Uncooperative Diabetic Question

Specialties School

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Alright nurses! Help me figure this one out! Having issues with this student and family on multiple fronts.

4th grade boy with type I diabetes. Diagnosed 1 year ago. Has the Dexcom G5 CGM and an Omnipod pump. Usually very responsible with it. In the fall I attended his parent/teacher conference because parents had some concerns that his 504 wasn't being followed. They were specifically concerned that he wasn't being escorted to the health office by an adult when he was feeling or alarming that he was low. Turned out that he was not being walked to the office but was observed down the hallway while he walked to the office. Also parents were concerned that he was missing too much time by going to the health office to do finger pokes and treat his highs and lows. We came up with a plan that everyone seemed happy and comfortable with.

Fast forward 5 months. Here I am thinking everything is going along just fine when, about 2 weeks ago, I get an angry phone call from this student's father. Dad has just found out that yet another nurse (our 3rd one this year) has quit and he is angry about the turnover and the fact that every time a new nurse starts they get multiple phone calls a day while the new nurse is figuring out this student's routine and treatment. I acknowledged his frustration, expressed my concern also and my goal of keeping their son safe at school, yada, yada, yada and then directed him to my boss, the Director of SPED to voice his concerns.

I get more phone calls throughout the week about the parents' concerns that this student's treatment plan isn't being followed and that we don't trust their son to put in his own numbers and that we aren't allowing him to be independent. Their son is telling them one thing and I was able to confirm via our charting and speaking with the health office nurse and his classroom teacher that what the student is telling his parents simply isn't true.

Now we have a series of subs in the health office as we conduct interviews to find a permanent replacement. I have given them a heads up about this family and have advised them to contact me first if they have any questions and we can try to troubleshoot and only call the parents if necessary because they seem to get so angry about being contacted.

Today's sub contacted me because he is being quite defiant and uncooperative. He gets annoyed that we ask what his BG is and how many units the pump is giving him, how many carbs he's eating, etc. He seems to think (and maybe his parents do also?) that he shouldn't need to tell us any of this information. All we do is write it down and let him go on his merry way. But we are responsible for his safety and shouldn't we know this information each day?!?

Anyway his spring parent/teacher conference is tomorrow and I am attending again along with his counselor/case manager (he's currently being evaluated for SPED which I think may be part of parents' bad attitude) and his classroom teachers.

Basically I guess my question is how do I go about informing his parents about how uncooperative he is being (sometimes he is downright rude!), our need to know his daily numbers, and that he isn't being truthful with them without ruffling their feathers even more? Right now they really seem to think that we are the bad guys.

Specializes in Pediatrics Retired.

You don't hit the mule in the head with the 2 X 4 to move him but to get his attention. Don't mince words or try to sugarcoat your input. The kid isn't old enough to manage his diabetes independently. Quit with the games and get on board. So what if they get upset.

All excellent advice above.

Specializes in Med-surg, school nursing..
We do not have access to his CGM. Parents monitor it remotely. They never call the school to tell us if he is trending high or low or even when it isn't working at all which has happened several times over the last couple of weeks. We literally have ZERO communication with his parents and when we do call they get angry.

His Dexcom is the one that is FDA approved for dosing instead of a finger poke. His parents were complaining that the nurses aren't following orders about dosing using number on the Dexcom. Again, after talking to the nurse she said that wasn't true. The day I spoke with her he hadn't done a finger poke at school for nearly 3 weeks.

How in the heck are you supposed to dose him based on something you don't have access to??? That is total crap IMO.

1. Get the doctor on board if you have a release to talk to them, if not, get one. This is unacceptable, he's only been diagnosed for a year.

2. Get admin involved. You HAVE to know how he is trending. It's dangerous to not know that. If parents refuse I would make them sign a release relinquishing the school from responsibility, as he could be dropping fast and you'd never know.

3. My T1D's have the G5 and at home they don't finger poke. BUT (a big one) the peds endo that see's all of our kids in the district WILL NOT write for us to dose based on the dexcom. Treating a low, yes. But insulin absolutely not. This was hard for parents to understand. I would make sure that the doctor is okay with this. Here is why: Diabetes is expensive. So parents will usually (understandably) try to get a week or two more use out of the dexcoms. The longer they've been on, the less reliable they are. If you had a trust-worthy kid and helpful parents that told you when the thing has been on for three weeks, you'd know that it's probably not that reliable. I've had alerts of 55 and finger sticks of 233 because the sensor was old. THAT is why our docs won't do it.

I still can't believe that parents want you to dose based on something you aren't allowed to see. Are they crazy?!?! Do they not realize how quickly things can go bad. Ugh.

