Help for friend's Type 1 diabetes daughter

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Specializes in ER.

Not sure if I am posting this in the correct area - Sorry this is so long.

My best friend's daughter (16), found out she has type 1 diabetes. For the past few months she has been showing the signs and I told my bf she needed to be checked out. I know a tiny bit about diabetes, I had gestational diabetes when I was pregnant with my daughter. My bf took her to the Dr. last week and they immediately sent her to Children's with a BG of 640. Right now, they are still trying to regulate her insulin and trying to figure out what works.

Here is the problem, she missed a week of school due to being in the hospital and her school is giving them problems. Last Friday, they went to the school with all of her paperwork, a glucose meter, insulin, Ketone strips - everything she would need at school. Her mom talked to the school nurse and her counselor. The nurse told her mom "yeah, my son had that when he was younger, but he doesn't have it anymore.":eek: The counselor said "That's not where you have to count carbs is it? That's a pain." It sounded to me like they know nothing about diabetes. There is another counselor at the school (not her's) that has Type 1 and I told my friend she should really talk to her, she would understand, but it seems that counselor is never there.

There was a situation this week when daughter tested her BG, it was 430 and the nurse sent her off to lunch. When mom found out, she was very upset. She has talked to the principal and the vp as well and no one seems to understand the importance of her situation. Her mom is not taking any of this very well and I am worried about both of them.

I figured since I am here reading all of the time, this may be a great place for help. What do you think she should do to help educate the school staff? Does anyone have experience with this or advice on what she can do?

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Specializes in Oncology.

At 16 years old, after an adjustment period, the girl should be able to manage the condition herself while she's at school. It's frustrating, and will definitely take some transition. Blood sugars will never be perfectly controlled. There's no reason someone at 16 should need a school nurse checking her bg for her, counting carbs, or drawing up insulin.

There is no reason not to eat because of a high bg- insulin should be given to cover the carbs and the high bg, and plenty of water she be drunk.

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It sounds as if the school staff are not "educable". I would advise the person to keep in close contact with the daughter's physician and depend upon him/her to get her straight. There should be a nurse in the office to take the time to do the education if the doctor is too busy. The school nurse sounds as if she is close to worthless. I would not be relying on her for anything concerning my child's health. And yes, 16 is plenty old enough to take responsibility for self care.

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Specializes in Acute Care Cardiac, Education, Prof Practice.
At 16 years old, after an adjustment period, the girl should be able to manage the condition herself while she's at school. It's frustrating, and will definitely take some transition. Blood sugars will never be perfectly controlled. There's no reason someone at 16 should need a school nurse checking her bg for her, counting carbs, or drawing up insulin.

There is no reason not to eat because of a high bg- insulin should be given to cover the carbs and the high bg, and plenty of water she be drunk.

Honestly I don't agree here. At 16 or 38 a new diagnosis is something that takes time to learn from and adjust to. Now I do recognize you noted her needing "an adjustment period" however the school nurse should be more than capable, and is responsible to help her with this transition.

A diagnosis such as Diabetes at such an age can be nearly as scary as any other diagnosis. There is fear of rejection, alienation and the unknown. I believe this girl needs someone supportive in her school to help her learn to manage her diabetes and to act as a resource for when she isn't quite sure how many units she needs or how to deal with new feelings of hypo/hyperglycemia.

To the OP: I have left a message for my mother in law who has been working peds and managing school nurses for over forty years here in Georgia. I will see if she has any suggestions on who this child's mother can contact to get support in helping educate the school. I would assume the state BON might be of help, however maybe there is something more specific to school nurses. Until then I would try and help my friend support herself and her daughter and educate themselves as best they can on how to manage her sugars.

430 is painfully high to me...

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Specializes in Oncology.
Honestly I don't agree here. At 16 or 38 a new diagnosis is something that takes time to learn from and adjust to. Now I do recognize you noted her needing "an adjustment period" however the school nurse should be more than capable, and is responsible to help her with this transition.

A diagnosis such as Diabetes at such an age can be nearly as scary as any other diagnosis. There is fear of rejection, alienation and the unknown. I believe this girl needs someone supportive in her school to help her learn to manage her diabetes and to act as a resource for when she isn't quite sure how many units she needs or how to deal with new feelings of hypo/hyperglycemia.

To the OP: I have left a message for my mother in law who has been working peds and managing school nurses for over forty years here in Georgia. I will see if she has any suggestions on who this child's mother can contact to get support in helping educate the school. I would assume the state BON might be of help, however maybe there is something more specific to school nurses. Until then I would try and help my friend support herself and her daughter and educate themselves as best they can on how to manage her sugars.

430 is painfully high to me...

