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**
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.
Yup! Please do this at least 1-2 weekly and document thoroughly.
As the mother of a diabetic, I can tell you that this does indeed need addressing. The organ damage is pretty much "time under the curve." My son was pretty much kept in reasonable control while living with us, but he fell apart when he went off to college. Now years later he's got kidney, vision, nerve and other issues.
Specializes in ICU/community health/school nursing.
On 2/17/2019 at 6:20 PM, aprilmoss said:
As the mother of a diabetic, I can tell you that this does indeed need addressing. The organ damage is pretty much "time under the curve." My son was pretty much kept in reasonable control while living with us, but he fell apart when he went off to college. Now years later he's got kidney, vision, nerve and other issues.
I'm sorry to hear it. I think that's "developmentally normal" for them to fall apart, but the consequences for young adults with chronic illness are staggering.
I'm sorry to hear it. I think that's "developmentally normal" for them to fall apart, but the consequences for young adults with chronic illness are staggering.
This is why you rarely hear T1D in report in an acute setting. I know one friend, an RN who is in her 50's, and healthy. She kept tight reign on it and was raised when carbs were controlled instead of "added in". I am very sad every time my T1D comes in and has BS in mid 200's and every reading under 100 gets treated like it is under 50. I kind of blame modern endocrinology that says why try diet control when you are going to lose so let them eat cake and try to average their SS meaning more shotgun coverage than good control. My T1D, followed by a big name hospital endo, averages of 248 with no sugars below 100. The office says she is well controlled. I guess my 1980's education is behind the times.
What is the expiration date on the Physician orders? Not sure what state you are located in, but in some states, the MD orders have a start and end date. If the orders are not in date, your only other option is to have the parents come to the school to manage his care if he is not self sufficient. They will grow weary of doing that.
Specializes in ICU/community health/school nursing.
55 minutes ago, MrNurse(x2) said:
My T1D, followed by a big name hospital endo, averages of 248 with no sugars below 100. The office says she is well controlled. I guess my 1980's education is behind the times.
Ummm.....yeah, mine too. What does that A1C look like with 248 avg?
TxRn408
9 Posts
Yup! Please do this at least 1-2 weekly and document thoroughly.