Ketones and Diabetic Students

[nurse__ab19]

Hello all!
Just curious if you have any advice about this.

Some background: I have a diabetic student who is a very sweet kid but has been known to use their diabetes as a "get out of jail card." They have been caught multiple times on their phone during class and will lie, telling the teacher its diabetes related (they have a CGM) when it's very much not, among other things including attendance issues. Mom has been informed many, many, many....many times about their behavior but she enables it and always has an excuse for them. They have also been having attendance issues; mom always blames it on having ketones - which I can believe to an extent; I have access to their CGM and can see if sugars have been high.

However, my question is, do you guys make your diabetic student parents "prove" the kid has ketones if they are going to miss school? I know this sounds awful but I'm getting a ton of pressure from our truancy officer to figure something out because they think mom is just using ketones as an excuse. I have extensively educated our admin about ketones and that it can become a serious diabetic emergency if not treated. I guess I just feel stuck between the two and am not sure what the right course of action is. 

[NutmeggeRN, BSN]

Possibly a release and talk to the provider re expectations re at what level of + ketones (adding in anything else) that they should not be at school. Mom will probably give the level as enough to miss school, but it's an honest stab at trying to make sure the child is able to access their education.

Good Luck!

 

[k1p1ssk, BSN, RN]

Our diabetic student orders for high ketones are to call the provider for instructions - it would usually be to replace their pump catheter/pod but also for a 1x dose of SC insulin via syringe, watch and recheck ketones in a set amount of time. We would only send home if the ketones still weren't going down - and realistically, they're probably going to be instructed to proceed to their endo or the ED. I mean, if they've been spilling for over a day and on the verge of ketoacidosis, then that's one thing, but if it's happening that frequently, then they probably need some adjustments to their insulin regimen. 

All of that to say, no - I don't think the kid should be missing that much school for high ketones and letting the endo know would  be a good first step...