I was diagnosed with type 1 at 19. I lived by myself, worked, and was in college full time. It's doable. I don't mean to sound harsh, but the sooner she learns to take care of it herself, the better. Communication with her parents or a CDE would be the best way to determine doses if the nurse isn't trustworthy. If the school nurse, and she may not even be a nurse for all we know, doesn't know anything about diabetes, she's not going to learn quicker than the girl or her family.

430 isn't "painfully high" for a girl who was running 600s for who knows how long before.

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Specializes in ER.

Thank you Tait and thank you everyone!!

This girl is like a daughter to me. She is taking it well. This has had an affect on her vision (they have an Opthamologist appt. next week), and she turned 16 last Saturday, so she was upset about not getting her drivers lic. - lol

Mom has called me with suggestions on foods and snacks for her. I have told her foods may have different results on certain people - I could eat tortilla chips but not with avocados - my sugar would skyrocket. They have an appt. with a nutritionist today, so hopefully they will learn alot.

Her family has no experience with diabetes at all. She is a smart girl and I have no doubt that she can handle this and grow confident with how to handle situations. I am just worried about the "what if's" and hoping the school would know how to handle an emergency situation - too high/too low.

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What credentials does the "nurse" at the school hold? That may explain some of the issues with her. She may not be a nurse at all.

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Specializes in ER.
What credentials does the "nurse" at the school hold? That may explain some of the issues with her. She may not be a nurse at all.

I will ask. I am not sure, but I was thinking in TX that it is a RN position. I could be wrong on that.

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Specializes in School Nursing.

Has the physician not given her a care plan for the school? I'm a school nurse, and my diabetic students come to me with a care plan in hand that spells out exactly what to do for blood sugars at certain levels. With the BSG of 430, most careplans I have seen would require her ketones to be checked and if she had moderate/large ketones or was symptomatic, some care plans recommend an extra "sick day" dose of insulin.

I would also check into the credentials of the nurse, and perhaps call the Health Services (or similarly named) department of the district. Surely they have protocols in place for this. If not, perhaps the diabetic educator can do an inservice for the student. If things get bad enough, consider asking for a 504 meeting, since this is a condition that could effect the child's learning. There are laws in place to ensure that children with medical needs are able to receipe appropriate education, and that the school makes reasonable accomodations for them.

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Are they working with a diabetes educator? If not that is step #1. He/she will work with your friend, her daughter and the doctor to help the two of them understand their treatment plan and stay on top things. The diabetes educator can even go to the school and work with the nurse to make sure everyone is on the same page.

Have your friend insist on a 504 plan. This will help with situations where she misses school or tests, and it will also make sure everyone involved with her daughter during the school day is aware of the seriousness of her situation. They will hold a meeting complete with nurse, principal, teachers, etc, and everyone will get a copy. Once this plan is in place any deviation requires a trip to the school by your friend, and a face-to-face meeting with whoever thought it was a good idea not to follow her treatment plan.

Her daughter needs to take charge of her situation. Yes, I know and agree that there is an adjustment period. Unfortunately the fact of the matter is no one is going to take care of her like she is. If she has a BG reading of 4-something there is no way she should quietly go off to lunch. Not only does she need to correct that high but she needs to count her carbs and dose for her food before she eats it. She needs to be assertive enough to let the school staff know what is and isn't acceptable when it comes to what she needs to do to manage her diabetes. Teach her to say "I have type 1 diabetes, and this is what I have to do right now to manage my condition" if anyone gives her a hard time.

Tell your friend to check out sites like childrenwithdiabetes.com and jdrf.org to find other parents and kids that are going through the same thing. They also have forms, like the 504 plan, and other helpful stuff.

As the mom of a 10 year old type 1 diabetic I know how hard it all is. Unfortunately, type 1 DM is often in the shadow of type 2 and many people just don't understand the disease. I've even had people ask me if I fed my son too much sugar when he was little.

Good luck, and let me know if I can help at all :heartbeat

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Specializes in Nephrology, Cardiology, ER, ICU.

We can offer support but we can not offer medical advice:

1. Please don't state things about covering her BS with x-amount of insulin, consuming water, etc., that is medical advice.

2. Please don't suggest diets/foods to eat/avoid as this too is considered medical advice.

We can not and should not provide ANY MEDICAL ADVICE as this is against our terms of service.

I would suggest that discussing the care of the pt at the school be done between the parents and the school as well as the child's provider.

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Specializes in School Nursing.
I will ask. I am not sure, but I was thinking in TX that it is a RN position. I could be wrong on that.

Now that I know it's in TX I can comment more :)

Check out this link:

http://www.dshs.state.tx.us/schoolhealth/schnurs.shtm

I would have your friend contact the School Nurse Consultant. The way the school is handling this is scary. :eek:

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