Diabetes screening question

  1. So I have a teen, who is very overweight, comes from a very unsupportive household. Not sure where one parent is and the other is reported to not be very kind to the child. Reports urinary incontinence at night. (I know HUGE red flag there..has previously been referred to state) In the past any outreach to the parant has resulted in a not great time for the child. Not necessarily abusive but...

    I know I cannot to a finger stick to check the CBG without an order (especaily as it is invasive) but could I ask them to use a dipstick to see if sugar is spilling or if there are ketones? I would like to have something to back up my concern so it is not fluffed off by parent. The child is not a great historian either and is easily led by questions.

    Thoughts?
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  2. 10 Comments

  3. by   OldDude
    Teenagers...too old for me but how about asking mom if it's OK for "him" to do the dipstick and you look at the results?
  4. by   ruby_jane
    I appreciate your good heart and your willingness to help but I would say don't do anything without an order (even a non-invasive dipstick). Are you able to assess acanthosis nigricans markings on the back of the neck, in the crevices of the elbows, or on the bridge of the nose? That's something we do as part of our episodic vision/hearing screenings here in Texas. If mom asked for the dipstick test or even the fingerstick that might cover you, though...

    My favorite boss (in TB) used to tell me "A decision to test is a decision to treat." What she meant was - unless you have the resources to treat (doctor's orders and medication) refer it to someone who does.
  5. by   BeckyESRN
    Quote from ruby_jane
    My favorite boss (in TB) used to tell me "A decision to test is a decision to treat." What she meant was - unless you have the resources to treat (doctor's orders and medication) refer it to someone who does.
    Your former boss is very wise, I like this saying a lot
  6. by   Flare
    Just to clarify, are you asking to have the parents do the fingerstick / dipstick themselves at home or are you looking to do the diagnostic at school with parent's permission?
  7. by   NutmeggeRN
    Quote from Flare
    Just to clarify, are you asking to have the parents do the fingerstick / dipstick themselves at home or are you looking to do the diagnostic at school with parent's permission?
    I was looking to do it here so that I could push for a follow up with some definitive findings. Argh....Ruby_Jane you (and your boss) are probably right.

    I love you guys!!!!
  8. by   scuba nurse
    Do you have a social worker at school? I would speak with them about this.
  9. by   aprilmoss
    They do a urine dip annually here in gym class (glad I'm not responsible for that).
  10. by   Jen-Elizabeth
    Quote from scuba nurse
    Do you have a social worker at school? I would speak with them about this.
    That is actually a pretty good idea. Social worker may also know the family and how to best continue working with them to get the supports this student needs.
  11. by   NutmeggeRN
    Quote from Jen-Elizabeth
    That is actually a pretty good idea. Social worker may also know the family and how to best continue working with them to get the supports this student needs.
    She has been involved and is equeally frustrated.
  12. by   Jen-Elizabeth
    Quote from NutmeggeRN
    She has been involved and is equeally frustrated.
    Alas. Been there. Have the T-shirt. ::

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