I know it can be challenging in many ways to deal with parents of diabetics. Many times you just can't get parents to get on board with doing their best for their kids.
But what about the opposite? The ones who micromanage their kids at school?
I have a diabetic 6 year old 1st grader on an insulin pump who I've been caring for at school since Kindergarten. His family is Hispanic. Mom and Dad and sister and brother (both in high school) are awesome and involved. However, mom comes to school every day. She insists that when the nurse or health aide checks blood glucose or when the nurse pushes the button for insulin, someone watches and signs that we did it right.
Ok - we've managed with that.
Now, she's decided that if her son's BG comes back at a high number (no specificity of how high) we have to make him wash his hands again and recheck. She's evidently gotten different numbers at home that make her think he isn't doing a good job washing his hands. Well, we watch him do that as well. Mom is there every day so if she says she wants us to check again, we check again. There are no physician orders for this.
Friday she didn't come to school for the 1st time this year. Her son's BG was low before lunch so he got 2 glucose tabs. After 15 minutes it was still low, so two more glucose tabs. No symptoms by the way. After 15 minutes he was 88 and off to lunch. He ate 59 carbs (he's not a big eater) and got insulin for those carbs. An hour later he needed to be checked before PE and was 288. There are no orders to do anything at this number (he's on a pump remember) and I was confident this was due to the glucose tabs. No symptoms. Mom walked up right then and I told her about his day. She always wants to know his IOB (Insulin on Board) numbers when he is low and to be nice the aide usually writes that down (I was covering for the aide that day as she was absent). But I've been told by the pump manufacturer and the doctor and the nurse handling his case that this is not important or necessary. Plus there are no orders so I don't write it down. Then mom asked if I rechecked that high blood sugar and I said no. I didn't think he did anything wrong with his handwashing. When he got home that day his blood sugar was low. So it went from high to low in an hour. And mom thinks that's my fault because I didn't recheck.
She's requested a meeting with the principal and me with a translator. I'm obviously in contact with the child's doc and the nurse and the pump manufacturer but I wanted to know what you all do.
I know blood sugar fluctuates - you can take a blood sugar on the right hand and on the left hand and the numbers will be different.
Do you do a re-check of a high blood sugar if mom states she wants it or do you stick with the physician orders?
Seems like nursing judgment goes out the window when mom is so deeply involved. I applaud them for being such great parents but she shadows this child most of the time. She translates for him but that's another story - the teachers would love it if she wasn't in in class all day.
Quote from Klimpys
She shadows him to keep him alive. As he gets older she will loosen the reigns. My ds does most of his own care, but puberty is wreaking havoc on his BG numbers. These are things you don’t learn in nursing school. The pediatric endocrinologist and the certified diabetes educator haven’t taught me diddly compared to other parents in the trenches. You sound like a caring and competent school nurse. Sadly there are some that aren't and that is why parents of Type 1 diabetics become anal retentive.
Thank you. I realize my perspective is compounded by how difficult it is to find a common ground between what the parent wants and what the diabetic educator RN and the doctors say. Which is one reason we have done what she asks.
Usually the health aide does the morning blood glucose and afternoon blood glucose. I'm technically only here for pushing the "GO" button for insulin. In California, only a nurse or physician may do this. (Of course the parent can do it and funny enough the parent can train someone who doesn't work for the school district to do it too).
The mom isn't worried about IOB with low blood sugars. She is worried about highs.
I guess my question is more pointed towards do we keep accommodating the mom in ways we are not necessarily supposed to do. Most school nurses here in my county say if the mom is there, the mom does the care for the student. That frees the school nurse to do more since most school nurses have more than one school and sometimes thousands of students. But we do all the care while she is there and she watches to make sure we do the right thing. I've been told we have bent over backwards for this family. Last year she didn't want him to go on the bus at the scheduled time because she fed him breakfast at that time. She didn't have a car to bring him to school. Our district decided to send a bus back for him after they'd already delivered the other kids.
There are no orders regarding IOB and what to do with insulin and/or carbs. All the examples of what to do with IOB are for the parents or the student as he gets older. We cannot do anything about that at school - I've been told not to pay any attention to that so I appreciate what you posted.
I do frequent the children with diabetes website. I've gone to training with the pump manufacturers. I've done the H.A.N.D.S. Diabetes training. I want to do the right thing for my students.
I appreciate your advice. I have a husband with Type 2 diabetes and he isn't exactly compliant. And if I had a child with diabetes, I'd be homeschooling him also. (I did homeschool my kids in early grades).
Last edit by Spidey's mom on Oct 2, '12