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elementary/middle school diabetics

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Where are your 5th graders with diabetes at in the grand scheme of "total dependent care to complete self care?"

I have a 5th grade student who is almost exclusively dependent for care (my first year with them). They've been diagnosed for at least 4 years, so this is not new. For every "issue" I present or that comes up (ie, you're on the bus and you feel low and you don't have your supplies, insulin calculation, carb counts, to not even giving themselves insulin yet) it's "well, I'd ask my mom and she would do it for me" My response is always, no what do YOU do, not your mom. She looks at me like I have 3 heads. It's just not sinking in with her.

Thankfully we have her 504 meeting coming up, so I am going to discuss things to work on with mom (and wins too, because there are lots of those). BUT, I want to know...what do you expect from your 5th graders with diabetes? Am I being too hard? I've never had a 5th grader with diabetes prior to this year, but the 6th graders that I have had in the past have all been 90% INDEPENDENT. She is nowhere close to there. It scares me knowing that I won't be here next year and I am not confident they'll be able to find a nurse to replace me.

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Flare is a ASN, BSN and specializes in school nursing, ortho, trauma.

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if my fifth grade student has been diabetic for a reasonable amount of time them I do expect a bit of autonomy from them.  They should be able to calculate their dosage with me checking their numbers before they dose and I should not see many errors from a "seasoned" diabetic.  They should be able to recognize when they are feeling low and know what to do to treat it during times that the nurse (or parent) is unaccessable.  If they are needle dependent, then they should be able to give their own shots.  If they are pump dependent, i don't necessarily expect them to know how to change their set, but they should be familiar with it and how to do basic care tasks like change their cartridge and prime the line.  

But all of this is largely dependent on their level of self care at home.  I do recognize that some children just naturally take to their care faster than others, but by and large by age 10, i don't think it's unreasonable to have a child start taking a more active role in self-care of their life-long condition.  

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by ARN Member Nurse

ARN has 12 years experience and specializes in medsurg/school nurse.

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my 7 year old type 1 knows he needs to eat a starburst if he feels low or some other fast form of carb and at home he knows where they are, although we decide how many grams of fast carbs and help him do that still. he can read labels for total carbohydrate count. he can check his dexcom and put his blood sugar into his pump for a correction, and can put carbs into his pump. he frequently doses himself with his pump with us double checking that he did it correctly. he can also check his blood sugar with his glucometer himself with a little supervision to make sure he doesn't forget to clean his finger first. he still forgets to wash his hands after going to the bathroom so 🤢. he doesn't always want to do those things but I try to give him the opportunities so he knows how. 

I am hoping by the time he is in 5th grade he will be mostly independent with adult backup for most everything. I expect I will be helping him put his dexcom sensors and omnipods on for a while though. he already knows a lot of carb counts for his regular foods. like he can go to the pantry and get a prepackaged snack that he eats frequently and will yell out how many carbs in this mom? and before I answer he will tell me what he thinks and he is usually correct. we have some foods we don't dose fully for that are high in fiber etc that tank him if we do and he has figured that out. 

we are always talking numbers and he loves math. 

I hope you can get mom on board with giving him more small responsibilities at home and building his Independence.  

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ruby_jane has 10 years experience as a BSN, RN and specializes in ICU/community health/school nursing.

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I feel your frustration. But you cannot care more than the parent. And remember the parent may still (even four years down) be grieving/controlling/whatever. It will change when the parent is willing to change it. You can try to enlist the provider/nurse to lean on the parent. Good luck.

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by ARN Member Nurse

ARN has 12 years experience and specializes in medsurg/school nurse.

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https://www.sugarsurfing.com/single-post/2016/07/22/Gaming-Your-CGM-ala-Pokémon-GO

a fun idea to get kids to engage in their care more. maybe make up a guessing game with him based on something he likes to try to get him to come up with some answers on his own. maybe start by getting him to tell you how many carbs are in one food item in his lunch. he has no interest so I feel like you might need something to get him started. 

we already guess at what the glucometer is going to say vs what the cgm says. I have my kiddo tell me what number he feels like he is. Sometimes he is super close. he might say im like way low, like urgent in the 50's. or im in the 60's. sometimes he is wrong and he feels low because he just had a big drop so we talk about that and why its important to double check and wait before treating. 

