Self-care of students diabetes

[lissaq10]

I am fairly new in school nursing and trying to get a grasp on things. I have a 10 y.o. student that was diagnosed with diabetes a year ago. Last year, my health assistant had to do everything for him. He just got a pump right before the start of this school year. I gave a courtesy call before school started and mom said that he was going to do everything by himself this year in the classroom and would no longer come to the Health Office. I was taken aback and didn't say anything. The day school started, I decided I wanted him to come to the Health Office for awhile to make sure he was truly competent in self care.

The student (and mom) are very passive-aggressive. I am not at that school very often and he needs to check in with my health assistant. She is very frustrated because he will skip coming into the office to show her what he is doing at times. He has been confused counting his carbs at times and has made a few other minor errors. I told mom that it is important that he shows the assistant why/how he is doing as part of showing his competencies. Mom called me today and is very mad at me, feels it is outrageous what I am doing. I said it is to keep him safe. She has put all the responsibility on this 5th grader (from what I can tell). She says that he will have to live with it and knows himself best and better than anyone else. She says he is responsible, but then later says he forgot to check himself before the PE 1 mile run and was low after.

I was so bugged after a call, I was almost in tears.

Am I being too cautious? What is your protocol/policy on self-administration of diabetes. Does someone have a policy they can share?

Thanks

[Rosie67]

I have 2 diabetics in 5th grade this year and several others in the school. One year is a fairly new diagnosis. It seems strange mom wouldn't want and need your support. I have an 8th grader diagnosed 4 yrs ago, now with a pump and just recently identified independent by his MD. I have his current care plan to reference for questions and emergency orders. It clearly states independent daily routine diabetic care. I would insist on such documentation from MD. Diabetes requires a health plan and usually a 504. He needs to have emergency interventions in place even though he may be deemed independent. Don't feel alone about this- get your principal and social worker involved. Can you contact the diabetes educator that works with the student? I haven't had a 10 yr old yet who doesn't need supervision of some sort. It's ok to feel uncomfortable and challenge the appropriateness of this situation.

[Jolie, BSN]

I echo Rosie67's response.

Insulin is a medication, and like any other medication, is authorized in the school setting ONLY with a physician order, parental consent and individualized care plan, at the minimum.

I have found most parents of diabetic students to be quite pro-active, wanting to keep me informed of their child's status and willing to share information from the doctor's office freely.

This child's mom may genuinely want to help her son achieve independence, but I am more concerned that she is either overwhelmed herself, in denial, or doesn't want to deal with her son's condition and need for constant management.

If you don't have physician orders, I would start there, and gently remind Mom that they are a must for her son to operate his insulin pump at school. Perhaps you could ask her for a meeting so that you can gain an understanding of her son's knowledge and level of independent functioning, as well as to develop and emergency plan.

Since the child is unwilling to come to the health office (that doesn't surprise me at this age) you might get better cooperation if you find a place in his classroom to store supplies and do testing.

Good luck!

[Flare, ASN, BSN]

In my state there are laws in place that allow diabetic students to test and admin in class if needed to allow for minimal disruptions in classes. It sounds great on paper, but in reality, the kids still need to check in. The students that want to cut free from me are never totally free. They still must at a minimum stop by weekly to give numbers for the week. They are still expected to report to my office if they feel their blood sugar dropping and they are still required to keep a cache of supplies in my office. And if I catch them slipping in not recording numbers or if I feel like they are not keeping good control of their disease, i reserve the right to require daily office visits.

It's great that mom wants her son to learn how to be independent with his care, but he is not only very young, but he is still a reletively new diabetic. It sounds like the mom is placing too much faith on the insulin pump and her 10 year old son.

If she insists on him not making office visits, refer to your school policy and your state meds in school laws. If neither give you the backing you desire, then i would have both the parnets and the doctor sign something to allow for the self care and not holding you liable for any errors or complications that may come of this child not making visits.

[Arnu]

Does he have MD orders in place saying he can self care? Children that age do NOT want to be different. Having to stop by the nurse is being different. Having to 'check in' is being different. I'd encourage you to 1, make sure you have MD orders stating he can self care and 2, open communications with mom. I wouldn't get any social workers involved just yet. Typically parents of kids with type 1 diabetes are very knowledgable. 10 years old is young, but its not unheard of for self care with diabetes. I have several kids that age that do self care. They do, however, have protocol in place that if things go haywire with hypo/hyperglycemia I do step in.

I would encourage you to keep the lines of communications open with mom and the child, be as gentle as possible with mom, nonaccusatory as possible. Like I said before, I would not notify any social worker at this time, unless there is evidence of neglect.

[nursejen63054]

We usually take the lead from the child, with MD approval. Communication with the parents is so important also. if you have orders saying the child can provide self care, then I would get onboard with it and work with them. Of course, not all 10 yr olds wills be responsible enough to self care at that age, but if mom, MD, and child are confident then you shouldn't question it.

I have had students as young as 3rd grade do self-care, and I have had a 7th grader who didn't want much responsibility at all. It is always agreed that if self-care doesn't work, then we 9the parents, md, and myself) will work together to come up with a plan that does work. Minor errors, occasional missed checks, etc are going to happen, use them as teaching moments for the student.