Just a question on diabetic kid

[MrsNurse08]

Good morning to my new found school nurse friends,

I have a 1st grader who has diabetes Type 1. Everyday mom brings in his lunch and she already has his Carbs counted for me. So for example: If he's eating 15 carbs, the doctor order to give 1 unit per 15 carbs. Sometimes mom would say give 1.5 units of insulin, but that's not what the doctor ordered. In her defense, she knows 1 unit will not help and he will run high later. And she is right most of the time. I told her to talk to his doctor and get an updated order, but i just chart per mom to give 1.5 units. So my question to you all, would you give 1.5 units like mom said or what the doctor ordered?

[GdBSN, RN]

Depending on what your orders say. The orders I receive say the "parents are allowed to make changes based on the following guidelines..." Check your orders and see if parents can do that, then you don't need new orders.

[OldDude]

I would follow the MD order. If mom wanted to give more than the max dose she would have to do it.

[MrsNurse08]

Depending on what your orders say. The orders I receive say the "parents are allowed to make changes based on the following guidelines..." Check your orders and see if parents can do that, then you don't need new orders.

I just read the order and it said school nurse may decrease total insulin dosage but nothing about parents

[MrsNurse08]

I would follow the MD order. If mom wanted to give more than the max dose she would have to do it.

Are have the MD update the order for her to make that decision right

[WineRN]

Depending on what your orders say. The orders I receive say the "parents are allowed to make changes based on the following guidelines..." Check your orders and see if parents can do that, then you don't need new orders.

I'm in the same boat. When my kiddo with TD1 runs high, we only go up to 5 units, even if the sliding scale says to give more because anything over that she has a history of crashing down into the 30s and 40s. So I usually call mom, talk to over and then chart gave X units per mother request. If i didn't have the parent loophole in the order, I would have to just follow what the doctor says until it is changed.

[Flare, ASN, BSN]

agreed - i am not keen on violating the written order. It is a matter of protection for me and a matter of the parent communicating with the doctor and letting them know that the orders need to be tweaked.

[ruby_jane, BSN, RN]

Call the MD and get the verbiage that the parent may direct changes in dosing. Then you're covered. Because I hate to be in the position of justifying an action "because the parent said so" - even fully acknowledging that parents of students with diabetes are often the experts in the care of their kids.

[OldDude]

Call the MD and get the verbiage that the parent may direct changes in dosing. Then you're covered. Because I hate to be in the position of justifying an action "because the parent said so" - even fully acknowledging that parents of students with diabetes are often the experts in the care of their kids.

I'm ok with this but I would require an email, text message, or some other written record of the parent's instruction regarding giving more insulin than ordered on the DMP.

[ohiobobcat]

Most of, if not all, of my T1D kids have the "parent may adjust insulin dosage within certain parameters" as part of their plan from the endocrinologist. I communicate with the parent and adjust, but if we are consistently having to adjust, then I encourage communication with the endo so a new plan can made. My kids are teens and they are ALL over the place with blood sugars, so I like having this allotment for minor insulin adjustments in the orders.

[MrsNurse08]

I'm ok with this but I would require an email, text message, or some other written record of the parent's instruction regarding giving more insulin than ordered on the DMP.

Yeah that's my school policy to have something on file signed by MD

[JenTheSchoolRN, BSN, RN]

Most of, if not all, of my T1D kids have the "parent may adjust insulin dosage within certain parameters" as part of their plan from the endocrinologist. I communicate with the parent and adjust, but if we are consistently having to adjust, then I encourage communication with the endo so a new plan can made. My kids are teens and they are ALL over the place with blood sugars, so I like having this allotment for minor insulin adjustments in the orders.

Same here. Orders I have let me and parent adjust insulin dosage within a certain parameter as well as hold dosing if needed by school nurse. Puberty is ride for BG and it gives me room to adjust for the bumps and curves.

Of course, any adjustment I document and talk to a parent about. Why I do text with some parents of my diabetic students as it does make communication easier (and hasn't been abused of yet). And yep, if a pattern of changes emerges, I urge communication with endo to change up the long-term plan.