Type 1 diabetics, help!

[cjl_RN, BSN]

Question I have a student that comes in at 10am. She corrects only at this time. Let's say she's 119 correction target is 120. So she doesn't require any correction insulin. She comes in at 12pm before lunch her sugar is now 175. Is it okay to give her a correction dose of insulin now with her carbs? My second question at any type you can give a carb bolus?

[KelRN215, BSN, RN]

Are you saying this student only corrects for her glucose at 10am?

My diabetic patient corrects every 3 hours. In the example you gave, we would correct him for the lunch time sugar since he hadn't gotten a correction dose of insulin in the past 3 hours.

[grammy1]

Ours are every 2-3 hours also. Yes I would definitely have her add the correction dose to her bolus.

Anytime they have anything to eat, they take a carb bolus. It gets hectic around holiday party time. Pumpers are much more likely to be compliant with the carb bolus than those on MDIs.

[algae1492]

The responses in this thread are terrifying.

Follow physician orders. Not all students require carb coverage. If you have any concerns or input you should consult provider assuming you have a release.

[JenTheSchoolRN, BSN, RN]

The responses in this thread are terrifying.

Follow physician orders. Not all students require carb coverage. If you have any concerns or input you should consult provider assuming you have a release.

I have yet to run into a student with type I diabetes that does not require carb coverage for lunchtime at school. You are correct to say to refer to the orders and you do not need a release to talk to the provider to clarify orders. Sure, I'd likely tell the parent I was doing so, but I don't have to technically. I don't find any of the responses here "terrifying."

OP, every kid is different. For example, a bolus with carb coverage at a BG of 175 would cause one of my students to bottom out by dismissal time. It was a trend I noticed, despite orders to bolus with carb coverage and I connected Mom and the provider and orders with adjusted accordingly.

But a bolus with lunchtime carb coverage is what a lot of pumps with calculate depending on orders. Is your student using a pump or not?

[kidzcare]

The responses in this thread are terrifying.

Why terrifying?

One response asks for clarification and then other mentions bolusing when there is a snack. I see nothing scary there.

[tamarae1]

Do what her doctor's orders call for.

[MWOOD,LPN]

Always follows physicians orders!!!! Our students have diabetic management plans filled out from the endocrinologist that we use. Some of my parents are able to change doses within a certain range and the endo will put that down on the form as well. Very helpful to have especially when you are out and have a sub covering.

[WineRN]

You should have clear physician orders, and it doesn't sound like you do... I have strict guidelines for both carb coverage and sliding scale with all of the TD1 students.

[cjl_RN, BSN]

Correction dose only of insulin. No carb bolus. And yes of course she checks and corrects every three hours if needed.

[ruby_jane, BSN, RN]

Remember....insulin is a 4-hour med. So if insulin is given at 1000, at noon (or whenever lunch is) - the insulin is still working on those carbs. I have never had a kid who doesn't bolus for lunch carbs but.... If those are the instructions you're given then that's what you work with. If she has a super-high at 1000 there should be instructions to recheck (usually 4 hours later). Can you call the provider's office to clarify?