Setting diabetics free

rn/writer, RN · Feb 23, 2011

Love "free range diabetics."

When I worked child and adolescent psych, the diabetic kids would do their own testing and insulin in front of me. I watched, but they did it all, unless there was a problem.

Maybe you could use observed self care as a transitional step, both for your peace of mind and just to be certain that they know what they are doing. Keep in mind that in the real world few diabetics swab testing/injecting sites with alcohol.

I'd also ask the district to come up with a written agreement for parents and students to sign, absolving the school of the responsibility for anything the child is supposed to be doing for themselves, with the understanding that they can always come to you for help if they need it. The liability waiver would just cover things they choose to do themselves.

The idea of keeping a log is also a good one, but I wonder if that puts the liability back on the school. Again, this might be a good transition tool rather than a permanent practice.

LACA, BSN, LPN, RN · Feb 23, 2011

I had a 5th grade student last year who was transitioned to a pump around Christmas break. It made his life so much easier, but Mom had a very hard time relinquishing her "oversight" even the tiniest bit. Finally, I got him (and her!) to the point where he could check his BS in class (or in the hallway, bathroom, etc) in the morning and afternoon and come to me for lunchtime to check again and count carbs. By the end of the year, before he went to middle school, he was counting carbs on his own and inputting everything on his own and I was simply there observing. I did recheck his numbers and stuff, just so there wasn't any liability on the school.

Once I convinced Mom that he could handle a bit more of the responsibility of his diabetes and such, life became a lot easier for her, him, and me. It made a huge difference once she was willing to "set him free".

Jolie, BSN · Feb 24, 2011

All of my middle schoolers were "free range." All were experienced diabetics and had detailed plans made prior to the start of school during a meeting with the principal, myself, key teachers, student and parents. Our local ped. endocrinologist group encourages, and expects this. They have a school hotline that is answered immediately during the school day. Works well. Frankly, I can't imagine all of those students coming to the office multiple times per day. It would overwhelm the office staff, and probably lead to non-compliance by the students.

As for logs, they are not really necessary if your student(s) use programmable pumps or an on-line tracking service, which most of mine did.

schooldistrictnurse · Feb 24, 2011

All middle and high school students in my district are pretty much self-monitored, partly due to the size of the buildings. So if we have a student that was diagnosed while in elementary, by the end of fourth and during fifth grade, the mantra is always "you will be doing this by yourself when you get to MS" Naturally, we would make other accomodations if needed. I check in with the office staff/teachers from time to time and have a consultation with the students once a semester (wish it could be once a quarter, but the days just disappear) Seems to be working ok for us.

BunnyBunnyBSNRN, ASN, BSN · Feb 24, 2011

"free range diabetics" :yeah: that made me lol!

I have two diabetics (Jr High) right now. One is MR and there is NO WAY he could do his own care. He's in all main-stream classes, and appears "normal", but his memory is non-exsistant. The only reason he remembers to come see me is because it's his routine and his teachers and other students remind him. On testing days, I have to go find him - he never remembers.

My other guy is a 6th grader, and I may suggest to mom that next year he would be able to do this on his own. He's really on top of things - the only thing is he may not recognize when he is low. He came in the other day saying he "felt high" and was 68. After a juice box, he was 64. After 4 glucose tabs, he was 140. I think with some reinforcement of teaching, he would be able to handle things on his own by next year, and if not, the year after.

Purple_Scrubs, BSN, RN · Feb 24, 2011

I have a 4th grader who performs all her own care in front of me. All I do is add up her carbs and calculate her insulin and correction dose for her. Our joint goal is for her to be 100% independant by middle school, so I have slowly been letting her take over her own care. I think for the rest of the year we will keep doing as we have been doing, but I told her that starting next year she will be expected to calculate her own doses (under my watchful eye). She is one of those kiddos who struggles with math, so I am the most hesitant about releasing control of this step. But I figure if she has a year of me guiding her through it and checking her calculations, by middle school she should be fine.

Flare, ASN, BSN · Feb 24, 2011

all my students perform their own care and make their own calculations - this is more of the fact of not having to make daily visits to my office and not have to miss class or lunch due to testing.

geocachingRN · Feb 27, 2011

I'm in a Title 1 school district with a population that doesn't see diabetes as a problem unless they are symptomatic. The high schoolers are on their own mostly and thank goodness we log! We get to show them that their BS is all over the map and find out what they eat every day. If they don't have their BS under control by HS, then they are going to have serious problems in college, or when they're on their own.

Therefore I would advocate for some sort of transitional monitoring and also consider a 504 plan. If they have one in place, it is required to be updated at least once a year and that way you know all parties are on board. Also, it can stay with them when they go off to college which can be a very tough transition when they are totally without their parents guidance and oversight every day.

I realize most parents are far more proactive than the ones that I work with, but if it were me, I'd want to have something in place.