Man! I've been so busy in my new district that I rarely even get to check this board much less ask a question!
I have a 4th grade diabetic diagnosed only 6 months ago. He is amazingly responsible and very tuned into how his body is feeling. He uses a Dexcom CGM and his parents monitor his BG throughout the day.
There has been some concern that the teachers were perhaps not responding quickly enough to his monitor and perhaps not accompanying him to the health office as is stated in his 504. I was asked to come to his parent teacher conference this evening along with his case manager so we could all get on the same page regarding his diabetes care at school. I will also add that he is new to this school this year since our elementary is divided between 2 buildings and he is now in the 4-6 building.
At the conference his father said he wants his son to stay in class as much as possible and wants us to treat him based on his CGM and not a finger poke (with a few stipulations) by providing snacks in class so he doesn't have to come to the health office when he is low. The father stated (and I confirmed) that the Dexcom G5 is the only CGM system approved by the FDA to use for treatment decisions rather than a finger poke (again with stipulations). This will be our first diabetic that we treat based on CGM rather than finger poke.
I decided to investigate and visited the Dexcom website. They actually have a pretty good PowerPoint presentation specifically for School Nurses regarding how the system works.
Despite all of this I am nervous about treating based on a CGM! I did ask parents to please get an order from his endocrinologist stating that we are to treat based on the CGM and not a finger poke (with those pesky stipulations I mentioned above -- if student feels low despite the CGM registering a normal blood sugar, if the CGM becomes dislodged, etc.)
Do any of you have diabetics that you treat with CGM and not finger pokes?
Sep 29, '17
Quote from aprilmoss
The CGM is pretty much what the fancier insulin pumps have been doing for a while now. This is a recognized technology. The diabetes care plan should be signed by a physician (I disagree that it needs to be the endo, though that is probably advisable) but that is no different for CGM than traditional bg testing.
It's not the nurse's job to second guess the efficacy of a physician-ascribed treatment plan.
Sorry, if I'm a little touchy on this, but I've been beating on diabetic treating PREJUDICES like this with my own son and the school system for over a decade.
I understand being a little touchy on the subject, but important to note that a school nurse still needs the orders and signed plan to do this. Thus far, it seems like it is a parent request, but needs the physician order to proceed on this new plan.
I have had a few students with a CGM. I work with older students (7th-12th) and honestly, I have not met a teen yet who wants to wear it as prescribed. Who remembers to change it as prescribed. Or who only wears it for about a week prior to an endo appointment. I know it does awesome things from a couple of very good adult friends with type 1 who love it, but it is as good as the user using it, of course.
My follow-up is that if Dad wants student to remain in class, will you be coming to him to treat if needed? Will he dose on his own/with a teacher?
Again, I work with older students and part of the transition of being independent with their diabetic care (I'm trying to help student prep to manage their own health by the time they graduate, my own personal goal) is that if they are stable and compliant, they do their own BG check at lunch and insulin coverage at lunch. Sometimes they call my office for a check to report carbs and insulin given. Parents totally on board with this. I have a 9th grader in this transition currently and she is doing very well. (Flip side, had another HS not do well and back to me tracking student down all the time because student do not want to check BG ever.)
Last edit by JenTheSchoolRN on Sep 29, '17