Maddening T1D non-compliance

Specialties School

Published

SO frustrating.

Middle schooler dx in May with T1D. I've been telling the kid for a MONTH that their glucose levels were starting to go up, that their "honeymoon" phase seemed to be ending and they needed to get on top of managing things. I was telling the kid LAST week they really needed to be checking their glucose in the mornings, even if they don't eat anything. I've been trying to pull the kid from class to do diabetes education with them. I was telling the mom TWO days ago that the student can die from this, the numbers are trending up, that she really needed to attend the education class at the local children's hospital, etc.

What happens instead? Kid walks in for glucose check before lunch and it reads "Hi." They almost immediately start vomiting. Kid still claims they can't pee enough to check ketones (same story every time they have been over 250 this month - UGH!) even though they peed just fine this morning. 6 units, still "hi" 30 minutes later, 6 more units, STILL "hi" 30 minutes later (under endo direction). Emesis x2 more. Mom arrives, EMS arrives, kid goes to the hospital.

Per kid, they hadn't checked glucose since yesterday at school when it was high (300s, then upper 200s 2hr post). They felt sick last night, ate pizza for dinner, didn't take short acting with it. Fortunately took long acting at bed. Woke up feeling sick, still didn't check glucose. Mom's story? She tells kid to check glucose, but he's always tired and doesn't want to.

...

I know mom doesn't get it (doesn't help that there is a language barrier), and it's a lot to take in and learn. But MAN is it frustrating.

Specializes in Pedi.

This is a child protection case. A middle schooler is still a child and it's the parents' responsibility to make sure blood sugar checks are being done and insulin taken. This actually reminds me of a child I had on my caseload when I was a pediatric home health manager. The child was about 14, and his HgbA1C was about 14 as well. His father viewed diabetes as his son's issue and basically said if he didn't take care of himself that was his problem.

Specializes in School nursing.
This is a child protection case. A middle schooler is still a child and it's the parents' responsibility to make sure blood sugar checks are being done and insulin taken. This actually reminds me of a child I had on my caseload when I was a pediatric home health manager. The child was about 14, and his HgbA1C was about 14 as well. His father viewed diabetes as his son's issue and basically said if he didn't take care of himself that was his problem.

Um...what?

People like that should not be having kids. Kid may actually be non compliant in hopes that his dad might pay attention if he ends up in the hospital and seems like dad won't care. I feel for that kid!

Specializes in CPN.
This is a child protection case. A middle schooler is still a child and it's the parents' responsibility to make sure blood sugar checks are being done and insulin taken. This actually reminds me of a child I had on my caseload when I was a pediatric home health manager. The child was about 14, and his HgbA1C was about 14 as well. His father viewed diabetes as his son's issue and basically said if he didn't take care of himself that was his problem.

I don't disagree. It needs a little more time, IMO, though. Parent is scheduled to attend education class on Wed. If they skip out, and there is a similar situation that occurs, I will make a report. Until then, I'm hoping it's an education/coping issue.

Specializes in CPN.

Can't pee for a ketostick? Here, sit with me and drink 20 ounces of water until you can...guarantee that will only happen once.

Ruby, I did this the week before Thanksgiving and it FREAKING WORKED! Kid was 580 at lunch today and peed without a fuss! And did it again this afternoon for rechecks. So excited.

Also, as a general update, mom attended the recommended education class and was glad to connect to parents dealing with similar stuff. She also happily agreed to our offer to have a teacher call her who not only has been struggling with a non compliant teen, but also speaks Spanish and will be able to speak easily with mom. Kid isn't interested in Freestyle Libre, but mom is. She's gonna try to convince him to at least try it for a couple weeks. We'll see how it goes.

Specializes in ICU/community health/school nursing.
Ruby, I did this the week before Thanksgiving and it FREAKING WORKED! Kid was 580 at lunch today and peed without a fuss! And did it again this afternoon for rechecks. So excited.

Also, as a general update, mom attended the recommended education class and was glad to connect to parents dealing with similar stuff. She also happily agreed to our offer to have a teacher call her who not only has been struggling with a non compliant teen, but also speaks Spanish and will be able to speak easily with mom. Kid isn't interested in Freestyle Libre, but mom is. She's gonna try to convince him to at least try it for a couple weeks. We'll see how it goes.

ALL the good news!

I would respectfully posit (to the kid) that the kid doesn't know what s/he wants because it's just so difficult being diabetic and that age. I mean it. It stinks, and it takes a lot of resilience to get through. I would be interested to know how that Freestyle works.

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