Unstable Diabetic

Specialties School

Published

Hello,

Im an LVN working at a 7-12 grade school. We have a 7th grader unstable diabetic whos on a pump, and her Dr orders state she is fully independent, but she comes up to my office to test daily because her numbers range from 500- 44 all in one day. We have a field trip next Friday, that we are trying to figure out who needs to go with her. It is at a water park so they have trained medical staff there, but I guess its an issue with the bus ride to and from. They want someone who is glucagon trained to ride with her. CA ED code does not really explain the glucagon trained person has to go. Focuses more on EPI-PENs. Any ideas on who is ultimately responsible to go and care for her?

Specializes in School Nursing, Public Health, Home Care.

Our paraprofessionals don't volunteer, it's written into their job description. I know I may be flamed for saying so, but I feel our system is safe. Yes, it is not the perfect scenario, but consider this--the parent isn't a nurse, either. Our paras work with these kids 180 days every year and have a good understanding of how to follow the guideline set by their training. Plus, a nurse is a phone call away if there is a question.

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Specializes in School nursing.
Our paraprofessionals don't volunteer, it's written into their job description. I know I may be flamed for saying so, but I feel our system is safe. Yes, it is not the perfect scenario, but consider this--the parent isn't a nurse, either. Our paras work with these kids 180 days every year and have a good understanding of how to follow the guideline set by their training. Plus, a nurse is a phone call away if there is a question.

No flames from my end - I wish I had a paraprofessional who I could train! ;)

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Specializes in School Nursing.

Thanks everyone for all the feedback. Ive tried to pour over all the Ed Code, and Diabetes literature trying to figure out what is the best outcome. So far my boss has not asked me to go, but I have no idea what shes planning on doing. Im in a sticky situation as I am only the LVN, and RN is basically retired at this point in the school year.We are a very small school district of maybe 4 schools. I only have 1 health aid at the elementary school to converse with. My mom is an RN but a hospital setting is way different than school. The trip is planned for next Friday, so I will keep posted as to what happens. I have no experience with Pumps, and if I go and hers gets knocked off or whatever, I cannot fix it. Im just very nervous to have any responsibility for this kid. Scares me to death.

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Specializes in Complex pedi to LTC/SA & now a manager.

Why not have the district contract with a private duty nursing agency such as Bayada or whatever is local?

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Specializes in School Nursing, Public Health Nurse.
Thanks everyone for all the feedback. Ive tried to pour over all the Ed Code, and Diabetes literature trying to figure out what is the best outcome. So far my boss has not asked me to go, but I have no idea what shes planning on doing. Im in a sticky situation as I am only the LVN, and RN is basically retired at this point in the school year.We are a very small school district of maybe 4 schools. I only have 1 health aid at the elementary school to converse with. My mom is an RN but a hospital setting is way different than school. The trip is planned for next Friday, so I will keep posted as to what happens. I have no experience with Pumps, and if I go and hers gets knocked off or whatever, I cannot fix it. Im just very nervous to have any responsibility for this kid. Scares me to death.

You need your RN involved in this. It doesn't matter if she's retiring or not. She is still in her position until the last day of her contract whether that's the last day of school or the day after. She can't just throw up her hands and say, "Oh well! I'm almost done!". A meeting should be coordinated with you, the RN, administration, the student, and the parents. And DOCUMENT all communication attempts between any and all people involved in this.

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I go on all field trips. I was on a trip with our diabetic. He is only in 2nd grade so I was there to check his sugar and give insulin. I didn't follow him the whole day. I just parked myself at a central location.

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Specializes in ER, Trauma ICU, CVICU.

This is off topic, but it sounds like your student might be a prime candidate for a CGM (continuous glucose monitor). It is programmable and can be set to alarm with high and low parameters. There are a few brands, I know Medtronic and Dexcom have different models. It seems like this is something that you should look into for her and maybe get the information for her parents. It could literally save her life.

Also, I might add that my mom is a school counselor. She has NO medical training. There are three Type 1 Diabetic students on her campus. She, and one other office staff member (other than the nurse) had to attend special training to respond to a diabetic emergency if the nurse is unavailable. It seems like something to consider for your situation.

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Specializes in orthopedic/trauma, Informatics, diabetes.

I know CA is has addressed the issue of administering insulin. Question about epi-pens? Glucagon is not much different than that. I am not in Ca but I am a parent of a T1 child and the schools have to provide care. That is federal disability law. The parent does not have to go. Schools must provide care.

Off topic, pumps are not the be all, end all. My son is now 10 and pretty good at managing, but he forgets and has BS too high and sometime stacks insulin so ends up low. It is an art, not a science. Sometimes the sites are not working properly. It also sounds like this student is not aware of highs and lows. She needs some help, but that is not the school's priority. There is also the "dia-bulimia" issue where, girls especially, let themselves run high to keep weight down.

It's a tricky issue.

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