Managing type 1 elementary

I have a high school student who we treat this way. He checks before lunch, goes to eat and then I insulin pen him after lunch (he is a special needs student). Our lunch is only 20 minutes, so while he might spike during that time, it most likely is due to the food he is eating, which I will be covering with insulin shortly. It works for him and he has pretty good control over his blood sugar. There is also a kindergarten student we have in our district with a pump, they cover her 1/2 carbs before she eats, then cover the rest after so they can subtract something she doesn't eat or add on if she decides to drink a juice or something like that. I am involved on the fringes of this student's care (covering when her usual nurse is out sick).

You can always call the diabetes clinic your student uses and talk to them (with parent permission). Both clinics in our state are super helpful and are willing to work with the school nurses to find a plan that works best for that child.

I always have my T1D come to me with her lunch and tell me what she will and won't be eating. She has a pump and many times I will split the dose depending on her lunch.

I've done similiar with students in the past - usually my little kinder kids. The last little kinder diabetic I had would sometimes eat everything and other days only a few bites - she was never consistent. I would check BG before lunch, look in her lunch box (parents were never consistent on giving me carb counts) then send her to the cafe to eat. We did not allow her to throw anything away in the cafe - she packed up what was not eaten and returned to my office, I would then give insulin according to what she ate. Parents were ok with me doing this and it worked well for the year.

Welcome to our nurse's station!

I think this is a good strategy for a young student who may not eat the entire lunch. If you give insulin based on what is in the students lunch and then he/she skips have of it, he/she may bottom out fast and you'll be calling 911. Is this student newly diagnosed and they are trying to find a good balance?

If you are worried about covering yourself, I would call/fax the dr office with something along the lines of "XYZ Student does not always eat everything in his/her lunch. Would it be alright to hold the lunch bolus until after the student has finished eating to ensure we are only covering the carbs eaten?" Check with the parents first and then you are covered.

Thank you all for the replies! I believe overall it is just a policy in the district for most of our elementary kids. I think I will look in to perhaps getting a waiver or adjustment if needed. I understand the reasoning was just worried from a legal stand point I guess. I do know once I know the kids better I'll be able to make some more informed judgment calls. Just a tad apprehensive with the new atmosphere.

Thank you again!

I believe overall it is just a policy in the district for most of our elementary kids. I think I will look in to perhaps getting a waiver or adjustment if needed. I understand the reasoning was just worried from a legal stand point.

I don't care for my diabetics based on district policy. I care for them based on their signed diabetic plan from their medical provider, along with input from parents. To have a blanket district policy that dictates how a nurse should care for diabetic students would be, in my humble opinion, dangerous. My diabetics are all so different, I approach their care differently as well, and would not like a school policy holding me back from making decisions within the written orders that will best benefit my students.

Eventually I would want to move away from it. I know there have to be some students who consistently eat their entire meals so there should be less worry about them eating less carbs than covered for. I think the suggestion to reach out to the provider and request a change to the plan so I am covered, but I will have to wait until I know the students more.

In the school I am at most of the time, we have diabetics who each have this defined in their individual diabetic plan from the doctor. Nursing judgment must also play a part here. You need to know the student's eating habits. I have one girl who consistently eats her entire meal and another who might just take a few bites from a lunch kit full of 50 CHOs, and she's a brittle diabetic! We have to treat them differently because they are different. I think the idea of getting an order from the doctor is a good one. But as a nurse, you must use the skills school gave you and decide what is best for your particular kiddo. I'm not about to load my brittle one up with insulin and have her crash 45 minutes later. I would never be able to explain that to a review board.

I currently have two diabetics, one newly DX'd kinder kiddo and the other is a 4th grader. I check both blood sugars before lunch (calculate the insulin coverage for the blood sugar) then calculate the lunch coverage after they come back with their trays. The kinder kiddo usually doesn't eat all the food. I'll recheck the sugars again before dismissal usually around 3 but the timing changes depending on the situation. If I end up giving someone a big dose of insulin I call them down earlier and/or check them twice before dismissal. Bottomline I get paranoid and I don't want someone dumping on me.

I speak with the parents and diabetes NPs and MDs all the time and get amended orders when needed. This is the safest way to care for the child and hold onto your license, not an educational policy that holds no medical weight.