Concern for Type I diabetic

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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?

Specializes in School nursing.

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

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Specializes in Telemetry, Gastroenterology, School Nrs.
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!

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Specializes in Telemetry, Gastroenterology, School Nrs.
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.

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Specializes in Telemetry, Gastroenterology, School Nrs.
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.

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Specializes in Telemetry, Gastroenterology, School Nrs.
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!

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Specializes in Telemetry, Gastroenterology, School Nrs.
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.

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Specializes in Telemetry, Gastroenterology, School Nrs.
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.

The timeframe definitely falls a good two hours after eating breakfast.

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Specializes in Telemetry, Gastroenterology, School Nrs.
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?

The student is 11. T

this particular physician's orders dictate calling the parent when BG 500 or greater, and I call her each time. Fortunately, the BG has only been within that range a couple of times, although I have spoken to her about the consistent high readings, suggesting a call to the physician to determine need for insulin adjustment, on numerous occasions.

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The student is 11. T

this particular physician's orders dictate calling the parent when BG 500 or greater, and I call her each time. Fortunately, the BG has only been within that range a couple of times, although I have spoken to her about the consistent high readings, suggesting a call to the physician to determine need for insulin adjustment, on numerous occasions.

A few years ago, I dealt with a really apathetic parent of a diabetic student. The student would come in to check BS straight off the bus and it was not at all unusual to have readings of 400-600. Student had an insulin pump and would report having pop tarts for breakfast. I would consistently tell her that poptarts were not a good choice and make other suggestions. It was in the diabetic plan to call mom with any reading over 500 and I would call and she would be sleeping and ask me in a really exasperated tone "Well, what the hell do you want me to do? I'm not there!" I wanted to shout "Get up and make a decent breakfast for your diabetic 11 year old child!"

Mom also brought in twinkies and cookies for the student to have in case of low blood sugar. It was a constant battle. DCFS was constantly on them and about a year after she progressed out of my school, I heard that the student was taken from mom to live with relatives by DCFS.

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Specializes in School nursing.

Mom also brought in twinkies and cookies for the student to have in case of low blood sugar. It was a constant battle. DCFS was constantly on them and about a year after she progressed out of my school, I heard that the student was taken from mom to live with relatives by DCFS.

Cookies and twinkies! Wow. Did the student carb cover for the pop tart breakfast at least?

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Specializes in Peds, Oncology.
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.

I should also add that the consent to release information is built into our diabetic packet that the parents and doctor sign.

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Specializes in Telemetry, Gastroenterology, School Nrs.

How sad for that poor student. Hopefully, the relatives were able to help her get into a healthy routine. I feel so bad for these kids, in these situations. They need help managing something of this nature and magnitude and when they don't feel like they have someone they can trust to help them out, they are constantly trying to claw their way out of a no-win battle. So sad

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