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COVID-19 (Coronavirus) Updates

Tips for Quarantine:

Clinic Advice:

The COVID-19 crisis has introduced many new challenges for all of us, including children with T1D and their families. Below, we have compiled resources to assist with the mental health struggles of the crisis and tips on keeping your children healthy and educated. You can use the links above to navigate to a particular subject.

 

Please check back on this page as the COVID-19 situation develops to be informed on the most up-to-date recommendations and advice.

We appreciate your patience and resilience in this historic moment and we would like to reassure all of our patient families: you are not alone. The U-M Pediatric Diabetes Clinic remains committed to caring for your children and teenagers during this time.

Health & Safety Tips

The best defense against any contagious illness is frequent and effective handwashing and seeking immediate medical assistance if experiencing symptoms.

Below are our recommendations for patients and families:

  • Wear a cloth or disposable face mask whenever you go out in public. Research has shown that face masks can help prevent the spread of the disease.

  • If you are socializing with people outside of your household:

    • Be sure to wear a mask​

    • Practice "social distancing" by staying at least 6 feet apart

    • Try to socialize outdoors where there is more airflow and less chance to spread germs

  • Wash your hands with soap and water. Young children may enjoy singing one of their favorite songs to help achieve the recommended 20 second pace. If you're a fan of University of Michigan Athletics, try following along with these handwashing instructions set to the U-M fight song!

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  • Avoid touching your eyes, nose or mouth with unwashed hands.

  • Cover your mouth and nose with a tissue or use your elbow when coughing or sneezing.

  • Avoid contact with people who are sick.

  • Disinfect "high-touch" areas in your household frequently, including sinks, counters, appliance handles, doorknobs, and bathroom areas.

  • Stay home if you are sick and contact your healthcare provider right away if you are experiencing coughing, fever, or shortness of breath.

Please refer to the links below for the most current information on taking precautions, symptoms, and situation updates:

JDRF recorded this conversation with Dr. Mary Pat Gallagher, Director of the Pediatric Diabetes Center at Hassenfeld Children’s Hospital at NYU Langone concerning T1D and coronavirus.

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Mental Health Tips

The COVID-19 situation, "social distancing," and the state of Michigan's stay at home order introduced new challenges for all of us, including children and teenagers with diabetes. If your family is experiencing "diabetes burnout," we encourage you to read our tips on Overcoming Stress with T1D in addition to the tips below. If you or someone you love is experiencing depression or extreme diabetes burnout, please talk to our psychosocial team at the U-M Pediatric Diabetes Clinic by calling the clinic. We encourage parents of young children to visit Zero to Thrive's website for helpful information on explaining the coronavirus situation to them.

Increasing social distancing without increasing the blues

Children and teenagers need social interaction and activity for typical development. Social distancing encourages limiting interactions with large groups and contact with potentially ill individuals, or those that potentially carry the virus without symptoms. While many of the activities we enjoy are limited at this time, we can think creatively about activities that can promote a positive mood. Here are a few ideas:

  • Good ol’ technology: Consider adjusting screen time limits to allow children to interact with their peers  via technology. Also – consider using video chatting to connect with elderly family and friends who may be socially isolated themselves. Grandparents might enjoy spending craft time with young ones or reading books together. That’s a win-win! You should continue to monitor the content of your child’s technology including video games, streaming websites like Twitch and YouTube, and social media apps like TikTok, Instagram, and Snapchat to set age-appropriate limits.

  • Get outside! We know that being in nature is good for our mood. Plan to get out of the house for a while each day. This may include a family walk around the neighborhood, walking your family pets, raking leaves (or other spring yard work), a picnic lunch, or just sitting on the grass while reading.

  • Move it, move it! You may have heard it many times, but physical activity does wonders for mood. Even 5 minutes of moderate activity can boost your mood. It doesn’t have to be push-up and sit-ups - try dancing to your favorite songs or kicking a soccer ball around outside. Consider setting a goal as a family to do at least 30 minutes of activity in the morning and 30 minutes in the afternoon/evening. Doing it together will help the whole family! You can read up on Exercise & Activities with T1D to make sure your blood sugar is steady during any intense activity.

  • Take a grateful approach. Spend time each day as a family identifying things from the day each person is grateful for. It doesn’t have to be extraordinary, just meaningful. For example, a parent making a favorite food or a sibling sharing a toy.

  • Limit popular media about the COVID-19 situation. It is good to stay informed, but focusing too much on the crisis can put you in a funk and children may pick up on the stress.

