Diabetes question...questioning myself...

[nursingnow]

Hi. Today, a student's pre-lunch BG was 59. Normally, we give 15g carb snack and recheck within 15 min. Since he was eating lunch, I didn't recheck until he finished lunch..about 25 minutes later. He ate a total of 61g carbs for lunch. His recheck BG was 256. It seemed counterproductive to give him insulin, but we normally cover carbs at lunch and BG over 200. He has a pump. I chose to give insulin since his BG did get so high. He got 3.4 units for his carbs, but I didn't use his 256 BG as part of his calculation. (Hope all that makes sense... ) Something just didn't feel right though.... He was due to be rechecked an hour and a half later before leaving school; his BG was 149 with no treatment necessary. But the lunch issue... ? How do you handle a pre-lunch low, then a really high re-check...? Thanks in advance.

[JenTheSchoolRN, BSN, RN]

Do you have anything in the student's insulin orders that talk about a pre-meal low? For example, when I have one of my type I students come in pre-lunch with a BG of 65, we still carb count his meal and subtract 10-15 carbs (i.e. 75 carbs, becomes 60 to input into pump). However, this is tricky and not a hard and fast rule. Here, this is the plan discussed and set forth by the child's doctor.

Do you have the ability/info/permission to talk with this student's doctor if the orders don't clarify? And is this a regular thing or a one time occurrence because maybe the child was outside for gym or recess? I ask because when I see a pre-meal low/low end of normal for my Type 1 students, it usually almost always occurs on Mondays, the day in which lunch period in 40 minutes later than the rest of the week.

[nursingnow]

His recess is in the afternoon. If he's low it's usually at his afternoon check. There are no specific orders for how to handle a pre-lunch low. I used my best nursing judgment at the time, but I still left the situation unsure...

[NursChu]

I either give them an extra 15 gram snack (30 if blood sugar

I also make sure they eat right away.

[Flare, ASN, BSN]

i do the same as Chelsea - i want my students to learn to be as independent as possible so we make the decision together as to if they want to take the extra carbs or just want to subtract the carbs from their lunch, then right off to lunch and recheck afterward.

[schooldistrictnurse]

I like to have them have a juice box in this situation because there is a short time lag (get in line, get your tray, go through the line, pick a seat, etc etc) and I want to correct that low as quickly as possible. We have some docs (all in the same clinic--go figure) who like insulin before eating and some who like insulin after eating.

[Tina, RN]

Each diabetic is so different...

For my particular diabetic, I'd give her 2 juice boxes for BG 59, and recheck in 15 minutes. Once she gets that low, 1 juice won't do it for her. If her number was decent, I'd send her to lunch. After lunch, I'd recheck BG. Assuming that the BG will now be on the high side, I'd cover only for the lunchtime carbs. I wouldn't cover for the BG at that point.

[Spidey's mom, ADN, BSN, RN]

Our 2nd grader with an insulin pump has orders that say if low at the before lunch check, give 15 gms carbs and recheck in 15 minutes. That means he cannot go eat lunch until recheck. If still low, 15 more gms carbs and recheck in 15 minutes. If still low, THEN he can eat lunch. Recheck after lunch. If ok - give insulin based only on lunch carbs.