Difficult Diabetic Student

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I have a 9th grader that is a type 1. He has been at our school since middle school and been problematic from the beginning. He does not have a pump and honestly will probably never get a pump because he is so uncontrolled. His mother expects the school to go above and beyond for him but yet he is not monitored at home. I have his orders from the dr. which says he has to be monitored at school and the carb ratio. Mother states he is not mature enough to handle his diabetes by himself which ok I do understand that but truthfully he is capable of doing it all but the problem is a behavior issue. He has been diagnosed since he was 7 so he knows what to do. Anyway he is supposed to come in a do his calculations and insulin and write everything down the secretary makes sure that he does what he is supposed to and report to me if there is a problem. I serve 3 different schools so I am not able to be there each time he checks But there is always a problem. His IHP from Dr says mother can make changes to dosage and so he is always changing it up. Of course the secretary doesnt know what to do and honestly I am lost as what to do. He refuses to write anything down after multiple conversations about needing to write it in the log book. Mother says "just have the principle punish him" but we cant do that. And with mother constantly changing it then how is anyone supposed to know if he is doing it correctly. He came in with a CGM yesterday saying he no longer has to check his blood sugar. I explained that he will still need to prick his finger before he doses. He said "No mom says just use this." Today he comes in wanting to know why the CGM and his monitor were way off and I explained that is why we had the conversation yesterday. Mother is very difficult to deal with and hasnt signed a form for me to be able to communicate with his Dr. The last nurse said it didnt matter even if she did speak with the dr. The parents do what they want to "managing" his diabetes. I know you cant fix ignorance you can only document so that is really all I have going for me right now.

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Specializes in Pediatrics Retired.

What you say is true...but you can call CPS if you suspect medical neglect.

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I feel your pain. I was just going to post this morning about my T1D second grader who has been an issue since the beginning of last year. Similarly, poorly managed at home and mom wants me to manage him here. Poor communication, poor compliance. I just wrote a letter I am sending home today that mom needs to sign and send back because she sent him to school today with no breakfast thus no insulin and called the teacher telling her "just have the school nurse do it" . Anyway, my point is, I am sorry you are dealing with this. Even harder for you since you are not in the school all the time. A few thoughts- can you call the endocrinologist and talk to them directly and get orders faxed over with clarification of calculation, sliding scale, and use of CGM as sole source for blood sugars? I was able to call my student's resource nurse to clarify some things. Regarding the CGM, who told you you have to still do a finger stick? I am only asking because my neighbor has a sixth grader with a new CGM as of last June and she was told to stop finger sticks and rely on the CGM. Her mom is ON IT and super compliant and she too has T1D so we had a long conversation about finger sticks and CGMs. Just wondering if the MD told them not to do finger sticks anymore. I would def make sure mom has signed a release so you can all the doctor yourself and clarify everything. Hang in there. I know how hard it is. I have posted about my T1D student and his family issues many times on here. At he end of the day we want what is best for our students and to make sure we are not risking our license, etc. Parents tend to lose sight of that.

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Specializes in Pediatrics Retired.
... At he end of the day we want what is best for our students and to make sure we are not risking our license, etc. Parents tend to lose sight of that.

Absolutely this! And if something ever goes "bad" these types of parents will deny they have ever been informed of a problem at school, regardless of how much documentation, and won't hesitate to throw you under the bus. That's why I say, when the parent participation falls below the "reasonable and prudent" threshold, call CPS and get all that on a third party record.

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Specializes in Community and Public Health, Addictions Nursing.

That's so frustrating to have to deal with. And I feel bad for the student, too- so young, and I can only the imagine the damage being done to his body with the total lack of glucose control.

Reminds me of a patient at a health center I used to work at- 20 years old, totally resentful of his T1D diagnosis and burnt out from it, and never had a parent who could help him learn to manage it. When I knew him, he had spotty insurance and was frequently in ICU for DKA. Good for you, ABRN, for keeping up on this! I wish I could give more guidance besides try to figure out which of his providers will work with you on this, but I don't.

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Specializes in School Nurse, past Med Surge.

I feel like he's old enough to start hearing about some of the long-term consequences of not managing his diabetes. Impotence is one I liked to throw out to my stubborn male patients in the hospital...but maybe he's a tad bit young for that one. :)

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Specializes in Dialysis.
I feel like he's old enough to start hearing about some of the long-term consequences of not managing his diabetes. Impotence is one I liked to throw out to my stubborn male patients in the hospital...but maybe he's a tad bit young for that one. :)

no but he could sure learn about amputations!

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Oh believe me he gets a lecture everytime about amputations!

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Specializes in ICU/community health/school nursing.

I even went to "diabetes is a disease of the microvessels" and talked kidneys and member and fingers and toes. But that was high school.

There was a BRILLIANT post on here last year by a diabetic nurse who spent most of her high school and some of her college life not complying with her treatment regimen. I wish I knew how to find it for you.

I don't have much more for you. If you're following both your policy and the doctor's orders and documenting when LD is/is not coming in, you're covered. You can't care more than the parents do...I know you know that.

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Specializes in School nursing.
I even went to "diabetes is a disease of the microvessels" and talked kidneys and member and fingers and toes. But that was high school.

There was a BRILLIANT post on here last year by a diabetic nurse who spent most of her high school and some of her college life not complying with her treatment regimen. I wish I knew how to find it for you.

I don't have much more for you. If you're following both your policy and the doctor's orders and documenting when LD is/is not coming in, you're covered. You can't care more than the parents do...I know you know that.

Ooo, if someone finds that post I'd love to read it.

I have a friend with T1D, who is now approaching 40. She was diagnosed at 15 and very stubborn with treatment all through her teens and 20s - she is lucky that she isn't seeing major complications yet, but she has had some minor bumps in her 30s that jolted her a bit. She gave me some great perspective when I was struggling with a very non compliant HS student a couple of years ago. The student did not change their ways (student's mom was equally frustrated) but it did help me understand a bit more how the student might be feeling.

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Specializes in School Nursing, Home Health.

Scare them. In the nicest way. Pull up pictures of a diabetic ulcer. Explain how increased blood sugar in their system affects them. How it can damage small blood vessels. Do they like their eyes? How about not having to do dialysis?

I sit down with the kiddo and teach them. I make it clear I am not a teacher, I am not admin, I am hear for their health. Ultimately the one that gets affected is HIM/HER not me. Of course, it is easier for me because I am the only nurse here at my HS.

Like somebody said above, call CPS/CYFD if parents aren't managing it. Do they have a 504 in place? If they can't comply with school policy, there has to be some kind of consequence.

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Specializes in Cardiology, School Nursing, General.

Explain the consequences to student and parent with admin involved. Things ain't settled, CPS. Make sure you document EVERYTHING.

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