I know! Such a big part for her first school play. We're very proud! Drama meets every Wednesday after school. For the past 2 weeks, her specials rotation has meant that she has PE on Wednesdays as well. PE falls at the very end of her school day. Her PE class ends at 2:55, and school gets out at 3.
She eats lunch at 12:30.
The school nurse leaves campus at 3:30.
Drama doesn't end until 4.
Sooooo...
She needs to check her BG before PE...by then it's been just shy of 2 hours since lunch. Experience has taught us that she's likely to go low, so to compensate we give her a snack and cover it with insulin, minus 10 carbs, while taking the current BG/IOB (active insulin on board) into consideration before administering the final dose. We've learned through trial and error that 10 uncovered carbs helps prevent lows during PE class, AND highs that strike from feeding carbs without insulin.
On any day, except Wednesday, I'd be there at the end of the day to follow-up after PE.
BUT...on Wednesdays she has drama.
So there lies the dilemma.
She's just had a snack and a carb bolus an hour before the end of the school day, followed by intense physical activity for 45 minutes, and the school nurse is preparing to leave campus.
She needs a sugar check, right? And probably a snack to cushion her from a potentially drastic drop in blood sugar. But how much insulin should she get?
Remember, there's still plenty of active insulin circulating from the pre-PE snack an hour beforehand (that may or may not have included a correction), and I'm not there to use the adult level critical thinking skills that keep her alive from one bolus to the next (okay, maybe that's a tad dramatic -- but this is a post about drama, after all!). The school nurse will be leaving soon, and anything can happen with the peaking-insulin-post-activity-drama-adrenaline combo.
She's on her own to choose a snack, consider the physical activity she just participated in (which could vary based on weather), and administer insulin while compensating for whatever BG pops up on the meter.
It's a tough call for an adult to make, but it becomes more precarious when a child needs to figure it out.
She's 8 years old and gaining increased independence every day. I'm administering boluses and prompting blood sugar checks less often, while she's stepping up and taking responsibility more often. Learning to step back has been a struggle for me, but I know it's necessary for her growth and well being.
Fortunately, her Animas pump doesn't make this as much of a dramatic moment as it may seem. The IOB feature will deduct insulin she doesn't need from the dose while compensating for her current BG. She's responsible for pushing the buttons, but we rely on the pump's algorithms for keeping her safe.
Because, let's face it, Toto is a superstar who needs her own personal security detail!
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