Just a question on diabetic kid

  1. Good morning to my new found school nurse friends,

    I have a 1st grader who has diabetes Type 1. Everyday mom brings in his lunch and she already has his Carbs counted for me. So for example: If he's eating 15 carbs, the doctor order to give 1 unit per 15 carbs. Sometimes mom would say give 1.5 units of insulin, but that's not what the doctor ordered. In her defense, she knows 1 unit will not help and he will run high later. And she is right most of the time. I told her to talk to his doctor and get an updated order, but i just chart per mom to give 1.5 units. So my question to you all, would you give 1.5 units like mom said or what the doctor ordered?
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  2. 15 Comments

  3. by   GdBSN
    Depending on what your orders say. The orders I receive say the "parents are allowed to make changes based on the following guidelines..." Check your orders and see if parents can do that, then you don't need new orders.
  4. by   OldDude
    I would follow the MD order. If mom wanted to give more than the max dose she would have to do it.
  5. by   MrsNurse08
    Quote from GdBSN
    Depending on what your orders say. The orders I receive say the "parents are allowed to make changes based on the following guidelines..." Check your orders and see if parents can do that, then you don't need new orders.
    I just read the order and it said school nurse may decrease total insulin dosage but nothing about parents
  6. by   MrsNurse08
    Quote from OldDude
    I would follow the MD order. If mom wanted to give more than the max dose she would have to do it.
    Are have the MD update the order for her to make that decision right
  7. by   WineRN
    Quote from GdBSN
    Depending on what your orders say. The orders I receive say the "parents are allowed to make changes based on the following guidelines..." Check your orders and see if parents can do that, then you don't need new orders.
    I'm in the same boat. When my kiddo with TD1 runs high, we only go up to 5 units, even if the sliding scale says to give more because anything over that she has a history of crashing down into the 30s and 40s. So I usually call mom, talk to over and then chart gave X units per mother request. If i didn't have the parent loophole in the order, I would have to just follow what the doctor says until it is changed.
  8. by   Flare
    agreed - i am not keen on violating the written order. It is a matter of protection for me and a matter of the parent communicating with the doctor and letting them know that the orders need to be tweaked.
  9. by   ruby_jane
    Call the MD and get the verbiage that the parent may direct changes in dosing. Then you're covered. Because I hate to be in the position of justifying an action "because the parent said so" - even fully acknowledging that parents of students with diabetes are often the experts in the care of their kids.
  10. by   OldDude
    Quote from ruby_jane
    Call the MD and get the verbiage that the parent may direct changes in dosing. Then you're covered. Because I hate to be in the position of justifying an action "because the parent said so" - even fully acknowledging that parents of students with diabetes are often the experts in the care of their kids.
    I'm ok with this but I would require an email, text message, or some other written record of the parent's instruction regarding giving more insulin than ordered on the DMP.
  11. by   ohiobobcat
    Most of, if not all, of my T1D kids have the "parent may adjust insulin dosage within certain parameters" as part of their plan from the endocrinologist. I communicate with the parent and adjust, but if we are consistently having to adjust, then I encourage communication with the endo so a new plan can made. My kids are teens and they are ALL over the place with blood sugars, so I like having this allotment for minor insulin adjustments in the orders.
  12. by   MrsNurse08
    Quote from OldDude
    I'm ok with this but I would require an email, text message, or some other written record of the parent's instruction regarding giving more insulin than ordered on the DMP.
    Yeah that's my school policy to have something on file signed by MD
  13. by   JenTheSchoolRN
    Quote from ohiobobcat
    Most of, if not all, of my T1D kids have the "parent may adjust insulin dosage within certain parameters" as part of their plan from the endocrinologist. I communicate with the parent and adjust, but if we are consistently having to adjust, then I encourage communication with the endo so a new plan can made. My kids are teens and they are ALL over the place with blood sugars, so I like having this allotment for minor insulin adjustments in the orders.
    Same here. Orders I have let me and parent adjust insulin dosage within a certain parameter as well as hold dosing if needed by school nurse. Puberty is ride for BG and it gives me room to adjust for the bumps and curves.

    Of course, any adjustment I document and talk to a parent about. Why I do text with some parents of my diabetic students as it does make communication easier (and hasn't been abused of yet). And yep, if a pattern of changes emerges, I urge communication with endo to change up the long-term plan.
  14. by   Euro_Sepsis
    I feel for these parents because I've left appointments for my child with a specific plan developed with the endo only to later find it mistyped or copied forward from previous orders.

    Trying to call for updated orders, prescriptions, etc to some of the university mega clinics is hellish; you have to work through a phone tree and a litany of ancillary schedulers or MAs who forward your message -hopefully transcribed correctly- to the doc or their RN and hope to hear back in a day... or 10.

    Sorry for the random rant, but I can totally see why some of your kids' parents may appear to just be doing their own thing.

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