Can you please give me an idea of what a typical day your students with T1D looks like? When are they coming to see you, when are they getting insulin, etc.
Many here know I have been dealing with a first grader since September who is very poorly managed, almost consistently in the 300-400 range. His endo clinic is of little help.
He was out yesterday and mom just dropped him off and there were papers in his folder "for the nurse" that were discharge papers from our local ER, Diagnosis "hyperglycemia" No answer from mom when I call her. I am waiting for the endo clinic to open so I can inform his resource nurse and ask about a plan.
I am feeling very lost in terms of support from anyone really. The last time I reached out to his endo nurse she scolded me saying he is a six year old kid and should be allowed to eat like a six year old kid. Very frustrating all around.
Right now, my instructions from the endo clinic are to just check him before lunch and then 20 minutes after, give him his insulin based on BG and carb count. That's it! Obviously if he is showing any signs of being low (has b=never happened) he gets checked, but I used to check him mid-morning and the nurse questioned why I was "giving him an extra stick"!?! It seems crazy to think that he should only be checked once before lunch. He is not on a pump by the way. He was supposed to be on one as of October and mom keeps failing the pump training appointments.
Anyway, would just love to hear from others and get a sense of what goes on with your students with Type 1.
I am managing 6 diabetic students right now (this is down from 12 when I started here!).
I have two 7th graders who are both on CGMs and pumps. One trends high and the other is trending low right now. They see me at 8:30, Before lunch, after lunch (to report what they ate and how they covered), and at the end of the day.
I have a special needs student with Type 2 diabetes. He uses an insulin pen. I posted about this when it happened earlier in the school year, but I FINALLY got him to self-administer his insulin pen with me checking his dosing first. I have been with him since he was first diagnosed 4 years ago, and I will have him 1 more year before he ages out of school. I see him before lunch, after lunch (for insulin coverage) and at the end of the day.
I have one very non-compliant T1D whose parents let her do whatever she wants whenever she wants. I do my best to educate and encourage her to care for herself, but it falls on deaf ears (both the parents and student). I usually see her once a day when she is here, and not home "sick" or suspended from school (both frequent occurrences).
I have a semi-compliant T1D who has not been to an endocrinologist in at least 2 years, maybe longer. We are a rural state, and have 2 pediatric endocrinologist groups. They burned bridges with one group and a trying to get into the other group. She had an appointment in early March with the other group, but the doctor was sick so it's rescheduled for this month. Her "normal" blood sugar is in the low 200s (like from 200-230). She doses herself with insulin, but the dosing is from 2 years ago. Her A1C is like 14 or something. So when I say semi-compliant, I mean she comes and sees me every day twice a day and uses her insulin per her old plan, but she is not controlled AT ALL. We have had many meetings and expressed concern about the lack of guidance with her diabetes, and mom has no sense of urgency about this at all.
Then I have a compliant but "brittle" (hate that word, but everyone knows what I mean by it) insulin resistant diabetic. He uses Apidra insulin because just about every other insulin has failed him. He is on a pump and does a good job checking and covering himself, his numbers just are all over the place and have been since I have known him. He and I communicate by text a lot, because he leaves my campus and goes to vocational school for part of the day. Mom and dad are both right on board with this kid and we all have a good working relationship.
I have only communicated with the endo clinic one time. They called me to check on my non-compliant "does whatever she wants when she wants" student when she was with them at an appointment to find out exactly how often she was coming to see me. We were all on speakerphone for that conversation in the endo office. Good times.
MHD- you situation sounds SO frustrating. What is UP with that endo nurse, anyways? "Just a little hyperglycemia?" I wonder what she thinks is a LOT of hyperglycemia!!!
Nurse from diabetes clinic actually returned my call for once. She was very dismissive and said too me "He's totally fine, just a little hyperglycemia. Mom is great about calling me when she is worried, so if mom is not worried, I am not worried". I don't consider vomiting with high ketones and a BG in the 500s "just a little hyperglycemia", but ok thank you wise endo nurse. She drives me nuts- so condescending to me, like I am "just" a school nurse and know nothing about this family.
Are you sure that it is a nurse you are talking with?
Thats what I was thinking too. It may be time to get Child Protection involved. CPS will prolly confer with his Endo though, and will render any complaint useless.
My son is a Type 1 diabetic. School routine for elementary school was to come down and do blood test (and insulin if needed) at lunchtime. If at other times he felt that he was low or the teacher/staff noted a marked beligerance (a sign his bg was going down), he'd get another test.
By high school, I had lobbied long and hard that he be able to keep his meter and glucose tabs with him. Only needed to come to the office if he needed insulin or further assistance.
That is actually the plan I work towards with all my HS diabetic students. Currently managing 2, but did manage 4 at one point. One HS is now on a CGM pump and I have access to the data, so I will follow-up with student for extreme highs and lows, which has been happening a lot lately because this student is just starting puberty (otherwise very compliant).
When I worked elementary, it was usually 3 checks - one just before snack for carb coverage, one at lunch, and one just before student got on the bus.
