Managing a diabetic student with severe ADD

[BSNbeauty, BSN, RN]

I was substituting in a school last week and had a diabetic student with severe ADD. First, it two adults to assists with checking his blood sugar. When I arrived to his room he was jumping from table to table, throwing things, fighting and trashing the room. He literally could not sit still and on top of that he was agitated. The adults had to restrain him several times to keep him safe from harming himself and others. I checked his AM glucose and it was high. Ofcourse the student did not let me test ketones nor was he able to follow directions of holding the strip in the steam of the pee. The health room did not have cups so he was unable to do that too. Fast forward to the afternoon, I go to check his sugar and it was 35. He was still running around, and throwing tandrums. He refused to eat a snack or lunch. Thankfully, I got some juice in him. He has a history to dropping in the 20's and still running around the class room and having tandrums. My worse fear is that one day his body will finally say enough and shut down as a result of hypoglycemia. My question is: How do you manage these types of students? Especially when they are not on any medications. I just feel so sorry for this poor kid.

[Tina, RN]

Whoa. That is an insane situation.

I don't have any suggestions, but I'll be watching this thread to see what the more experienced school nurses say... It doesn't seem safe for this child to be in a "regular" school setting! He needs tons of help/support.

[BSNbeauty, BSN, RN]

I agree. The student needs to go to a school with less stimuli and more support. His case is so heartbreaking.

[Wave Watcher]

I would suggest 3 things:

1. Communicate with parents the issue you are having at school.

2. Communicate with his Endocrinologist and find out what they may suggest as plan of action.

3. 504 meeting with all involved.

OH, and:

4. Protect yourself and your license. Document.

[NutmeggeRN, BSN]

Sounds like his needs are great enough to warrant a 1:1 nurse. I agree with WW, document document document!

[RNCourt]

Sounds like we are in the same boat! I have a Type 1 diabetic student who is also diagnosed with ADHD and cannot be treated with medications due to its effects on his sugars. This is my first year as an RN let alone a school nurse so I can't really say I am experienced with this situation BUT I have come to learn many interesting things about this student and how to handle his particular situation.

One thing that helped this student improve significantly was encouraging him to get involved in sports. The last thing his parents wanted to hear was "Mom, can i join the wrestling team?". He is on an insulin pump so we had a lot of concern with his site being ripped out and being off the pump without basals for so long, etc. BUT all the worries are worth it. He found his niche. He found a way to focus his energy and gained many friendships in the process. Needless to say we are constantly working with his Endocrinologist to ensure his safety especially since he wanted to "cut weight" like all of the other wrestlers.

I work at a Charter School and this student is in the 8th grade. I cannot say enough how much this has improved his behavior both inside and outside of the classroom. At our school we have a policy that does not allow students to participate in sports if they have a certain number of demerit points or if they are failing a class. Knowing that, this student didn't want to risk losing his spot on the wrestling team.

My one last piece of advice: test his sugars if he is sent out of the classroom for misbehaving. If the parents realize how many times their child is being sent out when their sugars are off it will make it more apparent that there needs to be better management. I definately agree there should be meetings with admin, parents, and endo on a frequent basis.

Best of luck to you and your student. Hope this helps or at least gives you some ideas.

[BSNbeauty, BSN, RN]

Thanks everyone for the replies. I hope this little guy gets the care he needs.

[Flare, ASN, BSN]

it sounds like this kid is in dire need of a behavior plan. How old is he? most children once they reach school age, diabetic or not, severe add or not, can adhere to a certain level of routine once it's established in a cohesive plan. It's too bad that he has the mix of maladies that he has, but it's the hand he has dealt and he needs to learn coping strategies now. RNCourt is right that a functional use of his energy is a good outlet, but in the mean time, having him earn reinforcers like computer time, stickers, or playground time for going into the healthoffice and getting his sugars checked and insulin delivered without a struggle is a start. Then you up the ante. More time for doing it 3 times in a row. 5 minutes for doing it 5 times in the week without being reminded... etc... it's not difficult. It just has to be tailored to fit his needs. On the flip side, he also needs to know that there are consequenses for trashing a room or not cooperating during glucose checks. Administration can be involved in appropriate consequenses, but i'm always a fan of cleaning up the mess that one makes.