Ok, so I'm a school contract nurse through a home health agency working with a very young diabetic patient. The school is great, couldn't be more supportive of my role and continuously praise my efforts at keeping the client's blood sugar levels within range. That being said, the parents are much less than cooperative, downright non-compliant mostly. They have the "feed whatever whenever and cover with insulin" mentality, and cannot seem to understand why I won't jump on board with their dangerous, and if I'm honest, abusive behavior. After a particular incident occurred recently in which the client's blood sugar was well above the MD's range for the client, I refused to give the client a sugary, carb-filled treat with the client's classmates. I discussed the situation with my supervising RN as well as the school principal and we all agreed that adding fuel to the fire was a big no-no for BS levels, regardless of the fact that everyone else was going to have the treat. The client's parents were informed well ahead of the event that the class would have said sugary treat and could have brought in a diabetic-friendly alternative but did not do so. Furthermore, the parents called my employer after I clocked out to inform them that they were furious with me denying their child the sugary treat since everyone else had it (I took my client onto the playground so nobody ate in front of client) and since BS was high and I had to treat with insulin anyways why couldn't I just give the kid the treat?! Well, after much griping, my RN mgr decided to call me and determined it would be best if I were to take the next day off-without pay!!!- to let everyone cool down. So, what can I do about this whole situation? Keep my mouth shut and poison the kid next time like they wanted me to do so I don't get suspended without pay? ~feeling like a flamin' bag o' poo after being stomped on a few times right now
Specializes in Nurse Leader specializing in Labor & Delivery.
Are recommendations different for Type 2 DM or GDM? I work in a setting where I have to provide initial diabetic teaching to newly diagnosed DM2 and GDM patients (before they move on to a provider who has experts that do it), and I tell them to avoid sodas, sugary snacks, and eat lots of fresh fruits and veggies. These are people who are not (yet) on insulin or PO meds, but are taking QID blood sugars.
Sadly, I know WAY less about DM education than I would like to.
Denying a kid a cupcake once because of an honest mistake is not going to harm the kid in any way. That was what I was talking about.
It's kind of the whole judgemental attitude toward the family the OP had, calling them neglectful and abisive, and overall lack of knowledge of how type 1 DM is treated that's the issue here, which is literally the OP's only job.
I worked on a diabetic floor back in the age of ADA diets and food restrictions, so I can totally see where someone would make the mistake.
Here again. Most patients on a diabetic unit are going to have type 2 diabetes, where carb restricted diets are a common part of treatment.
Fun fact: ADA developed the exchange system, but never recommended any specific diet and doesn't like having ADA 1800, ADA 2000, etc, named after them.
Are recommendations different for Type 2 DM or GDM? I work in a setting where I have to provide initial diabetic teaching to newly diagnosed DM2 and GDM patients (before they move on to a provider who has experts that do it), and I tell them to avoid sodas, sugary snacks, and eat lots of fresh fruits and veggies. These are people who are not (yet) on insulin or PO meds, but are taking QID blood sugars.
Sadly, I know WAY less about DM education than I would like to.
Yes, and those are good recommendations there. Except the lots of fruit. Most of that will spike people's blood sugar quickly. Lean proteins, healthy fats, lots of green veggies, complex carbs.
Sorry, but as a parent I would have been livid if you'd overridden my decision and isolated my child from a class party. I don't have kids w/ DM, but my oldest daughter has a couple of friends w/ it. Their birthday parties always include cake. They cover for it; their (very knowledgeable and vigilant) parents don't make them eat a "diabetic friendly option." But anyway, I think it's GrnTea here on AN that says a medical plan of care is agreed with or disagreed with; it's not *complied* with.
What I think needs to happen is the endo should be consulted, and Rx written for meal/snack coverage, plus sliding scale. So for an example of how my hospital does it: check BG before eating, BG is 210. When meal comes, pt gets (depending on their particular Rx) 1unit per intended-to-eat carb choice AND 4 units to cover the pre-meal 210.
OP, are you one on one with this kid throughout the day? Sorry if it was covered already. I quit reading once the 16 year old "nurse" chimed in. More apologies, I know my opinion is unpopular on that subject.
Are recommendations different for Type 2 DM or GDM? I work in a setting where I have to provide initial diabetic teaching to newly diagnosed DM2 and GDM patients (before they move on to a provider who has experts that do it), and I tell them to avoid sodas, sugary snacks, and eat lots of fresh fruits and veggies. These are people who are not (yet) on insulin or PO meds, but are taking QID blood sugars.
Sadly, I know WAY less about DM education than I would like to.
