 an hour later. This doesn't seem right.
She suggests I check his fasting blood sugar in the morning.
I did.
It was 397.
Not good. Even my little Sawyer looked at the number on the display and said, "That's not good."
The next day I called his pediatrician and got him in to see the doctor.
He wasn't concerned. He told me it was probably a virus that kids get this time of year.
???
He said it's very rare to see it in kids this age. Not unheard of but rare.
Okay. Just do the blood work I say.
The next morning my little boy has to give up three vials of his blood. He was so brave and I was proud of how well he handled the needle in his arm. That's scary for some adults.
The pediatrician called back that afternoon and said that my son's A1C was elevated to 8.3. A normal A1C is under 5. They were sending the information to Children's Hospital and they would probably get back to me in a couple of days.
Seemed a little long to wait.
I was right.
The pediatricians office called back shortly after speaking with me and told me the pediatrician endocrinologist at Children's Hospital wanted us to get Sawyer there that night.
Twenty minutes to make arrangements, pack, notify our children and other obligations and head out the door.
That was the beginning of our journey to discovering that Sawyer had type one diabetes.
There is a lot to catch up on and I'll try to do that over the next couple of days. It's a lot to absorb, I know. We are still adjusting.
We are grateful there are treatments. Before insulin was discovered people had no hope of a long life. They died within 3 to 4 years after getting the disease. Thanks to the Canadian scientists Sir Frederick G. Banting and Charles H. Best who discovered insulin in 1921, diabetes is no longer a death sentence. A person with diabetes can live a long and productive life.