Parents of diabetic students

[Spidey's mom]

I know it can be challenging in many ways to deal with parents of diabetics. Many times you just can't get parents to get on board with doing their best for their kids.

But what about the opposite? The ones who micromanage their kids at school?

I have a diabetic 6 year old 1st grader on an insulin pump who I've been caring for at school since Kindergarten. His family is Hispanic. Mom and Dad and sister and brother (both in high school) are awesome and involved. However, mom comes to school every day. She insists that when the nurse or health aide checks blood glucose or when the nurse pushes the button for insulin, someone watches and signs that we did it right.

Ok - we've managed with that.

Now, she's decided that if her son's BG comes back at a high number (no specificity of how high) we have to make him wash his hands again and recheck. She's evidently gotten different numbers at home that make her think he isn't doing a good job washing his hands. Well, we watch him do that as well. Mom is there every day so if she says she wants us to check again, we check again. There are no physician orders for this.

Friday she didn't come to school for the 1st time this year. Her son's BG was low before lunch so he got 2 glucose tabs. After 15 minutes it was still low, so two more glucose tabs. No symptoms by the way. After 15 minutes he was 88 and off to lunch. He ate 59 carbs (he's not a big eater) and got insulin for those carbs. An hour later he needed to be checked before PE and was 288. There are no orders to do anything at this number (he's on a pump remember) and I was confident this was due to the glucose tabs. No symptoms. Mom walked up right then and I told her about his day. She always wants to know his IOB (Insulin on Board) numbers when he is low and to be nice the aide usually writes that down (I was covering for the aide that day as she was absent). But I've been told by the pump manufacturer and the doctor and the nurse handling his case that this is not important or necessary. Plus there are no orders so I don't write it down. Then mom asked if I rechecked that high blood sugar and I said no. I didn't think he did anything wrong with his handwashing. When he got home that day his blood sugar was low. So it went from high to low in an hour. And mom thinks that's my fault because I didn't recheck.

She's requested a meeting with the principal and me with a translator. I'm obviously in contact with the child's doc and the nurse and the pump manufacturer but I wanted to know what you all do.

I know blood sugar fluctuates - you can take a blood sugar on the right hand and on the left hand and the numbers will be different.

Do you do a re-check of a high blood sugar if mom states she wants it or do you stick with the physician orders?

Seems like nursing judgment goes out the window when mom is so deeply involved. I applaud them for being such great parents but she shadows this child most of the time. She translates for him but that's another story - the teachers would love it if she wasn't in in class all day.

Whaddya think?

[mc3, ASN, RN]

Spidey's mom, I have the documents in PDF format. If you want to PM your e-mail address, I'll send them to you.

mc3

[caregiver1977]

I have 3 school-aged children. I think if I felt that I had to hover over the staff at school that much because of my child's medical condition, then I might would consider homeschooling my child. I work at a public school that has a high population of special needs students. Some of these students are in classes for disabled student, some are in regular classes all day. Many students at my school have their own CNA/medical assistant to provide for that particular student's health needs. Maybe this mom should consider asking the school about this since she seems to trust the school so little.

[Spidey's mom, ADN, BSN, RN]

I have 3 school-aged children. I think if I felt that I had to hover over the staff at school that much because of my child's medical condition, then I might would consider homeschooling my child. I work at a public school that has a high population of special needs students. Some of these students are in classes for disabled student, some are in regular classes all day. Many students at my school have their own CNA/medical assistant to provide for that particular student's health needs. Maybe this mom should consider asking the school about this since she seems to trust the school so little.

She is there every day. She is inconsistent in what she asks us to do while she is there. One day a BG in the 200's will mean she wants us to re-check. Sometimes not.

I think what we are going to do is say on the days she is there, the nurse will be free to go to the other 10 campuses to do work.

I completely understand wanting the best for your child but you have to work with us, not against us.

