Snacks for hypoglycemic child in nut free school

[WhisperingAutistic]

My son has an organ transplant, so is immunosuppressed and has just been diagnosed with hypoglycemia. The doctor says he needs to eat slow release carb type snacks at play time at school but the school is nut free and I can't for the life of me think what to give him.

Due to his immunosuppressive status, he cannot have something like a sandwich in his bag as he's not allowed something that should really be kept refrigerated. It needs to be something shelf stable.
At home he would have a cereal bar or something, but the vast majority say 'may contain nuts'.

Any advice?

My peanut/milk allergic child has:

Mini soreens, they do banana and apple flavour.
Nairn's oatcakes, there are berry and chocolate flavour ones.
Bear yo-yos.
Cream crackers.

Don't think any of them are "may contain", although he does regularly eat things that are.

Also worth checking is it just peanuts or all nuts? Peanuts are a different category of plant, my son eats cashews and almonds for example.

The OP said her son had recently been diagnosed with hypoglycemia which basically means that his body produces too much insulin which can cause blood sugar levels to drop dangerously low. Have to treat it with sugar to get blood sugar levels back up quickly and then eat a slow release carbohydrate to keep blood sugar levels up over a longer period of time which will prevent another blood sugar level drop. Hypo kit is needed as the danger is a child/ adult can go into hypoglycemic shock - this can be given and obviously hospital attention would also be needed. The hypo kit is an injection which makes the liver release it's store of sugar straight into the blood stream and basically can save the person's life.. my son has type 1 diabetes and treating hypoglycaemia is par for the course. Xx

Challenge the policy.

I have nuts in my kitchen.

Therefore every single item I could ever send into school "may contain nuts"

If it’s this serious though why hasn’t o/p been given all this advice?

to say she just needs “slow release snacks” for school wouldn’t indicate a life threatening condition similar to a diabetic would experience.

nothing has been mentioned about taking food to get his blood sugar up quickly? Or glucagon rescue etc?

this is what I’m asking the o/p.

I had a child in my class who needed to bring a snack for similar reasons and it had to be kept cold. He gave it to us and someone went and put it in the fridge in the staffroom and got it out for him at the right time. It was very simple! You could be absolutely fine with a sandwich if you just ask. We actually kept entire lunches in there for kids who had real issues with eating food that wasn’t properly chilled (as in gagging on the texture of room temperature bread), parents had meetings with head and worked together to find the best and most stress-free (for the parent and the child) solution.

And although our school was a nut free school, ‘may contain nuts’ were allowed. Imagine trying to police 400 lunchboxes every day, it’s just impossible.

My son has been diagnosed with 'exercise induced hypoglycemia'. From what ive read, it's easier to control than just normal hypoglycemia. Basically, it only happens when he's running around or doing PE.
We haven't been offered glucagon rescue or any type of intervention. We've been told it's hopefully something he grows out of but they aren't sure if and when because he's a liver transplant patient and his liver is a live donor one, from his dad.

It's exercise induced hypoglycemia. The first time he experienced it, he was drifting in and out of what looked like fainting until I gave him lucozade. Sweating, clammy, white, couldn't keep his head up.
We haven't been advised to do anything other than control it with food.

The fridge that is used to keep Amoxicillin, glucagon kits, eye drops, cold packs and the like can be used to store snacks/Lucozade/other sweet drinks without breaching any rules. It's supposed to be a dedicated fridge for medication, rather than one for staff milk.

It's also possible to have a second lunch bag kept in the medical room/area off reception/wherever the epipens and spare inhalers are kept with long life nut free snacks. Where we've had T1 kids, it's just been a case of allocating a section of a shelf labelled 'Fred's shelf' for these, so no big deal adding 'Jamie's shelf' for exercise induced hypoglycaemia.

You should complete a health care plan to cover all eventualities, such as what to do if he gets woozy/sleepy/feels sick/whatever (very useful in cases where it might actually be a slow presentation of T1, as it ensures there are records that can be referred to if it becomes a frequent thing).

Depending on what your mornings are like and if he eats breakfast at home it is worth also looking at his breakfast to avoid a very carb-heavy meal and to try and include protein and slow-release carbs, eg wholemeal toast with peanut butter, porridge, eggs.