T1D Care Tips

School and after-school activities provide kids with diabetes additional structure and supports daily diabetes management behaviors. When students are out of school, it can be at higher risk of struggling to complete their diabetes care, even when they typically do really well! Being cooped up at home can also lead to less physical activity and exertion which may affect blood sugars.

 

Here are our tips on maintaining a healthy T1D routine at home:

  • A daily routine is key!  Help your child as much as possible to maintain a fairly consistent routine when it comes to to sleep and eating schedules. This helps anchor care to typical activities. Remember, you should be checking blood sugar when you wake up, before you go to bed, before every meal and snack, and any time you are feeling the symptoms of a high or low blood sugar.

  • Educate any additional caregivers. This situation has prompted many families to rely on new or less T1D-experienced caregivers. Be sure to share our education resources including the New Onset Guide or JDRF's resources to provide quick and accurate education.

  • If you’re not together during the day, send pictures of devices when possible. It’s better to lay eyes on the meter or pump than rely on verbal report - not because your child is dishonest, but because it helps keep them accountable in the moment.

  • Set up a family “diabetes care review” conversation each day. Use this time to review meters, pumps, or CGM together. Focus your attention on what went well during the day and problem-solving how to improve care for tomorrow. Avoid focusing on missed opportunities for care, as this is unlikely to help your child do better tomorrow.

Check out Diatribe's resources on COVID-19 for people with T1D for more information.

Education Resources

With schools closed, many children and teenagers are lacking the structure of their ordinary schedule. Below are some tips and resources for children and teenagers to maintain their academic skills during this time away from school.

  • Stay connected with school. If your child's school is offering virtual classes, be sure to help them connect and complete assignments as required. Review assignments from the school, and help your child establish a reasonable pace for completing the work. You may need to assist them with turning on devices, reading instructions, and typing answers. Stay in touch with teachers and school staff if your child is having trouble with the assigned materials or if you have difficulty connecting to lessons.

  • Create consistency. Create a schedule and routine for learning at home, but try to remain flexible. Start with a consistent bedtime and wake up time during the week. Break up the day with time for learning, time for play, time for meals and snacks, and time for physical activity. Most importantly, allow yourself flexibility in the schedule - it's okay to adapt from day-to-day as things come up.

  • Practice makes perfect! One of the best things you can do for your children is practice what they have learned in school. Review vocabulary words from science and language arts, practice math problems and create your own word problems, and give presentations on history or books they have read. You can search for instructional games or grade-appropriate activities online to help you.

  • Make learning fun. Children love hands-on activities like puzzles, painting, drawing, and making things. YouTube and Facebook can be great places to check for tips on these kinds of activities. Playtime can also be used in place of structured learning when appropriate - encourage your children to build a fort from sheets or practice counting by stacking blocks. Practice handwriting and grammar by writing letters to family members or starting a journal. Listen to audiobooks or see if your local library is hosting virtual or live-streamed reading events. JDRF has assembled this fun list of "quarantine activities" that can spark creativity or interest in learning.

  • Give freedom to explore. If your child is happily engaging in art, reading, science, or history, let them explore! Self-directed learning is one of the most effective ways to absorb educational material. Don't feel the need to move children from topic to topic if they are enjoying a particular subject and are staying productive.

Promoting Academic Skills at Home

Clinic Virtual Visits

For more information on how to sign up for virtual visits, check our Virtual Visits page.

Returning to Clinic Visits

For more information on what to expect as in-person clinic visits resume, check our Returning to Clinic Visits page.

Returning to School

We understand that patients with diabetes and their families may have special concerns about how COVID-19 may impact their health. Based on current scientific evidence, children and teens with type 1 diabetes do not appear to be at higher risk of becoming infected with coronavirus compared to their peers without diabetes. However, if they do contract COVID-19, it is possible that the child or teen’s course of illness may be more severe and impacted by potential challenges in controlling blood glucose levels and risk of developing DKA. Please keep in mind that we are learning new information about this virus on a daily basis and our advice may change to reflect new knowledge.

 

For more information on making back to school decisions for families with underlying health conditions, please check this Michigan Medicine blog post.

How can I prevent my child from getting COVID-19? Should I do anything differently?

We advise children with diabetes and their families to be vigilant to well-known preventative measures to help prevent infection. You can read more about our health and safety tips above.

If your child has concerning symptoms, please contact your primary care doctor or pediatrician to arrange for testing and seek medical advice. Please follow your blood glucose and ketones closely and follow your diabetes sick day plan.

My child has tested positive for COVID-19, what do we do?

