Concern for Type I diabetic

SnowyJ, RN · Feb 4, 2015

I would give the log to mom and have her call the Endo for orders. The student may just need an adjustment in dosage or type of AM insulin. But this is definitely an issue for the endocrinologist.

cynmrn · Feb 4, 2015

I have similar issues with one of my type I diabetics, however it is not always hyperglycemia, though the arrival in the office is often the exact same time like clockwork: around 9:30-10:00 am. She can have blood sugars anywhere from a 43 to a 527 one day. It is nuts. I talk to her and educate her about carb counting, eating a balanced breakfast, calculating her insulin appropriately, etc. and not much has changed in regard to her blood sugars. Sometimes, her explanation will be that she didn't eat anything for breakfast but a hot dog or something ridiculous and taking inappropriate insulin, others, it's a mystery. She recently had an MD appointment and the only thing they changed was a larger dose of long-acting insulin at bedtime. They have all her BS records in her meter....It is my first year as a school nurse, so I am not really sure what is the "norm" for a middle schooler's blood sugar fluctuations. But, you can definitely call the doctor/fax them and discuss your concerns; I don't think that is overstepping at all.

Supernrse01, BSN · Feb 4, 2015

Thank you!! I'm not sure what to do. If I give Mom the log, I'm not sure it make it any further than that and I hate it. Obviously something needs to be adjusted. I feel like my hands are tied I am hitting a wall. :banghead: :)

NutmeggeRN, BSN · Feb 4, 2015

Thank you!! I'm not sure what to do. If I give Mom the log, I'm not sure it make it any further than that and I hate it. Obviously something needs to be adjusted. I feel like my hands are tied I am hitting a wall. :)

I don't think it is unreasonable to have mom/dad/guardian sign a release and then you can share what you are seeing with the provider. I do this at the beginning of the year and am in touch as necessary.

OldDude · Feb 4, 2015

Any of you guys use "My Care Connect?" It's an on line program that, with the parent's consent, will send BG readings and actions you take immediately to the parent and the child's doctor every time you enter it and keeps a running log that can be easily accessed by all parties. No paper.

SnowyJ, RN · Feb 4, 2015

I would also wonder if the child is sneaking carbs. Or parent is miscalculating at meals. That happened with one of my diabetics.

Rubor · Feb 4, 2015

When they go to the appts they take the meters im assuming which stores all the info so endo will see it anyways. Having a convo with parents and child is good.

RatherBHiking, BSN, RN · Feb 4, 2015

When is she last eating before you check? Hopefully it's been at least 2 hrs or numbers will be high. Yes this is a problem for the endocrinologist to deal with. I'd fax dr records with short explanation so they can get her insulin adjusted and then tell mom. I don't think its overstepping your bounds as a nurse who is fulfilling dr orders to speak with that dr about the student's care if you're concerned about something.

KelRN215, BSN, RN · Feb 5, 2015

If the student has a blood glucose of 500 mg/dL, I'd hope you'd be calling the Endocrinologist. Endos in my neck of the woods expect to be called for any reading > 400 mg/dL. How old is the student?

jryanrn · Feb 5, 2015

Hope this doesnt sound too silly but, is Mom using an insulin pen or drawing up in a needle. Just had a parent of one of my students come in to make sure i was taking off the two "caps", before i injected her son as he uses the insulin pen. Maybe child not getting insulin/dose correctly. I have heard about that direct bs going straight to endocrinologist throght glucometer. I would think the dr would want to know.

Good luck

SassyTachyRN · Feb 5, 2015

We have one endo here. She expects calls for extreme highs or high ketones and any trends in highs/lows that we see. She will either ask the parent to bring in the meter to have data downloaded or have me fax my blood sugar logs over. I never hesitate to communicate with the endo after alerting the parents of a high/low and what I did for it.