DM1 in Elementary Setting - Dealing with Parents

[HCPSRMA]

This is my 5th year in our school clinic but my first time dealing with a difficult parent in terms of taking care of their diabetic child. Examples -- Lunches are packed daily and carb counts are always sent via a note however -- the meal goal (per dr orders) is around 60g of carbs and whats being sent is anywhere from 125-150g of carbs? Another example - students BG is over 350 and I asked student to choose another snack (what was provided was a 43g/carb cupcake!!!) and the parent was upset. Their answer is to eat whatever and just bolus for it. There are no healthy habits being taught and I try to do what I can but it ultimately will have to be changed at home. Have any of you dealt with this? Are our hands basically tied?

[ruby_jane, BSN, RN]

There is an order for ketones but I have been instructed by the parent to only check them if BG stays high.

At this point you probably just have to do what the orders say, document, and then document any communication from parent (and you're already doing that).

I have in the past called the hospital's clinic and spoken to the nurse when the parent seems not to be following the plan on his/her end. Sometimes that results in a call home from the clinic, sometimes not.

It's super frustrating. I had a diabetic eat half a dozen donuts this morning. And then come correct. All those cheap carbs hit him long before the insulin could touch him....

[MrNurse(x2), ADN]

Sadly, Press Ganey creeping across the board. Parents don't or won't say no to their darlings, so they will shop until they find the endo that will give them what they want. Law of economics, plain and simple. Friend of mine lost a husband to T1D at 36 because of this logic.

[OldDude]

Sadly, Press Ganey creeping across the board. Parents don't or won't say no to their darlings, so they will shop until they find the endo that will give them what they want. Law of economics, plain and simple. Friend of mine lost a husband to T1D at 36 because of this logic.

Sad but true! Sweet Petunia has been a Home Health PT for about 20 years now. When she first started she would treat 60 and 70 year olds for various and sundry amputations due to uncontrolled diabetes. That age group has dropped since she started. She now sees 30 year olds on dialysis and having amputations. In fact, for a while, Corpus Christi, Texas, right down the road, boasted the highest number of BKA's per capita in the nation; I haven't check lately to see if that still holds.

[MrNurse(x2), ADN]

, Corpus Christi, Texas, right down the road, boasted the highest number of BKA's per capita in the nation; I haven't check lately to see if that still holds.

That makes for a lovely welcome sign. Corpus Christi, the town that barely has a leg to stand on!

[Flare, ASN, BSN]

That makes for a lovely welcome sign. Corpus Christi, the town that barely has a leg to stand on!

bwahhhaaaaa! Pedicures! Half off!!

[Amethya]

I'm having this issue too, but because the mother complains and it means she's god and her word is law, I can't do anything about this carb intake. So all I can do is correct. I have called his doctor too, but they give me the same crap and "He can eat what he wants."

[NutmeggeRN, BSN]

I'm having this issue too, but because the mother complains and it means she's god and her word is law, I can't do anything about this carb intake. So all I can do is correct. I have called his doctor too, but they give me the same crap and "He can eat what he wants."

That is what they are doing, why fight with kids over their food choices? they do need some element of control over their life. If they are dosing correctly, hopefully their CBG reflects that.

Gotta pick your battles.

[compassionresearcher]

The endocrinologist at my hospital uses the basal bolus method. The families are instructed

to cover for the planned amount of carbs using a formula of units:grams of carbs. We tell the patients

yes you can eat whatever you want, outside of concentrated sugar, as long as you cover for it ahead of time. But

for other health purposes you want to keep splurges to minimum, just like people who don't have diabetes.

[kidzcare]

That makes for a lovely welcome sign. Corpus Christi, the town that barely has a leg to stand on!

bwahhhaaaaa! Pedicures! Half off!!

Hahahahahaha

[OldDude]

Hahahahahaha

This is what I did - out loud!! Thanks Mr. and Flare. I don't care who you are...that there is funny!