Specializes in Cardiology, School Nursing, General.

I agree with all the above but if they refuse to cooperate, that's when CPS has to get involved, for medical neglect.

My TD1 is the same grade, and he tends to be vocal (Not rude mind you) of not wanting to check himself, but I talked to him and his mother and he finally let up on that and does what I say.

At the beginning, it was difficult because I never worked with a kid like this, and mom was kinda intimidating, but once we talked it out in a meeting and worked together, he's doing well, and mom and I are on the same page on his health and we tell him to listen to me, or there will be consequences at home with his father (Hispanic family.)

Everything everyone said, do it. Get Admin involved, if you can get MD involved too, do it, and make sure to bring documentation that he's not cooperating and if they refuse to believe it then they are the most dumbest parents in the world to believe their 4th grader will never lie and is an angel.

Specializes in School Nursing.

Our orders specifically say to dose off of the Dexcom so I can't really do anything about that. :(

I, like many people, don't do well with confrontation and dad is a large, loud guy. He starts yelling and I just shut down. I am hoping that a face to face conversation with others in the room will be better than just he and I on the phone.

Conference is tonight. I'll just be glad when this is over. Spring Break starts tomorrow. When we come back we'll have 43 days left of school and I'm not coming back in the fall so I'll just suck it up and get through it. Thanks everyone for your advice. It is helpful.

Specializes in Neuro ICU and Med Surg.

My son is 8 and diabetic. He has been diagnosed almost a year. He is nowhere near being completely independent for his blood sugar checks, and insulin administration. He is on novalog pen injections, and once daily lantus injections. I think the parents are being a bit unreasonable. He also doesn't have a dexcom or insulin pump. I would not want to dose off dexcom alone. That just seems unsafe.

Specializes in School Nursing.
My son is 8 and diabetic. He has been diagnosed almost a year. He is nowhere near being completely independent for his blood sugar checks, and insulin administration. He is on novalog pen injections, and once daily lantus injections. I think the parents are being a bit unreasonable. He also doesn't have a dexcom or insulin pump. I would not want to dose off dexcom alone. That just seems unsafe.

The more information I am gathering from other staff members who have worked with this family the more I am realizing they are just one of those challenging families. So as long as I know we are doing the right thing for this kid at school...not much more I can do.

Specializes in Med-surg, school nursing..
Our orders specifically say to dose off of the Dexcom so I can't really do anything about that. :(

I, like many people, don't do well with confrontation and dad is a large, loud guy. He starts yelling and I just shut down. I am hoping that a face to face conversation with others in the room will be better than just he and I on the phone.

Conference is tonight. I'll just be glad when this is over. Spring Break starts tomorrow. When we come back we'll have 43 days left of school and I'm not coming back in the fall so I'll just suck it up and get through it. Thanks everyone for your advice. It is helpful.

If you have orders to dose off his dexcom THEN YOU NEED THE DEXCOM RECEIVER!!!! (I know you know this, but the parents need to realize it) But really. If the kid has proven to be untrustworthy in the past I would let them know that THAT is why he cannot be independent at school. Because he hasn't shown anyone there that he can be trusted with such a big LIFE OR DEATH responsibility. Sheesh. I am so thankful my T1 parents are awesome.

Specializes in Pediatrics Retired.
The more information I am gathering from other staff members who have worked with this family the more I am realizing they are just one of those challenging families. So as long as I know we are doing the right thing for this kid at school...not much more I can do.

I know it's easy for us to say what you should do or say or not do but you are the one in the game...just know we are channeling positive energy in your direction and I know you'll be the best advocate for this kid at school. Good Luck!!

Specializes in School Nursing.
I know it's easy for us to say what you should do or say or not do but you are the one in the game...just know we are channeling positive energy in your direction and I know you'll be the best advocate for this kid at school. Good Luck!!

Thanks OldDude.

Specializes in LTC.

Geeze, that sounds like a nightmare!

Specializes in School Nursing.
Geeze, that sounds like a nightmare!

This year has been the Year of the Difficult Diabetic Family. :( Myself and the other district nurses have dealt with several of them that are, in our opinions, unreasonably demanding. One of them wants the before and after school program to hire a 1-to-1 nurse for him.

Specializes in ICU/community health/school nursing.
This year has been the Year of the Difficult Diabetic Family. :( Myself and the other district nurses have dealt with several of them that are, in our opinions, unreasonably demanding. One of them wants the before and after school program to hire a 1-to-1 nurse for him.

Hugs to you. But you have 10-ish weeks left....does that help??

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