Type 2 DM that parents refuse to treat

NurseBeans, BSN, RN, EMT-B · Oct 14, 2017

I'm not sure how he has a 504 if he has no documented diagnosis. Don't you need that to even consider a 504? I was told early on that if there is no diagnosis, there can be no services.

River Song, RN · Oct 14, 2017

Oh sorry, 504 is actually mainly for a learning issue and this health issue was apparently tacked on. I was totally blindsided when I got pulled into the meeting during my lunch break

NutmeggeRN, BSN · Oct 15, 2017

I would ask for a release of info so you can get an updated note that the MD is aware of and recommending the current "treatment plan". You have knowledge of something and I believe that it is incumbent on the school to pursue it. Picture yourself down the road when mom says, :The school knew about his DM and did nothing to support it".

I absolutely believe the first responsibility is with the parents but, lacking that, I would want something in writing from MD.

ruby_jane, BSN, RN · Oct 16, 2017

What (if anything) would you be doing? DM2 kids at my school don't usually have insulin. If there are hyperglycemia issues you'd need that MD plan for diagnostic finger stick, but that could be treated just as easily with a parent-provided snack. Other than standard health counseling, do you need to be on the 504?

Rubor · Oct 17, 2017

You do not need a confirmed diagnosis to consider a student for a 504 plan. I am curious as what accommodations are being requested? Perhaps they are managing type 2 with diet?

River Song, RN · Oct 17, 2017

I should preface all of this with the fact that I've only been working as a school nurse for 6 weeks and that my "training" consisted of being given a bunch of manuals. For a variety of reasons (including being somewhat busy with students in the clinic), I'm just now getting around to doing IHPs. I'm still somewhat confused on the IHP vs 504 and this was the first time I had been in a 504 meeting. I hadn't been formally invited, just got pulled in during my lunch break so I honestly had zero clue what was even the topic at hand.

So now that I have digested all of this, it appears that the prior nurse tacked the Type 2 DM onto the 504 which was created for a learning disability and the many accommodations for that. (I'm assuming this as both myself and the counselor are new so we don't know the history). The former nurse has never had any medical documentation other than conversations with Mom and in looking at my paperwork there was never an IHP on file.

Am I right in thinking that for medical issues, the 504 takes the place of the IHP? Or am I confused on that?

I don't see a plan of care previously created, just a flag that the student has Type 2 DM and the nurse had no medical documentation.

My thought is that there really isn't anything medical that warrants a health plan or 504 as we aren't doing anything in regards to it.

I spoke with the Mom today (before I read all of these comments) and she is more than happy to have the doctor provide information to me. They are treating only with diet and she said that when she is at the doctor's office they have drawn HgBA1c levels in the past. She doesn't seem to have any concerns about this so I don't think it was initiated by her at all.

Of course after the fact, I don't think we can remove anything without a new meeting but I just want to wrap my mind about how this process is supposed to work so that I can be prepared in the future.

Thank you for your input thus far hive-mind :)

River Song, RN · Oct 17, 2017

What (if anything) would you be doing? DM2 kids at my school don't usually have insulin. If there are hyperglycemia issues you'd need that MD plan for diagnostic finger stick, but that could be treated just as easily with a parent-provided snack. Other than standard health counseling, do you need to be on the 504?

This is my thought as well now. The 504 mainly mentioned hyPOglycemia issues and in the absence of any medication or insulin, I think this would be quite unlikely. If anything, I would think hyperglycemia would be the only concern but they don't do any blood glucose monitoring on her at home and from the sound of it per Mom, they never have. This student like the rest of our school, receives the free school lunch. I'm really struggling at this point to find where the school has a role in this.

JenTheSchoolRN, BSN, RN · Oct 18, 2017

Ugh, I must admit that tacking on the health diagnosis with no paperwork or conversation with the doctor seems super odd to me. I will not personally do this to a 504 unless I can get a letter at least stating the diagnosis (or symptoms affecting student's school day if diagnosis unknown/pending). This is especially important if accommodations involve anything involved with state testing (or later down the line, SATs) as many states will require that paperwork to honor the accommodation (i.e. extra time for testing, breaks, needing snacks, ability for stop-the-clock testing if BG is low, etc.)

Also, it sounds like the doctor may be monitoring at this time with no concerns that you would need to monitor at school. Most I've done with a student with Type II is administer metformin at school for student that ate breakfast at school (and did not comply with meds in mornings at home). No order to test blood glucose at school. Insulin and metformin, I believe, are the only meds approved for kids with Type II to take (but someone correct me if I am wrong).