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tining has 26 years experience as a BSN, RN and specializes in School Nurse.

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As a middle school nurse  (where this kid will be in 7 short months) I need them to be independent.  I try not to hover with 'light' monitoring. 

Four years and this kid should be fluent in diabetic problem solving.

I appreciate what you are doing for the next nurse! 

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Jedrnurse has 25 years experience as a BSN, RN and specializes in school nurse.

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Last year I had a 4 year old who was getting pretty good with learning about the disease. This year, at the grand old age of 5, I was talking him through putting his numbers in the pump before I hit "dose".

After that, I'd have a hard time dealing with a "helpless" 5th grader...

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On 2/3/2020 at 3:20 PM, tining said:

As a middle school nurse  (where this kid will be in 7 short months) I need them to be independent.  I try not to hover with 'light' monitoring. 

Four years and this kid should be fluent in diabetic problem solving.

I appreciate what you are doing for the next nurse! 

Our middle school is 5th-8th. So, she technically is in middle school. Argh!

Thank you all for reassuring me that I'm not being too demanding in my expectations.

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tining has 26 years experience as a BSN, RN and specializes in School Nurse.

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Sounds like a juicy 504 meeting.  Can't wait to hear what mom says!

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164 Posts; 982 Profile Views

3 minutes ago, tining said:

Sounds like a juicy 504 meeting.  Can't wait to hear what mom says!

Right?! I have difficulty sugar coating things. I either don't talk or it ALL comes spilling out, so wish me luck! She might hate me after this 😂

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by ARN Member Nurse

ARN has 12 years experience and specializes in medsurg/school nurse.

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On 2/4/2020 at 10:05 AM, ihavealltheice said:

Right?! I have difficulty sugar coating things. I either don't talk or it ALL comes spilling out, so wish me luck! She might hate me after this 😂

even if she hates being pushed on right now (it needs to be done)....hopefully one day she will see the benefit of helping her child become more independent. 

personally i don't want my type 1 diabetic kid to live with me forever (or my other kid who is 4 and wakes up and climbs into my bed often at night). one day i'll miss them but also one day i will enjoy being an empty nester and not reminding my children to wash their hands, dose for food, don't leave your toys in the living room or the dog will eat them etc etc. 🤣 

my 23 year old brother still lives with my mother, doesn't have his drivers license, and I am not sure if he will ever move out. thank goodness he at least works but guess who takes him to and from everywhere...yup my mom. he was born with multiple health issues. was on ECMO and didn't come home until he was 3 months old I believe. when he did come home it was with a feeding tube, oxygen, heart monitor. his diaphragm didn't form completely and his organs were in the wrong places, lungs full of fluid, not fully developed, heart murmur, and his soft palate didn't form, bowel issues ( I can't remember all the technical terms for what happened it was just a random thing that happened to him and they knew when he was still in the womb so they were prepared when he was born to intervene). he is perfectly healthy now aside from asthma flare ups and he eats like garbage and has zero physical activity. anyway my point in sharing this story is, i have seen what it looks like to not push your chronically ill child to be independent and to coddle them. while it sucked he had to go through all that as a baby and had multiple surgeries as a child he could be totally independent of my mother now. fingers crossed one day she will push him to move out! 

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tining has 26 years experience as a BSN, RN and specializes in School Nurse.

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I have a 57yo brother-in-law with failure to launch.  Usually keeps a job 1.5 years , off on unemployment benefits x 1 year and then new job.  Therefore in 6 month he will be on unemployment, mom paying for his new truck and other bills.  Thank God he gave up the boat slip with a little RV at the marina $$$.  During the last job search failed a personality test, well duh.  With NO health issues except gout 🤣.

Edited by tining

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