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hoppynurse hoppynurse (New Member)

Independent Diabetics?

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Long post...

Looking for some insight about what you all do/don't do for your independent diabetics. I work in a highschool where, in the past, I usually had several years of lunchtime and prn visits from my students with diabetes before they transitioned to being fully independent during the school day, usually by 11th or 12th grade. This gave me time to get to know the student and their habits (both good and bad) as well as their parents.

This year I have 3 freshman who have been independent from day 1 of highschool. I have supplies for them in the nurses office but other than the very occasional visit to get a snack, I do not see them at all. I'm not sure if they really are so well managed that a prn visit just doesn't happen, or if they are dealing with their lows/highs by consulting (texting) with a parent rather than coming to the nurse...which makes me nervous. I don't know them well or their parents, and other than having orders from the physician with the "independent" box checked, I really don't know their level of compliance, understanding, etc. 504 meetings are quick and general and don't always give me a good sense of them. Its usually those daily check ins that really help me get to know the kids.

Most of these independent kids have pumps and cgm's that transmit to their (and their parent's) phones. While it makes me happy that diabetes care has come so far and the technologies are so advanced, it worries me a little bit not knowing what is going on with these kids on the regular.

Do any of you require students and parents to "contract" with you or sign some sort of agreement in order to be independent? Could I even have any say in this or is it really based on the student/parent/physician?

I do know that the end goal is to have students be independent, I just wonder if the new technology gives a bloated sense of security.

Thoughts?? And sorry for the ramble :)

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Why don't you just have a sit down with the kids, and call the parents, to familiarize yourself with them so that you ARE comfortable with how they handle their diabetes? If doc says they're independent and parents are in agreement, I'd be inclined to go with it. But getting to know the kids & letting them know you're there for them if/when necessary is never a bad idea.

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i am not at the high school level, but i will say this, as my students approach 8th grade, I can see them trying to assert independence. In some cases I can see it and support it, BUT I also make sure that they understand that my oders say that they are still firmly tethered to me and that they still need to do daily checks in my office (or whatever orders say). This year my 8th grade student had a cgm and a pump but is also very good about coming down to me to check with a meter for alerts of lows and symptoms of lows, despite cgm numbers. I feel blessed.

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I have several diabetics here, most all are independent in their care. Several will come to me "for a snack." If they are below 70, I make them stay. I don't require a contract for them to be independent, I think this is best decided by the parents and physician. Most of my kids DO text their parents constantly, even when they have come to me for needs.

If you are ever concerned, call the parents and talk to them about it. Do you have diabetic care plans from their doctor?

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I appreciate you wanting to provide excellent care for your students! Yes...that new tech is great until it isn't (a Dexcom needs a really robust internet connection or it will start throwing crazy values.)

What do the orders say? Completely independent? Then take Saltine's excellent advice above. If you really wanted to document- add something to say that you've sat with the kid/family and the doc/family believes the student is able to manage on his/her own; that you have indicated any concerns you have and that those have been addressed by the family.... We have a form somewhere where a parent declines to have an asthma inhaler or an Epi Pen at school. The parent is essentially declining all but emergent care for the kid and you can just confirm it in those words, right?

On the plus side...YAY for these kids, if they're managing well. It will be a lot easier in the long run.

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Both of my diabetic students are independent (one middle schooler, one high schooler). Last year was my first year here, and I met with both parents before the start of school to talk about their child's diabetes. I ask the parents to keep me in the loop whenever there are changes--a quick email will suffice. I think it's great that these kids are so independent with a little help from their parents. Before we know it they'll be off at college or living on their own and managing their diabetes on their own. Any time I see my diabetics I remind them that I've got extra insulin and fast acting sugars should they ever need it, and that I'd be happy to deliver if necessary.

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My independent students (at the Middle School level) don't come to me unless there is a problem, usually with their pump or site, which requires a call home anyway. The local children's hospital sets independence as a goal. Once a doc signs that they are completely independent I am here for support if needed. they must have emergency supplies in the clinic as well as an up to date diabetic management plan, but that's it.

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As both a school nurse and the mother of a diabetic child I have seen both sides of the issue. Back when my son was in school, it was a battle. The school really didn't have the concept of independence. Carrying meters, lancets, insulin and syringes, and glucose snacks was absolutely out of the question. I wasn't until I made a big battle when my son started spending part of his days at the "academy" (what we used to call vo-tech) that I argued he needed to be able to carry his supplies WITH HIM. Frankly, it's counterproductive not to allow these kids access to their own equipment that they know how to use.

In time, our district relented. With an IHP that approves it diabetics can self care. We also allow carrying of inhalers and in limited circumstances epipens by the older kids. I follow up withe parents to make sure that the child is compliant (pretty easy to see with a review of the history in the meters which they all do have now).

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My independent students (at the Middle School level) don't come to me unless there is a problem, usually with their pump or site, which requires a call home anyway. The local children's hospital sets independence as a goal. Once a doc signs that they are completely independent I am here for support if needed. they must have emergency supplies in the clinic as well as an up to date diabetic management plan, but that's it.

This!! I feel as though they should be independant!! as soon as possible!! I do email the parents the lunch schedule monthly.

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My independent students (at the Middle School level) don't come to me unless there is a problem, usually with their pump or site, which requires a call home anyway. The local children's hospital sets independence as a goal. Once a doc signs that they are completely independent I am here for support if needed. they must have emergency supplies in the clinic as well as an up to date diabetic management plan, but that's it.

YEP, this is what I do. My goal is independence by 9th grade and I start with them in 7th grade.

I have a 10th grader this worked wonders for. That student goes to camp each summer and I make her teach me something new when she and her mom (also a nurse) drop off her back-up supplies with me at the beginning of the school year. Mom loves this approach.

I want them to be able to self care when they go to college, get a job, interact with the real world. You can't do that unless you let them transition to management on their own in school.

And no, I don't do any contracts. My orders do say student can self administer care. Now, a non compliant HS student? I have had orders before that student must check glucose in the presence of the nurse because student would not otherwise. But that is a different thread.

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I haven't thought of this, since my only TD1 is going to 6th grade next year. We have to see what his doc says for next year.

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