diabetes type 1

MHDNURSE · Oct 31, 2016

I had a three year-old at my day care who was all over the place as well for the first 2 months or so. He had a pump and I would check him before meals/snacks, and anytime he seemed "off". I remember by around the 7-8 week mark he started finally leveling out, but initially it was a huge guessing game. His parents were great and very involved which helps. I don;t remember anything as high as 453 but I do remember some lows in the 60's and several in the 300's.

peaceful nurse, RN · Oct 31, 2016

The 453 was a morning one at 745 ...there are other times the child has been high in the mornings even dropping in the middle of the night according to mom. It just makes me nervous at times

JenTheSchoolRN, BSN, RN · Oct 31, 2016

The diabetic students I've worked with are in throes of puberty and they can be all over the place. I communicate with parents and sometimes providers to see how we can work together to get into a decent glucose range. Most students have pumps and it has led to changing basal rates ranges during different parts of the day (i.e. rate for 7 AM-3 PM; 12 AM-7 AM).

I assume you do mealtime coverage with short-acting insulin? Lantus peaks at 6 hours, with a low seen anywhere from 5-10 hours after if nothing else is at play. I had a student who took Lantus in the morning and evening and if no food was eaten at school (a norm for the student), that student would be hitting 60-70 around 2 PM.

Is the student consistently high in the morning? I might wonder about Dawn Phenomenon.

OldDude · Oct 31, 2016

The thing about elementary school aged type 1 diabetics is they are predictably unpredictable...sometimes it just doesn't make sense.

peaceful nurse, RN · Oct 31, 2016

Thank you all so much. I am just new to the whole diabetes in the school setting and the range that which this child goes is different than hospital nursing. My little one was 39 and perky and talking and I have never known a person in the hospital to be talking coherently at 39...just keeps ya on your toes

kidzcare · Oct 31, 2016

My little one was 39 and perky and talking and I have never known a person in the hospital to be talking coherently at 39...just keeps ya on your toes

Everyone and every hypoglycemic moment is different. I had a patient in a rehab facility who was 100% coherent, told me he was feeling low... 33. I asked him "How are you speaking? Let alone functioning enough to call me in the room??" He said he didn't know and reached for and opened his own juice.

Nurse_JackieVA, BSN, RN · Oct 31, 2016

I have two students with DM1, one that's had it for a few years and the other newly Dx'd. Both sugars range anywhere from the 70-350s. It used to freak me out at first because in the hospital it's more tightly controlled but I have to remember we're in school, food is not controlled as well and they're kids so I can't control everything. As long as they don't have any ketones in their urine or they're no other sx then I don't freak out as much. I worry though and when I worry I call and speak with the parents then document everything.

JenTheSchoolRN, BSN, RN · Nov 1, 2016

Thank you all so much. I am just new to the whole diabetes in the school setting and the range that which this child goes is different than hospital nursing. My little one was 39 and perky and talking and I have never known a person in the hospital to be talking coherently at 39...just keeps ya on your toes

I've had a student at 32 in school, talking to me, appearing to be just fine. Student looked at the number at said "Huh. That's why reading class seemed slow today."

I've also seen 500+ plus with no symptoms or ketones. [And a consistently non-compliant student return after a long vacation hit high on the meter with ketones and vomiting - off to ED for borderline DKA. Outcome good.]

Amethya · Nov 3, 2016

I only have one student with type 1 and he is all over the place because of bad diet. What I do to control it is this, he has PE M,T,TH,F and Lunch afterwards. So I check him before PE, if it's above 300, I tell him to drink his water, give him some insulin (Pump gives an accurate amount for him) and send him on his way. By the time he comes back, it should be lower. I do his carbs and insulin for lunch, which by the time I do his 3 check of the day, it should be at normal range. Then he comes to pick up his machine. Now here are days like today that even if I do everything right, it's still high. The only thing I can do is give him insulin and make him walk around and drink water.

Kids are super unpredictable at times, so just keep an eye on him for symptoms that he's not doing well. Mine gets very zombie-esque when his sugar is super high, and looks very sleepy when it's low.