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.
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.
What was the time frame between doses?
Dosing twice in a 3 hour period can cause a low. Short acting insulin hits its peak about 1-1.5 hours after administration. Even if the pump says it is okay, I will hold a dose it it means two doses in a 3 hours because in my experience it always causes a low with the students I have worked with.
But my orders say I can do that - basically they allow the school RN to use assessment to adjust/hold within a certain perimeter. Amethya, given you are not an RN, you really need clear instructions/guidelines here from the doctor and your supervising RN.
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.
JenTheSchoolRN, BSN, RN
3,035 Posts
What was the time frame between doses?
Dosing twice in a 3 hour period can cause a low. Short acting insulin hits its peak about 1-1.5 hours after administration. Even if the pump says it is okay, I will hold a dose it it means two doses in a 3 hours because in my experience it always causes a low with the students I have worked with.
But my orders say I can do that - basically they allow the school RN to use assessment to adjust/hold within a certain perimeter. Amethya, given you are not an RN, you really need clear instructions/guidelines here from the doctor and your supervising RN.