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Concern for Type I diabetic

Posted

Specializes in Telemetry, Gastroenterology, School Nrs. Has 18 years experience.

Long story (made as short as possible) :)

I have a student who was diagnosed as Type I, earlier this school year. Sugars have been all over the place and of course, several adjustments have been made in dosing.

My concern is, the student is in my clinic almost every morning at the same time due to hyperglycemia. I'm talking between 190-500 every time. Student is taking morning dose of insulin at home, before school. I have spoken with mom (several times) to voice my concerns over the consistent pattern but I am not noticing any improvements. I'm not sure what else to do. Should I fax the blood sugar log to the student's physician or is that overstepping my boundaries?

What would you do?

SnowyJ, RN

Has 28 years experience.

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

Specializes in School Nursing, Telemetry. Has 2 years experience.

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

Specializes in Telemetry, Gastroenterology, School Nrs. Has 18 years experience.

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

Specializes in kids. Has 25 years experience.

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: :)

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

Specializes in Pediatrics Retired.

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

Has 28 years experience.

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

Rubor

Specializes in School Nurse, Pediatrics, Surgical.

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.

Blue_Moon, BSN, RN

Has 18 years experience.

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

Specializes in Pedi. Has 10 years experience.

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

Has 21 years experience.

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

Specializes in Peds, Oncology. Has 4 years experience.

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.

JenTheSchoolRN, BSN, RN

Specializes in School nursing.

Does the child's orders include checking for ketones over a certain number (400/500/etc.)?

Supernrse01

Specializes in Telemetry, Gastroenterology, School Nrs. Has 18 years experience.

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.

This is a great idea, thank you!

Supernrse01

Specializes in Telemetry, Gastroenterology, School Nrs. Has 18 years experience.

Does the child's orders include checking for ketones over a certain number (400/500/etc.)?

No orders for Ketones at all, which I have always thought strange; however, in my knowledge of this physician, he often has some different practices.

Supernrse01

Specializes in Telemetry, Gastroenterology, School Nrs. Has 18 years experience.

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

They use an insulin pen. The student actually does all of this independently, and while I monitor the process here at school, I'm not sure there is much help while at home.

Supernrse01

Specializes in Telemetry, Gastroenterology, School Nrs. Has 18 years experience.

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.

I've never heard of this but am going to look into it!

Supernrse01

Specializes in Telemetry, Gastroenterology, School Nrs. Has 18 years experience.

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

I'm afraid a "standard" dose is being used in the morning without regard to what is being eaten.