Diabetic student, help!

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Hi again to all of you smart peeps! I have a middle school diabetic that has consistently high sugars. He usually is running in the high 300's. Most of the time he has moderate-large ketones. He has gone several times because he is symptomatic. He missed 4 days one week and told me his ketones never went away. There has also been times when he has a BG of 300-400 and "oh I'm out of ketostix". Or "I feel low" and I tell him to check he sugar..."oh I'm out of test strips". I can easily get ahold of family and they will bring supplies but he ends up missing tons of class. Today he had a high BG and "I don't have insulin left". I told family that I think we need to have a meeting. His teachers have been calling me asking about him when he is out of class, so I suggest they attend as well. There is a lot more details but I am not getting into but basically I don't think they ever communicate with endocrine. He does have an appt scheduled but all of my other students are on the phone tweaking daily insulin with consistent highs/low/ketones. I've been working so hard helping him count carbs, explains ect...but never changes. Thoughts?

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Who is the doctor that wrote his orders/ plan of care?

I would call/ include doc in a meeting with his parents.

The teachers can wait for now.

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I have had to call the doc several times. They have "call provider for ketones".. It also says contact parents but student and family spit out a variety of numbers. The nurse was actually getting annoyed. Now they have given orders so I go by that. But I know enough that they would have adjusted insulin with continued highs. He has an appt next week. I wonder if I should wait until after that appt before holding the meeting. I mean his a1c will be enough of an answer. His last a1c was almost 12

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Specializes in Pediatrics Retired.

Wait until the next appointment for an updated management plan. Get him into a 504 which will require a parent to be present. Lay out the plan for his care at school and accommodations for him missing class time for diabetes management and this should get everyone on the same page. If that doesn't work, go to plan B, which might involve CPS.

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How often do you communicate with the MD? Do you think it would beneficial to fax a copy of the BS, ketones, and insulin usage weekly to the doctor's office? I wonder if the family isn't being completely honest?

When I did my clinicals, there was a middle school girl who ran high constantly because her mother was so afraid of lows even though the dangers and risks of constant highs were explained to her. She just saw the immediate issues with a low BS, and couldn't see high being a problem. The girl wasn't newly diagnosed either. I left before there was any resolution, and I always wonder what happened to her.

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This kid is not newly diagnosed either. I was thinking about waiting until after his appointment and giving new dosing a try. However I'm starting to question if he isn't actually giving himself the insulin. I don't think they are honest at all. He doesn't have a downloadable meter either. Are there any resources for free supplies? They don't act like that's an issue, but there is a missing price that I can't place.i am planning on printing a report of all his levels, ketones, forgotten supplies ect. For his appointment. It's just so strange all of my others are very textbook most of the time.

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Specializes in Pediatrics Retired.
This kid is not newly diagnosed either. I was thinking about waiting until after his appointment and giving new dosing a try. However I'm starting to question if he isn't actually giving himself the insulin. I don't think they are honest at all. He doesn't have a downloadable meter either. Are there any resources for free supplies? They don't act like that's an issue, but there is a missing price that I can't place.i am planning on printing a report of all his levels, ketones, forgotten supplies ect. For his appointment. It's just so strange all of my others are very textbook most of the time.

You correct. There missing pieces to the puzzle. Wait for the updated management plan, call a 504, get everyone in the same room, shake the etch-o-sketch, and start from scratch.

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Specializes in School nursing.
You correct. There missing pieces to the puzzle. Wait for the updated management plan, call a 504, get everyone in the same room, shake the etch-o-sketch, and start from scratch.

Agree with OldDude. 504 plan is a must here. Sorry, OP, that is so frustrating!

I've worked with a student that blood glucose levels at 300+ were the norm. A1C of 11. No ketones, but I nearly called an ambulance on the kid for borderline DKA (parent picked up instead and went straight to ED). Not newly diagnosed at all - just very, very non-compliant. Poor parent was trying their best, but kid was a teenager and did not care. Very, very, very frustrating. Student did have a 504 that had me train two additional teachers on diabetes management because of student's non-compliance and likelihood to run high, etc. on field trips I could not attend.

What does the student know about management? Has he been taught about it? Just curious. Because middle school is a great time to try and get student's to play a role in their own help (to their ability, of course - kids can't control if Mom doesn't pick insulin/test strips), especially for chronic medical conditions.

Also, do you have a back up meter? A back-up insulin supply? For all of my kids with diabetes, I have a general back-up meter (if theirs fails or they run out of test strips unexpectedly), require them to leave a back-up vial of insulin in my office, and I carry urine ketone strips. (Basically each kid has their own back-up kit of supplies in my office with their glucagon - provided by the parent and I update if anything runs low.)

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Specializes in School Nurse.

I think there is a basic lack of knowledge of his condition by parents and student. High ketone levels can be a sign of a potentially dangerous situation. Ketones alter the chemical balance of your blood. If left undiagnosed and untreated, they can poison the body - ketoacidosis. I would offer to go with them to MD visit. Is the MD an endocrinologist? They need reeducation, home visits (by diabetic nurse), nutritional support. This young man is heading for some serious complications.

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Specializes in kids.
This kid is not newly diagnosed either. I was thinking about waiting until after his appointment and giving new dosing a try. However I'm starting to question if he isn't actually giving himself the insulin. I don't think they are honest at all. He doesn't have a downloadable meter either. Are there any resources for free supplies? They don't act like that's an issue, but there is a missing price that I can't place.i am planning on printing a report of all his levels, ketones, forgotten supplies ect. For his appointment. It's just so strange all of my others are very textbook most of the time.

You will be sending those yourself, correct? I would not trust the family to deliver said items...

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Specializes in School Nurse, professor, OBGYN.

It sounds like he is not sticking to the diabetic diet, and self adjusting meds.

I suggest nutrition consult, as well as talking with his doctor.

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I will be sending all reports myself. I have been educating him each day. He still will guess on carbs, when I want him to look it up on an app we downloaded to his phone. We talked about serving size and how important it is to dose for the actual amount. I've even gone though lunch and counted out chips to show how many ACTUAL servings are in the bag. I do not have any extra supplies/meter. I have mentioned to family to give me a few supplies to have here, but nothing. His doc is an endocrinologist. I have also update the nursing staff there that they may need additional resources if they can get him anything. He has been schedule 2 different education classes and has canceled several times since July. :sorry: I'm tired

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