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 haven't had to deal with a diabetic student yet but when I read about these non-compliant children, I think of my Aunt. She was diagnosed at age 11 and she was already the very spoiled youngest child per everyone's report. My grandparents didn't want to be "mean" i.e. properly manage her diabetes and complained about all of her doctors to my parents. She had to go to the hospital many times in her teenage years due to high sugars.
Despite being a "nightmare" as a teen (per my parents), she grew up into a very kind and considerate woman but was never well controlled, always ran high. She ended up on dialysis in her mid-30s, was on a transplant list and got called for a kidney and when she showed up to the hospital had blood sugar in the 500s and was declined the transplant. My grandma thought it was ridiculous they "punished" her for indulging at a work party because "she didn't know she was going to get called for a kidney."
She recieved a kidney two years from another transplant center (the first one removed her for lack of compliance which grandma chalked up to a personality conflict) but by her mid-40s started having chronic wounds that eventually led to losing one leg above the knee. She sadly went into heart failure and died in her sleep at 48.
I always wonder if things would have turned out differently had my grandparents' attitude toward her disease been different? Or if she would have had someone trying to help her like a great school nurse??
My son is 8 and a type 1 diabetic. He was diagnosed almost one year ago. For the most part his sugar is controlled. At home he has breakfast and is covered for carbs, then at 10:30 his class has snack (no carb coverage for snacks). Then at 1200 they have lunch. He goes to the office before he goes to the cafeteria has his sugar checked, and is given insulin and since we pack his lunch I count carbs. He then is checked again at home for dinner. He usually has a snack at home before dinner.
School calls me if there are treats, and if sugar is > 300. We test ketones if >300. Haven't had any ketones yet thankfully. His numbers have been going up and diet and insulin are adjusted. He is only on injectable. We haven't been offered the pump yet. I think he might be too young yet.
Specializes in Cardiology, School Nursing, General.
She is definitely a nurse. The clinic has 5 "resource nurses" on staff.
Wow... You would think she would be more helpful, especially given the circumstances. I agree with others, if this is getting out of hand, you can talk to your admin about CPS because this can be considered medical neglect, but as they said if he's going to the doctor and doing what's technically suppose to do, then they won't do anything.
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.
This gets me SO MAD for you. I would ask to speak with someone else because she just isn't being professional.
I have two TD1s both with pens. I see them before morning snack, we dose based on their sliding scale and carbs, glucose check before lunch and insulin post (sometimes we hold things from lunch if they are running high) and then the younger of the two has an afternoon snack we check before hand and will dose if they are above 200.
Both have plans in place to check for Ketones (one over 250 other over 300).
My older one just naturally trends high no matter what we do (200-220) and actually starts having signs of hypoglycemia at 100.
The younger one is better controlled.
Both see the same clinic which I LOVE. When I first started last year, I was frustrated that my older one was trending so high and I had a real great conversation with the nurse educator there AND the doctor called and followed up with me. The only thing we don't agree on is I feel like my older one should be on a pump and the doctor doesn't want to "change what already works".
I realize it's a bit different with older kids, but both my middle school T1D only check BG before lunch unless they are have symptoms of being high or low, or if they need to recheck 2 hours post lunch due to glucoseover 250. Now, I do try to encourage them to check before gym class, but at their age, I'm taking a bit of a hands off approach. One of my kiddos ran high a lot last year, but never more than "trace to small" ketones.
As for the food, I remind them occasionally about "carb free" snacks they can have if they are hungry, but other than that, I don't worry about their diet. Honestly, I can educate them on it, but it's not in my control. Besides, these kids have enough going on to make them feel different without adding a strict diet onto things. And not to mention that a "special" diabetic diet is no longer recommended for T1D from what I recall. Just the normal, balanced diet that they recommend to everyone.
Finally, our local pedi endo (with a major children's hospital) provides a diabetic care plan for our students. Parents are allowed to titrate carb ratio as appropriate in between appointments within certain perimeters. Do you not have a similar care plan?
Specializes in Cardiology, School Nursing, General.
Update: the mother went to the Peds and basically they want me to check him 4 times a day and to not give him too much insulin, but I'm confused on how much should he get in a day? Because if his BG is high, and he's about to eat lunch, the insulin given is high, so how can I fix this?
Update: the mother went to the Peds and basically they want me to check him 4 times a day and to not give him too much insulin, but I'm confused on how much should he get in a day? Because if his BG is high, and he's about to eat lunch, the insulin given is high, so how can I fix this?
Don't you have specific orders for how much insulin to give? Do you add together correction (for high BG) and bolus (for carb count) = units of insulin? If the calculations are correct, how can that be "too much insulin?"
Specializes in Cardiology, School Nursing, General.
Don't you have specific orders for how much insulin to give? Do you add together correction (for high BG) and bolus (for carb count) = units of insulin? If the calculations are correct, how can that be "too much insulin?"
The machine does the calculations for me, so the doctor has the orders that the machine does the calculations, but I have his old orders that actually specify how much to give when he gets to a certain BG, but the reason I was told that is because he came once in the morning, got insulin for 5.00 because he was high then he came an hour later for lunch and got 15 units for lunch, and that caused his BG to go really low. They told me that it's too much in a small period of time, so I'm confused how I could help him with his insulin if it's too much. Because his PE class and lunch time are after each other.
The machine does the calculations for me, so the doctor has the orders that the machine does the calculations, but I have his old orders that actually specify how much to give when he gets to a certain BG, but the reason I was told that is because he came once in the morning, got insulin for 5.00 because he was high then he came an hour later for lunch and got 15 units for lunch, and that caused his BG to go really low. They told me that it's too much in a small period of time, so I'm confused how I could help him with his insulin if it's too much. Because his PE class and lunch time are after each other.
If they come in before PE, we usually don't give the full correction (with physician's consent) because PE will frequently cause them to drop, and that could be what happened that day.
Specializes in Cardiology, School Nursing, General.
If they come in before PE, we usually don't give the full correction (with physician's consent) because PE will frequently cause them to drop, and that could be what happened that day.
Makes sense. I'll try to keep an eye on him and see how he does today.
When I completed my school nurse diabetes training, it was instructed that you prime with 2 units before each treatment. A few times, we did discover a bad needle that we would not have known of otherwise, and the insulin would not have been delivered.
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.
River Song, RN
84 Posts
I haven't had to deal with a diabetic student yet but when I read about these non-compliant children, I think of my Aunt. She was diagnosed at age 11 and she was already the very spoiled youngest child per everyone's report. My grandparents didn't want to be "mean" i.e. properly manage her diabetes and complained about all of her doctors to my parents. She had to go to the hospital many times in her teenage years due to high sugars.
Despite being a "nightmare" as a teen (per my parents), she grew up into a very kind and considerate woman but was never well controlled, always ran high. She ended up on dialysis in her mid-30s, was on a transplant list and got called for a kidney and when she showed up to the hospital had blood sugar in the 500s and was declined the transplant. My grandma thought it was ridiculous they "punished" her for indulging at a work party because "she didn't know she was going to get called for a kidney."
She recieved a kidney two years from another transplant center (the first one removed her for lack of compliance which grandma chalked up to a personality conflict) but by her mid-40s started having chronic wounds that eventually led to losing one leg above the knee. She sadly went into heart failure and died in her sleep at 48.
I always wonder if things would have turned out differently had my grandparents' attitude toward her disease been different? Or if she would have had someone trying to help her like a great school nurse??