While those are often given to T2DM patients like myself since losing weight, exercise, and diet can help us reduce complications they really are just good advice for everyone, diabetic or not. It's general common sense. The Idaho plate is a common, simple method for teaching people about portion size and making sure we don't overdo the carbs, but it's not just diabetics who benefit from reducing things like sugary drinks in their diets.
The parent's call the shots regarding .. denial or acceptance of the physician order.. not YOU.
I'm a school nurse and care for diabetic kids. We follow the physician order; not the parent's whim. We are bound by that. And the parents know that. It is spelled out clearly in the initial 504 meeting at the beginning of each year.
One student in 3rd grade has an insulin pump. We check his BG before lunch and treat for that if needed. Then he eats his lunch and we count those carbs and cover for that. Those are the orders from UC Davis.
Regarding the snack - we've encouraged parents not to bring in homemade snacks. In fact in some areas, there is legislation prohibiting that due to concerns about food poisoning, etc.
Homemade snacks are very difficult to carb count accurately.
We can let the child have the snack with his lunch and then add the carbs from the "snack" into his lunch carb count and cover for that. Or we let him take the snack home and mom and dad can decide. For the most part, he's a very conscientious kid and doesn't really care about the snack.
His teacher rewards kids in the classroom with cheese balls. Our kiddo may have one as a reward and the docs are ok with that.
He brings a lunch from home almost all the time. Not much true nutrition there - those fiery cheese snacks, PB&J on white bread, etc. They do send in low-carb drinks. And he keeps a bottle of water at his desk at all times.
We just treat for how many carbs and don't pay attention to the nutritional value. I'm not crazy about that having a diabetic husband who eats crap all the time. He doesn't carb count either.
The young boy's parents are very involved luckily and he's well on his way to being able to run that pump himself.
OP, are you one on one with this kid throughout the day? Sorry if it was covered already. I quit reading once the 16 year old "nurse" chimed in. More apologies, I know my opinion is unpopular on that subject.
I'm hoping you aren't referring to me. I'm a 16 year T1D, not a teenager. I'm an adult who developed diabetes type 1 16 years ago. And I'm a graduate nurse. And I have volunteered in crisis intervention with diabetics for 5+ years. I've attended several symposiums and spoken on this subject. I'm far from an expert, but I am well regarded among a community of people who treat type 1 plus eating disorders or type 1 plus self harm. I became a nurse very specifically to better serve this population.
@Gooselady, I'm starting to realize that even though I had the client's best interests at heart, and only the best intentions, nobody really cares. I truly care for this child and do not want to see them lose limbs like several of my older, non-compliant diabetic friends, and that was my motivation. All anyone cares about is the here and now, instant gratification (oh how different is a cupcake vs a banana), without caring about how that cupcake that *you didn't need* provided no nutritional value then, and contributed to your *now failing* sight and loss of limbs 15-20yrs down the road. Forgive me for having a heart in the nursing field; I guess I forgot to ditch it when I got my license like some others (oh just document, do your best, advocate on paper, blah blah blah).
Farmernurse26
I feel your frustration. First and foremost my friend you can't save them all. I happen to agree with you, I believe that carbs are killing us all, way worse than fats, and insulin is the devil! You have personally seen the long term effects of IDDM and even well controlled it is a sad road for a child.
I personally started on a Ketogenic diet a little over a year ago, I limit my carbs to 20g a day, eat no gluten, and try to stay away from processed anything. Here's the deal, while I am an educated professional, I am well aware that a debate between many other educated professionals will produce legitimate science on both sides of the carb debate. I am also a grown adult and can make my own choices and live with any consequences of the choices I make. While this child is unable to make his/her own educated decisions, the parents will make the best decisions they know how.
Fighting with the parents will get you no where. I appreciate your concern for this child, but you won't make any progress by challenging their parenting skills, even if you are right. Again, I agree with your thoughts on this child's diet, but I'm sure you understand that controlling his/her diet 24/7 is a family problem that is very complex and won't be fixed overnight. If you are giving conflicting information from what is being provided from their physician (and I suspect you are) you are the one who will look like you don't know what you are taking about. That is just the way it works unfortunately. This is a very complex issue that won't be fixed easily and I promise you that challenging the parents or especially challenging the pcp will make you the bad guy. If you feel strongly enough about this to keep fighting for this child, take baby steps. Small victories will help you eventually win the war.
Elle23
415 Posts
Yes! The nurse in question is starting to see the bigger picture, thanks to education from all of you!
Education was what she needed, not suspension (again my point).