Uncooperative Diabetic Question - page 2

Alright nurses! Help me figure this one out! Having issues with this student and family on multiple fronts. 4th grade boy with type I diabetes. Diagnosed 1 year ago. Has the Dexcom G5 CGM and... Read More

  1. by   OyWithThePoodles
    Quote from KKEGS
    We do not have access to his CGM. Parents monitor it remotely. They never call the school to tell us if he is trending high or low or even when it isn't working at all which has happened several times over the last couple of weeks. We literally have ZERO communication with his parents and when we do call they get angry.

    His Dexcom is the one that is FDA approved for dosing instead of a finger poke. His parents were complaining that the nurses aren't following orders about dosing using number on the Dexcom. Again, after talking to the nurse she said that wasn't true. The day I spoke with her he hadn't done a finger poke at school for nearly 3 weeks.
    How in the heck are you supposed to dose him based on something you don't have access to??? That is total crap IMO.

    1. Get the doctor on board if you have a release to talk to them, if not, get one. This is unacceptable, he's only been diagnosed for a year.

    2. Get admin involved. You HAVE to know how he is trending. It's dangerous to not know that. If parents refuse I would make them sign a release relinquishing the school from responsibility, as he could be dropping fast and you'd never know.

    3. My T1D's have the G5 and at home they don't finger poke. BUT (a big one) the peds endo that see's all of our kids in the district WILL NOT write for us to dose based on the dexcom. Treating a low, yes. But insulin absolutely not. This was hard for parents to understand. I would make sure that the doctor is okay with this. Here is why: Diabetes is expensive. So parents will usually (understandably) try to get a week or two more use out of the dexcoms. The longer they've been on, the less reliable they are. If you had a trust-worthy kid and helpful parents that told you when the thing has been on for three weeks, you'd know that it's probably not that reliable. I've had alerts of 55 and finger sticks of 233 because the sensor was old. THAT is why our docs won't do it.

    I still can't believe that parents want you to dose based on something you aren't allowed to see. Are they crazy?!?! Do they not realize how quickly things can go bad. Ugh.
  2. by   Amethya
    I agree with all the above but if they refuse to cooperate, that's when CPS has to get involved, for medical neglect.

    My TD1 is the same grade, and he tends to be vocal (Not rude mind you) of not wanting to check himself, but I talked to him and his mother and he finally let up on that and does what I say.

    At the beginning, it was difficult because I never worked with a kid like this, and mom was kinda intimidating, but once we talked it out in a meeting and worked together, he's doing well, and mom and I are on the same page on his health and we tell him to listen to me, or there will be consequences at home with his father (Hispanic family.)

    Everything everyone said, do it. Get Admin involved, if you can get MD involved too, do it, and make sure to bring documentation that he's not cooperating and if they refuse to believe it then they are the most dumbest parents in the world to believe their 4th grader will never lie and is an angel.
  3. by   KKEGS
    Our orders specifically say to dose off of the Dexcom so I can't really do anything about that.

    I, like many people, don't do well with confrontation and dad is a large, loud guy. He starts yelling and I just shut down. I am hoping that a face to face conversation with others in the room will be better than just he and I on the phone.

    Conference is tonight. I'll just be glad when this is over. Spring Break starts tomorrow. When we come back we'll have 43 days left of school and I'm not coming back in the fall so I'll just suck it up and get through it. Thanks everyone for your advice. It is helpful.
  4. by   nrsang97
    My son is 8 and diabetic. He has been diagnosed almost a year. He is nowhere near being completely independent for his blood sugar checks, and insulin administration. He is on novalog pen injections, and once daily lantus injections. I think the parents are being a bit unreasonable. He also doesn't have a dexcom or insulin pump. I would not want to dose off dexcom alone. That just seems unsafe.
  5. by   KKEGS
    Quote from nrsang97
    My son is 8 and diabetic. He has been diagnosed almost a year. He is nowhere near being completely independent for his blood sugar checks, and insulin administration. He is on novalog pen injections, and once daily lantus injections. I think the parents are being a bit unreasonable. He also doesn't have a dexcom or insulin pump. I would not want to dose off dexcom alone. That just seems unsafe.
    The more information I am gathering from other staff members who have worked with this family the more I am realizing they are just one of those challenging families. So as long as I know we are doing the right thing for this kid at school...not much more I can do.
  6. by   OyWithThePoodles
    Quote from KKEGS
    Our orders specifically say to dose off of the Dexcom so I can't really do anything about that.

    I, like many people, don't do well with confrontation and dad is a large, loud guy. He starts yelling and I just shut down. I am hoping that a face to face conversation with others in the room will be better than just he and I on the phone.

    Conference is tonight. I'll just be glad when this is over. Spring Break starts tomorrow. When we come back we'll have 43 days left of school and I'm not coming back in the fall so I'll just suck it up and get through it. Thanks everyone for your advice. It is helpful.
    If you have orders to dose off his dexcom THEN YOU NEED THE DEXCOM RECEIVER!!!! (I know you know this, but the parents need to realize it) But really. If the kid has proven to be untrustworthy in the past I would let them know that THAT is why he cannot be independent at school. Because he hasn't shown anyone there that he can be trusted with such a big LIFE OR DEATH responsibility. Sheesh. I am so thankful my T1 parents are awesome.
  7. by   OldDude
    Quote from KKEGS
    The more information I am gathering from other staff members who have worked with this family the more I am realizing they are just one of those challenging families. So as long as I know we are doing the right thing for this kid at school...not much more I can do.
    I know it's easy for us to say what you should do or say or not do but you are the one in the game...just know we are channeling positive energy in your direction and I know you'll be the best advocate for this kid at school. Good Luck!!
  8. by   KKEGS
    Quote from OldDude
    I know it's easy for us to say what you should do or say or not do but you are the one in the game...just know we are channeling positive energy in your direction and I know you'll be the best advocate for this kid at school. Good Luck!!
    Thanks OldDude.
  9. by   Crystal-Wings
    Geeze, that sounds like a nightmare!
  10. by   KKEGS
    Quote from Crystal-Wings
    Geeze, that sounds like a nightmare!
    This year has been the Year of the Difficult Diabetic Family. Myself and the other district nurses have dealt with several of them that are, in our opinions, unreasonably demanding. One of them wants the before and after school program to hire a 1-to-1 nurse for him.
  11. by   ruby_jane
    Quote from KKEGS
    This year has been the Year of the Difficult Diabetic Family. Myself and the other district nurses have dealt with several of them that are, in our opinions, unreasonably demanding. One of them wants the before and after school program to hire a 1-to-1 nurse for him.
    Hugs to you. But you have 10-ish weeks left....does that help??
  12. by   Cattz
    KKegs- How is today going with this situation. This is alarming on so many levels. One day this family will look back and realize what a great advocate you have been for this child. ( I am guessing it will be something like when our own kids grow up to be adults/parents- they realize just how smart we really have been all along!)
  13. by   KKEGS
    Quote from ruby_jane
    Hugs to you. But you have 10-ish weeks left....does that help??
    Yes it does. Spring Break starts tomorrow and when we come back I have 10 weeks left. And then I'm finished with my school nurse career. I haven't announced it because I didn't want to make a thing of it but I am expecting my position to be eliminated due to budget cuts. Even if it doesn't I'm giving my notice. I am going back to my first love: the NICU.

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