It is important to monitor your blood glucose and ketones closely and follow your sick day plan. If your child is having high fever, trouble breathing or other concerning symptoms, you should call their primary care provider or seek urgent medical care. Visit our Sick Days page for more information on how to manage T1D during an illness.

Should I keep my child out of school if it is in-person?

This will be a decision that each family has to make based on their situation. The benefits of learning, socializing with peers, and being involved in school activities must be considered with the risk of the virus. The decision to have school in-person will be based on the community transmission in your area. We recommend having a conversation with your child's primary care physician who may be able to advise you based on local community infection rates.

We would like to stress the importance of making sure your child is safe at all times and remind patient families that our primary focus is on treating diabetes concerns. If your child will be attending school remotely or learning at home, it is still very important that they have a dependable support system in place in case of a diabetes emergency. If they will be left alone, their health is still the parent or guardian's responsibility. Child Protective Services in the state of Michigan recommends children under 10 years old should not be left home alone.

Whether schools meet in-person or with distance learning, your child has rights. The American Diabetes Association has helpful resources on this topic. We recommend speaking with your child's teacher to establish a communication system for your child to excuse themselves to take care of diabetes concerns. This can be as simple as a colorful index card or a hand gesture. We can also assist you in drafting a Diabetes Medical Management Plan (DMMP) to ensure your child's diabetes needs are taken care of at school. Visit our Back to School page for more information and contact us for help.

Thank you for your dedication to your child’s diabetes management. As always, if you have specific concerns that come up, do not hesitate to contact our clinic.

COVID-19 Vaccine Information

As the nation and Michigan Medicine continue efforts to rollout vaccines for COVID-19, we wanted to take this opportunity to address some concerns our patient families may have about the vaccine.

You can find up to date information regarding COVID-19 vaccination on the following websites:

