I am going to post this in the School Nurse forum also but I want to get input from nurses experienced with managing Type 1 Diabetes...
I am a school nurse. One of the students in our district (5th grade) has Type 1 diabetes. It does not seem to be very well controlled so I have been called several times to go to his school and monitor him, usually because his FSBS is high. (I am the only nurse in the district and I am with the schools
16-20 hours each week).
My question is really this: in absence of a written plan from his physician, does he need to remain in the school office under close supervision of a nurse or a staff member who is trained to assist him with managing his diabetes (i.e. who can supervise him in checking his blood sugar and his self-administration of insulin and has basic education re: s/sx of hyper and hypoglycemia and how to manage both) when his blood glucose is high?
I'm asking because his fasting FSBS was 291 today when he arrived at school. He took a correction dose and coverage for his breakfast (he doesn't write things down so I am relying on his memory-hours later). His blood glucose reportedly peaked at either 256 or 380 something depending on who you are talking to and then dropped to either 42 or 56 (again depending on who you are talking to) all before lunch. I was called in this afternoon...and his FSBS was 174. His parents were called at 0930 and were coming to get him asap...he was still at the school at 1415 when I left.
I can understand wanting to keep him in the office when his blood sugar is low...but what about when it is "high"? His parents sent him to school with a 291 FASTING FSBS...he went straight to the office and never left. I know he feels bad (headache, etc) when his blood sugar is high...but he isn't going to feel any better or benefit in any way (that I can see) by sitting in the office rather than being in class...
What do you think? I have no experience with Type 1 diabetes. I've tried to educate myself because of this on going situation but I'm starting to wonder if this child has discovered that he can get out of class/be sent home if his blood sugar is high and he says he feels bad...He was dx'd last school year so this is new...he is currently an advanced student but I am concerned that if he continues to spend 25% of his school time in the office, he is going to fall behind.
Thank you for any guidance! I appreciate your assistance!