[schooldistrictnurse]

I think you have to function under the written plan from the endocrinologist, with input from the parent, but I don't feel comfortable having the whim of the parent guide my actions. In a lawsuit situation (heaven forbid) would you feel more comfortable saying "mom told me to do that" or "I was following the physician's directives."

[Spidey's mom, ADN, BSN, RN]

I think you have to function under the written plan from the endocrinologist, with input from the parent, but I don't feel comfortable having the whim of the parent guide my actions. In a lawsuit situation (heaven forbid) would you feel more comfortable saying "mom told me to do that" or "I was following the physician's directives."

That's what I've need saying all along but I'm new at this and the difference between the educational plan and medical plan is so huge that educators can't see it. I know that's part of school nurse horror stories here.

Our meeting is tomorrow. Only 1/2 hour with an interpreter. Hopefully we can fix this.

[Jolie, BSN]

She is there every day. She is inconsistent in what she asks us to do while she is there. One day a BG in the 200's will mean she wants us to re-check. Sometimes not.

I think what we are going to do is say on the days she is there, the nurse will be free to go to the other 10 campuses to do work.

I completely understand wanting the best for your child but you have to work with us, not against us.

I agree. Only the parent has the legal standing to do anything other than what the provider has prescribed. We acknowledge that in school. I must follow physician orders and district policy. A parent does not have to do so. If mom wants anything done other than what the child's doctor has ordered it is her responsibility solely, and you need not (and should not) participate.

Go do something else.

One question has been bugging me all along...if she has no transportation to get the child to school in the morning (requiring a special bus trip), how does she get back and forth herself?

[Spidey's mom, ADN, BSN, RN]

I agree. Only the parent has the legal standing to do anything other than what the provider has prescribed. We acknowledge that in school. I must follow physician orders and district policy. A parent does not have to do so. If mom wants anything done other than what the child's doctor has ordered it is her responsibility solely, and you need not (and should not) participate.

Go do something else.

One question has been bugging me all along...if she has no transportation to get the child to school in the morning (requiring a special bus trip), how does she get back and forth herself?

Thanks.

She rode the bus with her son last year. Remember we went back to get her son so he could eat breakfast at his usual time. Towards the middle of the year she got her license although it took a lot to do so because of her legal status. She drives him now or he can ride the bus at the same time as the other students now. But I think he's only done that once this year.

[bleemadden]

I had a kinder diabetic (he ended up moving) but mom was that same way. Fortunately because of an old student and their family, we had a policy in place at our school where we follow dr's orders only. We also had a policy where parents (and all volunteers) are required to be on a schedule. The first week back to school she was allowed to stay all day but after that she was only allowed to come 'hang out' from 11:00 to 12:30 which was his lunch through recess and a half hour after. She was fine with this policy as she was only really concerned with lunch time. It gets uncomfortable with somebody breathing down your back and you become more concerned with them than the student.

The mom and I had also had a meeting and decided to keep a log of his sugars in his backpack so she could look at the rest of the day's numbers when he got home. This saved me from having to call every sugar and I only had call in the extremes, which were numbers decided on by the physician.

[Spidey's mom, ADN, BSN, RN]

I had a kinder diabetic (he ended up moving) but mom was that same way. Fortunately because of an old student and their family, we had a policy in place at our school where we follow dr's orders only. We also had a policy where parents (and all volunteers) are required to be on a schedule. The first week back to school she was allowed to stay all day but after that she was only allowed to come 'hang out' from 11:00 to 12:30 which was his lunch through recess and a half hour after. She was fine with this policy as she was only really concerned with lunch time. It gets uncomfortable with somebody breathing down your back and you become more concerned with them than the student.

The mom and I had also had a meeting and decided to keep a log of his sugars in his backpack so she could look at the rest of the day's numbers when he got home. This saved me from having to call every sugar and I only had call in the extremes, which were numbers decided on by the physician.

I don't think she'll agree to the kind of plan you outlined in your first paragraph.

In the insulin pump pack there is a small notebook where we write down blood glucose and insulin and carbs for her along with out notebook that we keep at school. Also, the pump has a history where she can check on her own.