Juice at Lunch and HUGE Spikes

by Leighann on April 15, 2011

There are two things that I wish would have happened when my daughter entered school. (Okay, maybe more than two, but these two still bug me.)

First, when we registered her in the February before the fall when she entered kindergarten the form specifically asked if there were any medical conditions they should be aware of and if she needed medical attention.

I checked yes and wrote “Type 1 diabetes” on the form.

So the school district knows FIVE months in advance that they have an incoming kindergartener with diabetes, yet in the weeks leading up to the first day I was calling all over the district leaving messages trying to talk to someone, anyone, who could tell me if there was going to be a nurse at school for luncthime the first day.

I will say that the district seems to have gotten their act together a little because we received a long form to fill out about her diabetes regimen in advance of this school year. But I do not know if new students received this or just ones who had seen the nurse the year before.

Second, when I contacted the Director of Food Services with questions about the nutritional values on their website at the beginning of the year, why didn’t the director ask upon learning that my child has diabetes “What can we do to accommodate her dietary needs?”

In all honestly a daily vegetarian option would be grand, but that’s due to our family’s chosen lifestyle of (almost) vegetarianism and not because she has diabetes.

You may wonder why I am bringing all of this up, halfway through the school year. I do have a point.

On a Friday I got a call from the substitute nurse about 1:00 pm saying that Q didn’t feel well and her blood sugar was in the 400’s. FOUR HUNDREDS!

I was kind of critical of her because really, there is no reason for Q to ever be in the 400’s unless she is extremely sick or isn’t getting insulin.

I asked if she was sure that Q got her bolus at lunchtime. She said yes.

Since her lunchtime insulin hadn’t peaked I was nervous to give her the full 2.25 units that her pump suggested as a correction. I was so afraid that she was going to crash straight down. I advised to give her 1 unit. It was almost the end of the school day at this point and I wanted to wait it out just a bit.

When I got off the phone I had a terrible feeling about the whole thing. I hopped in my car and drove the five minutes to her school. I took her pump bag off the shelf in her classroom and scrolled through the records. She had in fact gotten a bolus at lunch. I checked her blood sugar and she was coming down so I didn’t think the pod was the issue.

By afternoon snack she was back in range. Actually at the low end of her normal range. But good.

So why this crazy spike? I was perplexed.

I had just been reading in Ginger Vieira’s book Your Diabetes Science Experiment* that there is an explanation for every high and low blood sugar. I needed to find out for myself why this happened. My first piece of evidence was her lunch slip that I send in every day.

Lunch consisted of pizza, salad, milk, and juice. JUICE. That had to be it.

We all know that juice is great for bringing up lows quickly, but it’s not something that I serve Q (or my other non-D child) unless she’s low. (He often wants whatever she’s getting, lol!)

Federal school lunch standards state that juice is considered a fruit (much like in the Reagan administration they tried to pass off ketchup as a vegetable, which is funny on two levels because tomatoes are fruit!). So the school district is within it’s rights to serve it, no matter how much I disagree with juice being a substitute for real fruit.

And even more, what kid, any kid really needs milk and juice at lunch? Did I mention that both chocolate and pink milk are offered alongside white milk every day?!

I digress.

I am 99% sure that the huge spike into the 400’s was the juice. She has pizza at school every Friday and it hasn’t been a problem. The only variable was the juice.

So I e-mailed the Director of Food Services and asked if my daughter could have fruit on days that juice is served because she just can’t drink it.

(And as an aside when I mentioned this situation on Twitter several people asked why I don’t just send in a piece of fruit for her on those days or not buy lunch. I would be spending extra money to send in the fruit which negates the cost savings and convenience of buying lunch in the first place.)

What was her response?

They are allowed to make substitutions for children only after they’ve received and approved a letter of medical necessity written by the child’s doctor.

A.) Why was I never told that there could be substitutions based on medical conditions. And,

B.) Really? A letter from our doctor. As if the endo doesn’t have enough to do. As if I don’t have enough to do. Ugh!

The first time juice was served after our letter of medical necessity was submitted and approved, I wanted so badly to sit back and watch what happened. Would they remember to send a piece of fruit over to my daughter’s school? Would the director give the nurse the carb count?

But being the control freak that I am, I e-mailed the nurse and the director of food services and reminded them that Q needed a piece of fruit.

The irony?

After school I asked Q if she got fruit instead of juice. She said she did, but she was so disappointed that she didn’t get to drink the juice.

Oh well. I can’t win!

*Disclosure: I received a copy of Your Diabetes Science Experiment for review consideration.

Further Reading

(Don’t) Think Pink

Bookshelf: Your Diabetes Science Experiment (coming soon)

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{ 7 comments… read them below or add one }

1 Scott S April 15, 2011 at 9:06 am

This is one reason why I am glad I grew up in New England where the school districts are mostly done at the town-level (as are all government agencies), and these decisions are slightly (not by much, but each town varies in size) are usually made much more locally and less bureaucratically than they are at a larger county-level or regional school district. I just find examples like these to be incredibly annoying because they could have been avoided if someone at the school was complying with the 504 plan. Having said this, we as parents need to push our endos to write these letters after we learn of these things happening. Being busy is not really a good excuse for a doctor; we wait in the waiting rooms for a long time to get our 15 minutes with the endo, and hey, we’re all busy. If parents do not ask, these things will fall through the cracks and be forgotten by a school district that is obviously too big to worry about such matters the way a parent would.

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2 Leighann April 15, 2011 at 10:32 am

Thanks for your comment Scott.

Our endo’s office was happy to write the letter, but I just couldn’t believe that I needed a letter from a doctor for this exemption.

Our school is great and works with us, but it’s when I have to go beyond the school to the district level that there are sometimes glitches like this.

I hear there is high turnover rate at the school lunch director position.

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3 Sarah Hill April 15, 2011 at 9:42 am

Do you have a 504 Plan for your daughter? The IEP is really for her safety–I’d make sure you have one and involve the administrators, school nurse, classroom teacher, cafeteria supervisor, and anyone else who contacts your daughter. Schools sometimes don’t like writing one, but, hey, tough. 🙂 It allows YOU to make the health decisions regarding your daughter and you know best.

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4 Leighann April 15, 2011 at 10:36 am

Hello Sarah, yes, we have a pretty detailed 504 plan in place and the school has complied so far with all of our decisions about her care while at school.

I just never foresaw that there was going to be an issue with juice at lunch! Never crossed my mind. And I was blown away that I needed a doctor’s letter for this substitution. These things were at the district level, not our school who is pretty accommodating.

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5 Stacey D. April 15, 2011 at 9:44 am

Wow, that is so frustrating. And so very different than when I was in school! Granted I don’t remember details like that from when I was in school but I do know that my parents didn’t have to go through so much trouble about my lunch. I feel for you Leighann, I really do. But you do such a great thing for Q and she’s only going to benefit from it.
And for the record, I never drink juice unless low either 😉

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6 Leighann April 15, 2011 at 10:39 am

Stacey- And maybe part of the issue too is that many schools are getting away from food being cooked at the actual school. In our district there is a central kitchen that sends out the food to each of the schools. If food was being cooked in our school’s kitchen I have no doubt that they would have said okay more quickly, but I had to go through the district’s school lunch director. Ugh!

I still find it so ironic that Q never really had juice until she was diagnosed!

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7 Angela (Toucan Scraps) April 15, 2011 at 1:11 pm

I can empathise.

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