I did have one very non-compliant HS student a couple of years ago. This was the student who I'd make cry at her 504 meeting for being honest about her non-compliance. No matter how nice I was, she would cry and tell me "I will never understand." She's right, but it didn't change the fact that a BG over 300 was the "norm" for her and that wasn't good for her health. Mom was on board and equally frustrated. As was the doctor. I started playing bad cop with this student (with Mom's okay) and it helped for a bit. Then it didn't. You can only do so much, sometimes, but I still think about this student after she graduated.
Thats what I was thinking too. It may be time to get Child Protection involved. CPS will prolly confer with his Endo though, and will render any complaint useless.
Exactly. He shows up for his appointments and logs everything , just has a crap diet, no one seems to care that 300's are his norm, including the clinic, so CPS will get nowhere.
Thanks everyone. I have to say it has been really interesting and educational to read how varied management is across the board. Actually makes me feel a little bit better about things. I still wish he were better controlled, but I know I am doing everything I can, documenting everything, and just hoping he doesn't have a major crisis.
What KILLS me about this is that the kid is young and young people should be more adaptable than a 57 year old woman. He needs to learn (hell, EVERYONE) good habits NOW that will carry him through his life.
Does anyone know if there's a diabetic kid video game out there? Like, if the kid can hit the good food, they get points -or if they hit a good food, they explain WHY its a good food (or bad food) for diabetics (a little cup of ice cream vs a 1/2 gallon) and then get points. If they get a low score or no points, there's a pic of an obese adult/kid needing help to go to the bathroom - no kid wants to think about needing help to go to the bathroom!
Specializes in orthopedic/trauma, Informatics, diabetes.
"Does anyone know if there's a diabetic kid video game out there? Like, if the kid can hit the good food, they get points -or if they hit a good food, they explain WHY its a good food (or bad food) for diabetics (a little cup of ice cream vs a 1/2 gallon) and then get points. If they get a low score or no points, there's a pic of an obese adult/kid needing help to go to the bathroom - no kid wants to think about needing help to go to the bathroom!"
There are no such thing as GOOD foods or BAD foods for Type 1 kids. OMG! Please re-educate yourself about type 1. Type 1 DOES NOT COME FROM BEING OBESE. What you just described above is discriminatory and bullying. Type 1 diabetes is an autoimmune disease in which the pancreas ceases to create beta cells, hence no insulin, which is why they have to GIVE THEMSELVES INSULIN.
I apologize for the caps but you don't have a clue about type 1 and you are caring for them????????? oh and by the way, I am a 53 year old woman with T2, it is hereditary and I make good choices. My A1c is 6.3. You REALLY need to quit generalizing.
No answer from mom when I call her. I am waiting for the endo clinic to open so I can inform his resource nurse and ask about a plan.
ohiobobcat
887 Posts
I am managing 6 diabetic students right now (this is down from 12 when I started here!).
I have two 7th graders who are both on CGMs and pumps. One trends high and the other is trending low right now. They see me at 8:30, Before lunch, after lunch (to report what they ate and how they covered), and at the end of the day.
I have a special needs student with Type 2 diabetes. He uses an insulin pen. I posted about this when it happened earlier in the school year, but I FINALLY got him to self-administer his insulin pen with me checking his dosing first. I have been with him since he was first diagnosed 4 years ago, and I will have him 1 more year before he ages out of school. I see him before lunch, after lunch (for insulin coverage) and at the end of the day.
I have one very non-compliant T1D whose parents let her do whatever she wants whenever she wants. I do my best to educate and encourage her to care for herself, but it falls on deaf ears (both the parents and student). I usually see her once a day when she is here, and not home "sick" or suspended from school (both frequent occurrences).
I have a semi-compliant T1D who has not been to an endocrinologist in at least 2 years, maybe longer. We are a rural state, and have 2 pediatric endocrinologist groups. They burned bridges with one group and a trying to get into the other group. She had an appointment in early March with the other group, but the doctor was sick so it's rescheduled for this month. Her "normal" blood sugar is in the low 200s (like from 200-230). She doses herself with insulin, but the dosing is from 2 years ago. Her A1C is like 14 or something. So when I say semi-compliant, I mean she comes and sees me every day twice a day and uses her insulin per her old plan, but she is not controlled AT ALL. We have had many meetings and expressed concern about the lack of guidance with her diabetes, and mom has no sense of urgency about this at all.
Then I have a compliant but "brittle" (hate that word, but everyone knows what I mean by it) insulin resistant diabetic. He uses Apidra insulin because just about every other insulin has failed him. He is on a pump and does a good job checking and covering himself, his numbers just are all over the place and have been since I have known him. He and I communicate by text a lot, because he leaves my campus and goes to vocational school for part of the day. Mom and dad are both right on board with this kid and we all have a good working relationship.
I have only communicated with the endo clinic one time. They called me to check on my non-compliant "does whatever she wants when she wants" student when she was with them at an appointment to find out exactly how often she was coming to see me. We were all on speakerphone for that conversation in the endo office. Good times.
MHD- you situation sounds SO frustrating. What is UP with that endo nurse, anyways? "Just a little hyperglycemia?" I wonder what she thinks is a LOT of hyperglycemia!!!