DM1 in Elementary Setting - Dealing with Parents

[HCPSRMA]

This is my 5th year in our school clinic but my first time dealing with a difficult parent in terms of taking care of their diabetic child. Examples -- Lunches are packed daily and carb counts are always sent via a note however -- the meal goal (per dr orders) is around 60g of carbs and whats being sent is anywhere from 125-150g of carbs? Another example - students BG is over 350 and I asked student to choose another snack (what was provided was a 43g/carb cupcake!!!) and the parent was upset. Their answer is to eat whatever and just bolus for it. There are no healthy habits being taught and I try to do what I can but it ultimately will have to be changed at home. Have any of you dealt with this? Are our hands basically tied?

[Farawyn]

Is there a Doctor's order with a sliding scale?

You take orders from the Dr., not the parents.

[Flare, ASN, BSN]

How long has the student been diabetic? Are they working with a diabetic educator and if so do you have free access to communicate with that person? If you do not have free access to communicate, then get it and send regular reports including carb counts. If the student does not have a diabetes educator, it may be a good idea to suggest that the look into finding one. They are commonplace for my diabetic students, but I can't say what's happening in other regions.

Does student have an order to check ketones? Generally my students check for BGs over 300. Perhaps if the parent was seeing the total effects of the high carb counts, high blood sugars and the (probable) elevated ketone levels, something would make sense.

[HCPSRMA]

I do have doctors orders but that's not where my concern is. My concern is the lack of healthy options being provided and habits taught at home. It's just frustrating because it's a simple fix (at home.)

[AdobeRN]

I think your hands are tied - we can only do so much especially if parents are packing the lunch and snacks. The only time I have somewhat a control of what my T1 diabetics eat is when they are buying lunch - I have one student that the parent lets him buy once a week, but I have to escort him thru the line. I try my best to keep the carbs within the doctor order range. The mom has told me he can eat whatever he wants but I kindly make suggestions to him, remind him of the carb counts. There are days he wants high carb items - ice cream & choc milk are his favorite - I just make suggestions....like if you want the choc milk you are going to need to put the ice cream back, can't have both...etc etc.

[HCPSRMA]

There is an order for ketones but I have been instructed by the parent to only check them if BG stays high. Unfortunately in our district, what the parent says, trumps the order when it comes to things like that. I just have to document that I was told not to. Again, very frustrating when it comes to advocating for your students.

[Rubor]

I think you just keep doing what you are doing and educating and encouraging healthy options, but really your hands are tied. Folks are going to do what they wanna do. Reach out to the diabetic educators as well. I know I have called mine before and they are great.

[Farawyn]

I do have doctors orders but that's not where my concern is. My concern is the lack of healthy options being provided and habits taught at home. It's just frustrating because it's a simple fix (at home.)

I hear you.

[SaltineQueen]

I do have doctors orders but that's not where my concern is. My concern is the lack of healthy options being provided and habits taught at home. It's just frustrating because it's a simple fix (at home.)

It's unfortunate, but not even the doctor can "force" the parents to make better choices to manage their child's condition. If I had a diabetic child, I'd be busting balls to change habits and teach new ones...seems so simple, but some people just can't be inconvenienced by it. Sad that the child is the one who will suffer.

I guess at some point you start to think about medical neglect, but neglect is tricky. It's not that the parents aren't treating the diabetes...they're just not being very bright about how they choose to treat.

[SaltineQueen]

There is an order for ketones but I have been instructed by the parent to only check them if BG stays high. Unfortunately in our district, what the parent says, trumps the order when it comes to things like that. I just have to document that I was told not to. Again, very frustrating when it comes to advocating for your students.

That probably wouldn't fly with the Board of Nursing. You work under the supervision of doctors. If the parent wants that then they need to talk to the doctor and have the orders changed or sign an ROI so you can talk to the doctor.

[HCPSRMA]

It's unfortunate, but not even the doctor can "force" the parents to make better choices to manage their child's condition. If I had a diabetic child, I'd be busting balls to change habits and teach new ones...seems so simple, but some people just can't be inconvenienced by it. Sad that the child is the one who will suffer.

I guess at some point you start to think about medical neglect, but neglect is tricky. It's not that the parents aren't treating the diabetes...they're just not being very bright about how they choose to treat.

It ran through my mind but in past experiences, if it's not what THEY deem as "life or death," nothing will be done. It makes me so sad.

[OldDude]

As mentioned above, just be encouraging and consistent. You're not going to change the parental perception of the dangers of diabetes. I've seen kids come through that I've referred for acanthosis in elementary, morbidly obese, hypertensive, seen the same kids in JH and HS, still morbidly obese, and see them out on the streets after graduation, no change - just bigger, and the only thing that consistently pops into my mind is, "dead man walking;" It won't be too many years before they start losing body parts.