Diabetic question!

[nicole.schoolRN]

Hi everyone! You all helped me so much with my last question, now I have a fun new scenario!

I have a diabetic student that was diagnosed back in June 2018. He is 10. He was last seen at the endocrinologist August 2018. His BG is all over the place but usually 300-400. Ketones usually negative but sometimes trace amounts.

The DMMP that I have on file (FROM AUGUST) only allows me to give him insulin during lunchtime. I have contacted the diabetic educator and MD multiple times for further instruction but because he hasn't been seen in such a long time they are unable to give me further instruction or orders. Yes, I have reported this (the Dr. office did too!)

His family will not take him to the doctor, nor will they give me any information why. I have offered to help in any way possible (car ride, insurance reasons, costs, etc.) but they wont accept help.

The last time he has a high BG (427) I sent him home and he didn't come back to school for TWO WEEKS!! Family said he is home until they are able to "regulate" his sugar. So now I fear sending him home....

My question is... What is your school policy on high BG levels? Do you send home at a certain point? 911? I don't know what else I can do!

**Help new school nurse and I don't have much information in my files about what to do in this scenario**

[OldDude]

One word...CPS...no wait, that's 3 words.

[nicole.schoolRN]

Done. Now what? Wait? Keep reporting it?

[OldDude]

The only other thing you can do is follow the current management plan. If you don't hear back from CPS you could certainly follow up on your report "regularly." You know...squeaky wheel.

[ruby_jane, BSN, RN]

Sweet baby Moses. There is no reason he needs to be home like that. The kid cannot be punished by staying home for something not totally within his/her control.

I don't know what your policy says; mine does not exclude for elevated BSG unless there's another reason (lethargy, etc.) I would get help from admin now because that's a truancy issue.

And I second OD's recommendation.

[AdobeRN]

Yes to what OD said.....Have you pulled the principal/AP into this or even higher up peeps?

[ruby_jane, BSN, RN]

9 minutes ago, nicole.schoolRN said:

Done. Now what? Wait? Keep reporting it?

Sadly, yep.

[nicole.schoolRN]

17 minutes ago, ruby_jane said:

Sweet baby Moses. There is no reason he needs to be home like that. The kid cannot be punished by staying home for something not totally within his/her control.

I don't know what your policy says; mine does not exclude for elevated BSG unless there's another reason (lethargy, etc.) I would get help from admin now because that's a truancy issue.

And I second OD's recommendation.

Thank you. Admin if fully aware of the situation. This breaks my heart seeing this poor kid so miserable.

[nicole.schoolRN]

I have! Everyone is fully aware of the situation. I just wasn't sure if other schools had a "send home policy".

[Amethya]

I do send home if he's super high and won't go down no matter what intervention I do. I have only one TD1 kid in my school, and one time his ketones and BG was super high. I kept him in my office, and checked him every 15 mins and did what I could, but no fix. I called mother and said, pick him up now and take him to the ER, because he's not going down. She did and they said he was close to be DKA, if not already. He stayed home for a few days and came back better.

That's my instructions from MD as well.

[nicole.schoolRN]

THANK YOU!!

[tining, BSN, RN]

I'm guessing LD is doing some in between snacking.

If you have no orders to give insulin for snacks, then LD should not eat snacks. Ask teachers if he is doing this, if yes = absolutely no snacks. Cupcake for birthdays, sure, at the end of the day when he goes home to parents.

If he is rising after lunch, then current insulin dose is too low.