diabetic question

[nicole.schoolRN]

Good morning everyone :)

I have what is probably a simple question, but curious what others so in this situation.

I have a new diabetic (in kinder). Mom wants me to give medication AFTER lunch because its not exactly known how many carbs she is really eating.

So do I.... Have student come to clinic, check BG, give correction dose, send back to lunch, after eating come back to clinic so that I can count carbs and give second injection to cover carbs.

Or do I.... Have student come to clinic, check BG, send back to lunch, after eating come back to clinic and give only one injection (correction dose + carb coverage).

Thanks everyone!!

[Keeperofbandages, LPN]

follow the diabetic management plan from the doctor. If it is not clear in the orders, I would call for clarification.

[CampyCamp, RN]

We do option A for pumpers, option B for pen users. That's the way the local peds endo group endorses. Yours may vary.

[MrNurse(x2), ADN]

My pumper with CGM gets preprandial sugar and cover after lunch. Hopkins endo is pretty lax with her control, to the point I have called often to clarify.

[AdobeRN]

I have done the 2nd option with my kinder kiddos when parents are worried. I would have the student stop by my office on the way to lunch with her lunch box - Check BG and glance at her lunch, send student to lunch & instructed not to throw anything away but to bring whatever was leftover in her lunch box back to me so I can see what she ate then I would administer the insulin at that time.

If buying lunch I would escort student thru the lunch line, figure out carbs, let her eat, set my alarm for 25 minutes and walk back to cafe to see what the student ate then admin the insulin.

Always worked well for me and parents were happy - peace of mind for them.

[cid1]

I do number 2 for injection kids. Number 1 for pump kids

[ruby_jane, BSN, RN]

What do the orders say?

If the orders are not specific and the kid is in kinder and is likely not to eat much off the tray I would be tempted to check and record but not to correct until after we saw what s/he ate. Exceptions: extreme low (under 70) or wicked high (over 250) that necessitated some action.

[ARN]

my kiddo is type 1. when he was first diagnosed at age 5 in pre k we were doing after his meal because he knew he needed a shot and didn't want one so he wouldn't eat much. as his appetite got better and he realized that he was going to get the shot no matter what he ate we were able to move the shot to middle of meal and eventually to before the meal.

Clarify with mom and endo what will work best for your student.

I have a high school student who still doses after he eats because he isn't always sure what he will eat. This wouldn't fly in my house but he isn't my kid. I try to offer him education without being annoying.

I hope you have found some clarification and your little kinder is having a good year!

["nursy", RN]

This probably wouldn't work in a lot of nursing offices, but I had my brand new TYpe 1 eat in my office because I really couldn't trust her on her own. I allowed a friend to come and eat with her, and they both enjoyed it. She was a pen user.

[mainecoonRN92, BSN, RN]

On 10/31/2019 at 8:14 AM, cid1 said:

I do number 2 for injection kids. Number 1 for pump kids

This is exactly what I do. I do clarify with orders but I also use my nursing judgment as well. If I cannot trust the student to eat everything I am dosing them for I have them bring back their tray after they eat so I can help them calculate the carbs.

This is also a huge teaching point for parents and the student. Usually I only have to do this for a few weeks until I can start to develop a trust and rapport with the student.

[Sarahnursey]

My type 1 diabetic (Kindergartener) has a tendency to "forget" what she ate at lunch, so we made it so she eats in my office at the spare desk so I can see what she is having. I give her pre-prandial and carb coverage at the same time when she finishes eating.

[Csn2016, BSN]

Like others said clarify with physician. For the diabetics I currently have, both use a pump--one does very well with eating all of his lunch (and he packs every day so carb counts are 'exact'). We do correction and coverage prior to lunch. My second diabetic who has a pump is terrible with lunch--one day she'll eat all of it, the next day she'll eat 2 bites. Because of this she comes in, checks her sugar, we do a correction if needed and I send her to lunch with a notebook that a cafeteria aide completes for me (student used to report she would eat 75-100% of something and in reality it would be 2 bites), also our lunch menus offer multiple options for sides/desserts which throw off anticipated carb calculations prior to lunch (student may claim shes picking one thing then goes to lunch and picks something entirely different), then she comes back after lunch we calc carbs and do the coverage. Prior to her having a pump I would do an injection for coverage prior to eating if she was 250 or over just to get the insulin in and circulating and not delay it.