  • What do I need to do to go back to school?
    Going back to school after a new diabetes diagnosis can be stressful. It is important that you are prepared to make the transition as smooth as possible. Be sure you have your supplies and tell the school what to do in case of emergencies, like extremely low blood sugars. Talk to your diabetes care team about developing a Diabetes Medical Management Plan (DMMP) and set up a meeting to create a 504 plan with your school administrators. If you have any questions about your child’s health, do not hesitate to ask us.
  • What is a school plan (DMMP)?
    A Diabetes Medical Management Plan (DMMP) outlines the specific care your child needs at school. Diabetes management is different for everyone. Some students inject insulin with a syringe and vial, some use insulin pens, and some use pumps and CGMs (continuous glucose monitors). Students often have different carb ratios at different times of the day and require different amounts of insulin. Some students manage their diabetes independently, and some younger or newly diagnosed students may need help with all aspects of their diabetes care. Your pediatric endocrinologist's orders will be specific for your child's health and well-being. Drafting a DMMP takes place between you and your care team. This is typically done in the summer months before your child returns to school. Please do not hesitate until school is about to start to bring this issue to our care team, as we typically have higher volumes of forms to complete at this time.
  • What is a 504 Plan? Do I need one?
    A 504 plan is a formal, legal action plan made with your child’s school that outlines the school's responsibilities in managing your child’s diabetes. For a sample 504 plan, click here. ​ It is a good idea for you to come up with a Diabetes Medical Management Plan (DMMP) with the school before each school year. The U-M Pediatric Diabetes care team can help facilitate this conversation if you would like. The 504 plan can help reinforce the commitments made in the DMMP. Remember, the school staff are likely not medical professionals; be patient and remember that you are a team in taking care of your child's health and well-being.
  • What is an IEP? Do I need one?
    If a student with diabetes has special education needs that qualify under the Individuals with Disabilities in Education Act (IDEA), an Individualized Education Plan (IEP) may be needed instead of a 504 plan. An IEP is a document that outlines what the school is going to do to meet the child's individual education needs. To qualify for an IEP, a child must have an impairment that affects his or her academic performance.
  • My child's school won't let my child attend because they do not have a school nurse. What can I do?
    It is not legal for your child to be barred entry to any public or private school that receives federal funding because of a T1D diagnosis. Even if your school does not have a nurse, all schools that receive public funds are required to train a responsible adult to carry out the Diabetes Medical Management Plan (DMMP). They cannot exclude a child from school because of type 1 diabetes or force parents to come to school to handle the diabetes care activities. It is important to remember, the school staff are likely not medical professionals; be patient and remember that you are a team in taking care of your child's health and well-being. ​ If you continue to have trouble with establishing the school's role in your child's care, you may contact us about creating a 504 plan.
  • My child's school wants me to come in and perform blood glucose checks and insulin injections. What can I do?
    You are not required to leave work or disrupt your schedule to perform routine care for your child's diabetes while they are at school. Even if your school does not have a nurse, all schools that receive public funds are required to train a responsible adult to carry out the Diabetes Medical Management Plan (DMMP). They cannot exclude a child from school because of type 1 diabetes or force parents to come to school to handle the diabetes care activities. It is important to remember, the school staff are likely not medical professionals; be patient and remember that you are a team in taking care of your child's health and well-being. ​ If you continue to have trouble with establishing the school's role in your child's care, you may contact us about creating a 504 plan.
  • What supplies should I take to school?
    Your Diabetes School Kit should include: Extra glucose meter Blood glucose test strips Juice boxes, glucose tablets, and/or glucose gel Glucagon Granola bars or other small snack Ketone strips Bottled water (if your child won’t drink school water) ​Your child should always have access to something to treat a low blood sugar. Snacks or glucose tablets should be kept with the student, in case of a fire drill/lock-down/shelter in place, as well as in classroom, in the locker room, and on the school bus. For younger children, ask the teacher to keep juice boxes or glucose tabs in their desk. Be sure any substitute teachers, including substitute bus drivers and office staff, also know about this arrangement. Older children should carry supplies in their backpacks or in their pockets.
  • Where should I keep my glucagon at school?
    It is very important that your glucagon is kept somewhere accessible where others can find it in case of emergency. If you leave your glucagon in your school's office, you need to have a plan in place for someone to retrieve and administer the shot. It is advisable that you leave your glucagon on your person, possibly in a backpack or handbag.
  • What if my child gets low at school?
    Highs and lows will happen at school, at home, and in many areas of your child’s life. Good diabetes management means responding quickly and calmly to correct blood sugar levels until they are back in target range. If your child is low at school, they should have access to a quick carb snack or glucose tablets or gel. Make sure your child’s teacher understands the need to have these supplies on hand and what to look for when your child is acting low. If your child loses consciousness, your child’s teacher or a responsive faculty member should have access to the child’s glucagon kit and be aware of how to give the injection. It is recommended that you review these steps with anyone who will be helping your child with their diabetes as a part of their T1D training.
  • What should I do during a test?
    By establishing a 504 plan with your school, patients are allowed special accommodations during Michigan state tests such as M-STEP/PSAT/SAT/ACT. If you need a snack, you are allowed to have one present during the exam. You may have permission to use a cell phone to monitor CGM values, but you must receive approval for all test accommodations with the test proctor and the school staff ahead of time. For certain tests, a letter from your clinician must be provided to the College Board in order to receive these accommodations. The College Board approval process may take up to 8 weeks, so be sure to plan ahead. A good reminder is to discuss standardized testing dates during the fall at the same time you are reviewing your 504 with the school. Please contact the clinic if you have questions about these issues.
  • How do I tell my friends about my diabetes?
    Talking about T1D with friends, family, and strangers can be difficult. Even if you are successful in managing your diabetes, it can be stressful discussing this personal information with new people in your life. JDRF offers a free PDF on how to talk about T1D with friends, family, coworkers, and in a variety of situations here.
  • Who needs to know about my child’s T1D at school?
    You and the school staff are partners in your child’s education and well-being. Strong and clear communication is crucial to the success of your child’s health. Staff you should consider educating about T1D include: Principal Nurse Guidance counselor Teachers P.E. teacher Latchkey / after-school program supervisors Cafeteria staff Coaches or extracurricular supervisors Bus drivers JDRF offers a free PDF that may help you in facilitating a relationship with your school here.
  • Are there scholarships for my college student with T1D?
    There are several scholarships just for teens with type 1! Click below to learn more about the College Diabetes Network (CDN) and other scholarship opportunities. College Diabetes Network (CDN) Diabetes Scholars Foundation Novo Nordisk Donnelly Awards (for teen tennis players with type 1) Seefred Trust Scholarship (Ohio residents only) ​Please note: These opportunities are typically open January-April. Check the Off to College (Teens) page for other opportunities.
  • How should I prepare for college life with T1D?
    Moving away from home with T1D can be a scary thought, but it is very possible to have a happy and healthy experience at college with T1D. To prepare you for this new chapter in your life, please check out our Off to College (Teens) and Off to College (Parents) pages. Please also feel free to check out College Diabetes Network's "Off to College" booklets on their website and request a physical copy in clinic.
Mental Health Tips
Health & Safety Tips
Education Resourcs
Clinic Virtual Visits
T1D Care Tips
Returning to Clinic
Returning to School
Vaccine
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