Type 1 diabetes

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You think you know diabetes until you take care of a kiddo with type 1! So I had a student elementary age who @ lunch was 255. I corrected him and gave him insulin for his carbs at 11:45. He then came to me at 12:57 w/ a snack in class a 19g carbs of Kool aid. He told me he doesn't check his sugar since it's been close and he doesn't feel low. But he will need a carb bolus. I covered him with a 1/2 unit. Rechecked his blood sugar at end of school day at 4:05 and it was 192. Parent called me and was upset said I should have never given him the 1/2 unit w/o getting a fingerstick. I recently took a class where they said it's unesscary to recheck blood sugar unless child is having s/sx hypoglycemia bc they have to be covered for the carbs. I feel like a horrible nurse now. Next time if I'm ever put in the situation I will attempt to call the parent. Do you Nurse's always check before carb bolus only not correction? Another nurse I shawdow didn't not check before carb bolus if it were close since last blood sugar. Constructive criticism welcome. I am very new at this.

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Specializes in School Nurse, past Med Surge.

What does his care plan say to do? That's really what it boils down to. (I haven't had any diabetics since I took this job, so I can't give you first-hand experience)

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Specializes in Med-surg, school nursing..

Per my md orders I always check a finger stick prior to giving insulin, even if their CGM says they are high. At home my parents go by the CGM only, but I cannot do that here. I will treat a low based on the CGM, though.

I would've let the parents know that the kiddo tried to play you and told you that that is what he does at home. 192 isn't a low glucose unless he dropped when he got home?

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Specializes in ICU/community health/school nursing.
What does his care plan say to do?

^Yup.^ However- kid was OK at 192 (and frankly would have been higher if you hadn't corrected for the 19 grams of carbs). So, smile, and know that from now to forever the parent demands that you do this even if it annoys the kid.

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Specializes in Pediatrics Retired.
What does his care plan say to do? That's really what it boils down to...

Aye, this.

BTW, if the MD care plan doesn't give you the option to check BG prn or provide specific instructions as to when...you can't.

Don't worry about.

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Specializes in Cardiology, School Nursing, General.

As OD said, exactly this. My TD1 kid, is a hard case, but basically the same idea, his MD told me to do PRN, but the mother wants me to check him at least 3 times a day, 4 times if I have to re-check for High BG. This kid ranges in the high all the time, and mostly is because he's being stubborn and not wanting to drink his water. His mother is a tough Hispanic mom and knows he's trying to rebel, so she's just trying to get him to understand to drink his water, care for himself or suffer the consequences. Lately he's been getting better at the water drinking, but it's because he's did a huge vomiting episode and his mother took him home because he wasn't drinking any water. Since that scare, he's getting better at it. :3

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Specializes in Telemetry, Gastroenterology, School Nrs.

My students always do a fingerstick before they bolus, be it before lunch, snack time, or party/celebration day. I'm not comfortable just giving a dose or 2 without knowing the blood sugar we are dealing with. I want the blood sugar as my basis and so does the scale we follow or the pump we use to bolus.

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Specializes in ICU/community health/school nursing.
Aye, this.

BTW, if the MD care plan doesn't give you the option to check BG prn or provide specific instructions as to when...you can't.

Don't worry about.

As usual, OD brings up a good point. Most plans allow for some sort of parental variation of the plan without a doctor's orders. Unless the kid had ketones at lunch, there's no medical reason to check blood sugar again for a snack 90 minutes after checking and correcting. With ketones we check in another 2 hours or whatever the plan says. So....if mom forces the issue...call the doc and ask for clarification. It may be that the parent actually doesn't understand that insulin is a four-hour medication and we can't just bolus with extra insulin every hour without a reason.

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You're very helpfully! I will from now on carefully review care plans as I don't help establish them d/t sub or attempt to call parent. Usually i do, do this, but when I get last min calls to come in and there is a clinic full when I get there, it's hard, not an excuse, just making a statement. But I am starting to know they like to play the sub! At the end of the day he was 192! With only 10 mins until he was home.

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Good point! Correct me if I am wrong here bc I am very new to this, we can give a carb bolus at anytime for any type of food? But can only correct a blood sugar every 3 hours (going by whenever last insulin was given for any reason correction or just carbs and there hasn't been a low treatment within 3 hours , or 1 hour since vigorous activity.

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Specializes in ICU/community health/school nursing.
Good point! Correct me if I am wrong here bc I am very new to this, we can give a carb bolus at anytime for any type of food? But can only correct a blood sugar every 3 hours (going by whenever last insulin was given for any reason correction or just carbs and there hasn't been a low treatment within 3 hours , or 1 hour since vigorous activity.

If that's what the orders say, then yes. In general we don't check BSG when the student is only having a snack EXCEPT if there were ketones or if it's been four hours since the last BSG check. All that's written in the treatment plan.

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But in general do you normal give insulin for snack w/o blood sugar?

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