@WhisperingAutistic you can get glucose in a gel contained in a tube - normally get three in a pack. Get some and give to school and make sure your son has some on him too. The gel can be squeezed inside his mouth. He was actually drifting in and out of consciousness - and if left can be very dangerous - I don't want to scare you but your son is still at risk of going into hypoglycemic shock .Obviously the way you treated it is the way it should be treated ie with a sugary drink/ sugary snack. But the gel is useful in case he is unable to swallow. If the hypoglycemia is only caused by exercise that does make it slightly easier to deal with - exercise makes the body use it's insulin more effectively hence why blood sugar levels can drop so quickly. My son is also at risk of hypoglycemia after exercise and he managed it by having some slow release carbs about 30 - 60 mins before exercise so you could try that - although now he is using an insulin pump he just reduces his basal insulin. Also diabetics are at risk of a hypo for 24 hours after exercise so although I appreciate your son isn't diabetic, you might just want to watch this too. Re the glucagen hypo kit - I would check with your son's medical team about this - it might be he can't have one because he has had a liver transplant. Re the sensors - if he is not experiencing hypos during the night you may not need or want to get these. They are available on the NHS or you can pay for them privately. As I mentioned in my previous post - a bag of crisps at bedtime kept my son's blood sugar levels up during the night after doing sports at school.

Wishing you and your son all the very best xxx

Thank you for this, it's really helpful.
I do feel like the GP didn't really give me enough information. We've got an appointment with his transplant consultant very soon so I'm definitely going to bring it up with them. There have been a few occasions where we've been walking and he just looks wiped out and says he's tired. I've always given food in that situation but I'm thinking that he needs his blood sugars checked properly, not just relying on giving him extra food and that's that.

@Cheekychop your experience is with Diabets which is very different to the o/p’s diagnosis of exercise induced hypoglycaemia.

his body will eventually right the issue by using the liver’s glycogen stores, so it’s very unlikely he’ll need actual medical intervention. It is just very unpleasant and worrying. As long as o/p, he, and the school recognise the symptoms and know what to do.

they’ve had medical advice, talk of hospitals, glucagon and hypoglycaemic shock is unnecessary. You are obviously well informed about hypoglycaemia in diabetics and the very serious consequences but that is not what this is.

See, I didn't know this at all and would have been trying to give him high carb. I seriously need to get some advice from a dietitian. Luckily we can ask for access from his transplant team.
Thank you for your advice.

We were told that after liver transplant, it's not uncommon for the child to end up diabetic so it's a good idea to keep track.
He has a care plan for his transplant issues and tomorrow I'm talking with his teacher to amend it for this issue.

@Lastnamedidntstick hypoglycemia is hypoglycemia - and if you look it up it is very dangerous. Hopefully as the OP said her son will grow out of it but until that day the condition still needs to be managed. Her son already has experienced a moderate hypo - not being able to keep his head up and feeling faint - the next stage is severe hypo when the person collapses. It is not scaremongering to ensure a mother and school have all the necessary information to make sure that her child is kept safe and well.

Most people can experience a bit of light headedness after exercise - that's a very mild hypo - but her son has experienced more serious effects than this which proves that his condition is serious and has to be managed properly. Sometimes health professionals are so pushed for time that they don't always explain things fully or at all. I would rather have more information which I can then get checked by the health professionals than not enough and my child suffer the consequences.@WhisperingAutistic I am glad you found some of what I said helpful. Please do speak with your son's health professionals. Wishing you all the very best xxx

@WhisperingAutistic just reading your updates - if it's not uncommon for a person to develop diabetes after a liver transplant then a libre sensor may be the way to go. You will be able to see his glucose levels without having to do lots of finger pricks and you will be able to see his blood sugar trends after sports or exercise which will help you to manage sports inorder to avoid hypos. Also you will be able to see straight away if his blood sugar levels start to go very high - which is the first stage of diabetes. Also keep a look out for the 4T's of diabetes - tiredness, thirsty, going the toilet more often and losing weight/thinness.

Also when having a hypo make sure you give sugar first and that his levels are back over 4.1 mmols before giving him the slow release carbs as if you give the carbs before they will slow down the absorption of the sugar and his levels will take longer to come back up.

All a massive learning curve I know - but if you need any further advice in the future please come back.xxx

Thank you @CheeCheekychop I'll definitely mention it at his clinic appointment