My student came in with a Stomach ache, we checked him and his machine was acting up, giving me a 31. Which is not possible, so we checked him again and he was 286. We checked his Ketones, it was moderate and I was doing his protocol of drinking water and resting. He stated that he ate dinner last night, but he couldn't find his machine, so he didn't do the carbs for it. He has been having this stomach ache all night and today, and didn't eat any breakfast.
I am trying to make him drink water, but he's refusing. I already called his mother to come pick him up because of his stomach ache.
What do you guys do in this situation? I'm thinking of maybe changing the pod, because it's on his thigh and last time it was there, it wasn't giving him his insulin properly.
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I'm very worried though because on how this is being cared for at the doctor's office and at home. He's not following a diet because his doctor said he can eat anything as long as he has the carbs for it and puts insulin. And this causes him to have extremely high glucose, like today. Not only this his mother is in the hospital for kidney issues because she herself has TD1 and is getting worse.
I hear you. My T1D kiddo is always between 230-475!!! He brings in lunches of rice, cookies and juice. Clinic says as long as he is getting coverage for the carbs it is ok- drives me NUTS. I have tried everything to do teaching, etc.
Specializes in Cardiology, School Nursing, General.
I hear you. My T1D kiddo is always between 230-475!!! He brings in lunches of rice, cookies and juice. Clinic says as long as he is getting coverage for the carbs it is ok- drives me NUTS. I have tried everything to do teaching, etc.
Because that is what the docs are doing now. All my kids pretty much eat what they want as long as they cover it. I'm sure they are taught carb counting, ratios etc. But the idea is to let them live as normal a life a possible (eating what their friends do) AS LONG as they cover the intake!!! (And the spike as needed). So I would be careful about querstioning the quality of care. It may be very good, but the doc is not sitting in class with the child. Is all of that info spelled out in the DCP? Are they testing as ordered?
This. One of My TD1s now argues with me when I tell her not to eat a part of her lunch when she is high (350+). "Mom says I can eat whatever I want". Lately she has been exhibiting hypoglycemia symptoms when she is in the 90s, which I think is because of this "I can eat whatever I want" train of thought.
One thing I will say about the pod is usually it is not working properly, I see students go much higher than 286. Last time I caught a jostled pod, student's sugar was 482. The thigh and hip can often get jostled; hip sites often sit right at the backpack level.
Puberty also creates even greater insulin resistance. So many increased blood sugars for a type one diabetic during puberty are thought to be because teens eat so much sugar and are non-compliant, but insulin resistance also plays a large role. Growth hormones contribute to it and the "dawn phenomenon" can happen where teens wake up with a very high blood glucose. So, yes, I've seen 200s a lot with pre-teens as insulin levels are constantly adjusted.
Nine is a bit young and a child that age needs a parent/guardian to help them with good habits of regularly checking sugar at home. If that is not happening, this is may be a losing battle, sadly.
All of ours are also told they can eat what they want as long as they cover for it.
I had a T1 cousin who was diagnosed before the days of carb counting. His was strictly avoiding sugar and taking his insulin according to his last bloodwork (before the days of home meters). There was very poor compliance with telling a teenager NOT to eat something. He was on dialysis by the age of 35 and bilateral BK amputations. Died at the age of 45.
I guess I'd rather they eat what they want and cover for it, just use some good judgement.
If you're really worried, file a report with CPS for neglect. You don't have to prove neglect, just suspect it. You can't "make" anyone do anything, especially make a pre-teen drink water.
Sure just add a CPS investigation to this already overly stressed family. That would help a lot.
This. One of My TD1s now argues with me when I tell her not to eat a part of her lunch when she is high (350+). "Mom says I can eat whatever I want". Lately she has been exhibiting hypoglycemia symptoms when she is in the 90s, which I think is because of this "I can eat whatever I want" train of thought.
Some diabetics are so used to having high sugars that they start feeling hypo even if sugar is low for them - that is, around 170, 160. So it's not surprising that a normal sugar of 90 feels low to your student.
Specializes in Cardiology, School Nursing, General.
Some diabetics are so used to having high sugars that they start feeling hypo even if sugar is low for them - that is, around 170, 160. So it's not surprising that a normal sugar of 90 feels low to your student.
This is true and I see it in my student. I thought that must be the case that he's so used of having super highs, that 140 or lower, makes him feel really bad.
I did let his doctor know about the highs, but they only raised his target to 180, so it's 160-180 for him.
Specializes in ICU/community health/school nursing.
Sure just add a CPS investigation to this already overly stressed family. That would help a lot.
With respect: "I'm worried" and "He's not following the diet" are perhaps indicative of pattern and history. I don't know. But in Texas (where OP is) we're all mandated reporters. Stressed out family or not, we have an obligation to report if we think medical neglect is involved.
Specializes in Cardiology, School Nursing, General.
With respect: "I'm worried" and "He's not following the diet" are perhaps indicative of pattern and history. I don't know. But in Texas (where OP is) we're all mandated reporters. Stressed out family or not, we have an obligation to report if we think medical neglect is involved.
That's true, but I mostly need to go by my admin first before reporting something, especially this issue.
Today the student came back, he seems better today.
With respect: "I'm worried" and "He's not following the diet" are perhaps indicative of pattern and history. I don't know. But in Texas (where OP is) we're all mandated reporters. Stressed out family or not, we have an obligation to report if we think medical neglect is involved.
Also with respect - involving CPS sounds unwarranted to me before a little delving into this family's situation by the nurse seems wrong. Maybe said delving isn't the school nurse's job but there must be someone who can try to help this family before turning them over to "the police"
Maybe a well-worded letter from school nurse to family and doctor, if this is permissible (contacting the doctor) would help. A conference involving the family, the doctor, and the SN should be the desired outcome of this letter. If the child still has bad control and SN thinks the parents just aren't understanding or cooperating for their parents' optimum good, then I see little choice but to involve the authorities.
Probably all RN's everywhere in America are mandated reporters.
Specializes in ICU/community health/school nursing.
Also with respect - involving CPS sounds unwarranted to me before a little delving into this family's situation by the nurse seems wrong. Maybe said delving isn't the school nurse's job but there must be someone who can try to help this family before turning them over to "the police"
Maybe a well-worded letter from school nurse to family and doctor, if this is permissible (contacting the doctor) would help. A conference involving the family, the doctor, and the SN should be the desired outcome of this letter. If the child still has bad control and SN thinks the parents just aren't understanding or cooperating for their parents' optimum good, then I see little choice but to involve the authorities.
Probably all RN's everywhere in America are mandated reporters.
Don't disagree at all. It's just a question of how long has this been going on and how "worried" are you. It never looks good to go in front of a regulating body and say you were worried enough to seek advice from strangers on a nursing site but not worried enough to make a call...
OP is not an RN; however, every adult in the state of Texas is a mandatory reporter.
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I hear you. My T1D kiddo is always between 230-475!!! He brings in lunches of rice, cookies and juice. Clinic says as long as he is getting coverage for the carbs it is ok- drives me NUTS. I have tried everything to do teaching, etc.