When Blood Sugar is too High

JenTheSchoolRN, BSN, RN · Mar 24, 2016

I wouldn't call for a pick-up at 488 alone myself, but I do regularly do with the older kiddos vs. younger ones. And 488 is not unusual for me to see in a teen from time to time, presenting with irritability, fatigue, or mild headache or general "I feel meh" - though some kids feel fine and are surprised they are that high when they check as well. Plan can differ kid to kid, but usually I correct via orders with insulin and re-check in 30 minutes to hopefully see a somewhat downward climb. If kid was testing or completing a complex work assignment, I will alert the teacher, stop the testing and find another time for student to re-do when glucose level is normal (we put this in every 504 plan). I will also call home typically to give a parent a heads up even when it is appears to be coming down. If it isn't coming down, plan changes :).

(EDIT: ketones! I need more coffee! I do a ketone check, though I have only seen ketones twice - once with what turned out to be a borderline DKA kiddo with a tons of other symptoms and a HI reading and another time with a MS kid; corrected with insulin bolus per student's plan - did call Mom and talked through plan with frequent BG checks through out day. Student had no symptoms.)

When the meter says HI, then I scratch my head - my back-up meter does that for anything over 550. But even HI with one minor or no symptoms I've seen correct with insulin, water, observation. Of course, some kids are used to different glucose levels and feel different with changes - I have one non-compliant kid that would tell me they feel normal at 500. Another kid that usually sits at 150ish may report more symptoms.

Keepstanding, ASN, RN · Mar 24, 2016

With my diabetic kiddo's I will check their ketones with a bs that high. If negative, I will sit them down and have them drink lots of water. Depending on the student, I will call parents to notify them of the high and see what they want to do. My kids are very tolerant to highs and mostly react to lows. If they are getting ready for PE, with all of the activity there, the blood sugar will usually go down fairly quickly. Some parents will want to come pick them up asap, and other's may want us to just monitor them.

Flare, ASN, BSN · Mar 24, 2016

ditto to these. Check ketones when it gets high and insulin as ordered and water. If i see a downward trend then we're good to go, but if not and if there are worrysome ketones present, then yes - off they go to get checked out.

OyWithThePoodles, RN · Mar 24, 2016

I would call home and let mom know. If you are lucky you have orders to correct with insulin and check for ketones, therefore a way to treat the high glucose.

My newly dx'd 2nd grader goes to an endocrinologist that is...a little too relaxed.

No carb counting...ONE unit of insulin if its above 150, TWO if its above 250, if its above 300, water and exercise. NO KETONE CHECKS.

This is where I just want to spit. She was 465 the other day, and my orders are to exercise her. Ya know, I've always wanted to send a kid into DKA, I guess this doctor is just trying to make my dreams come true.

The day after she was dx'd mom was here and she was in the 300's, mom tested her with brothers ketones strips and she had a moderate amount and getting ready to go to PE. She called the doctor and they said "oh we aren't worried about ketones, have her drink and move.

WHAT. THE. FOCALIN.

*Wasn't trying to hi-jack your thread, but just letting you know that if I were you and had orders that would treat the high glucose I would be okay keeping the kiddo at school unless the treatment was proving ineffective.*

JenTheSchoolRN, BSN, RN · Mar 24, 2016

I would call home and let mom know. If you are lucky you have orders to correct with insulin and check for ketones, therefore a way to treat the high glucose.
My newly dx'd 2nd grader goes to an endocrinologist that is...a little too relaxed.
No carb counting...ONE unit of insulin if its above 150, TWO if its above 250, if its above 300, water and exercise. NO KETONE CHECKS.
This is where I just want to spit. She was 465 the other day, and my orders are to exercise her. Ya know, I've always wanted to send a kid into DKA, I guess this doctor is just trying to make my dreams come true.
The day after she was dx'd mom was here and she was in the 300's, mom tested her with brothers ketones strips and she had a moderate amount and getting ready to go to PE. She called the doctor and they said "oh we aren't worried about ketones, have her drink and move.
WHAT. THE. FOCALIN.
*Wasn't trying to hi-jack your thread, but just letting you know that if I were you and had orders that would treat the high glucose I would be okay keeping the kiddo at school unless the treatment was proving ineffective.*

:banghead::banghead:

:arghh: :arghh: :arghh: :arghh:

Seriously, Sully, no words for that situation. What the Focalin, indeed.

OyWithThePoodles, RN · Mar 24, 2016

:banghead::banghead:
:arghh::arghh:
Seriously, Sully, no words for that situation. What the Focalin, indeed.

I spoke with my District Health Coordinator because I fear I am doing more harm than good. And without testing ketones I have no real way of knowing if she's on the verge ok DKA...til she's unconscious on the floor. UGH!!

DEgalRN · Mar 24, 2016

I spoke with my District Health Coordinator because I fear I am doing more harm than good. And without testing ketones I have no real way of knowing if she's on the verge ok DKA...til she's unconscious on the floor. UGH!!

I hope you're able to get some backup with the health coordinator because that is a scary situation!

ContraryMary · Mar 24, 2016

I know exercise can decrease BS but my orders say... "Additional water should be offered. Having the student exercise is not a good way to decrease the blood glucose level. If the student has ketones in the urine, exercise should definitely be avoided as it can make the BG level increase...Urine should be checked for ketones when BG levels are above 240 two times in a row."

SullyRN, that is scary! Does the student's brother have diabetes too?

JenTheSchoolRN, BSN, RN · Mar 24, 2016

I spoke with my District Health Coordinator because I fear I am doing more harm than good. And without testing ketones I have no real way of knowing if she's on the verge ok DKA...til she's unconscious on the floor. UGH!!

Do you have urine ketone strips in your office? I carry those just in case for my diabetics; not as good as a blood check, of course, but I can't afford an extra ketone meter.

OyWithThePoodles, RN · Mar 24, 2016

I know exercise can decrease BS but my orders say... "Additional water should be offered. Having the student exercise is not a good way to decrease the blood glucose level. If the student has ketones in the urine, exercise should definitely be avoided as it can make the BG level increase...Urine should be checked for ketones when BG levels are above 240 two times in a row."
SullyRN, that is scary! Does the student's brother have diabetes too?

Do you have urine ketone strips in your office? I carry those just in case for my diabetics; not as good as a blood check, of course, but I can't afford an extra ketone meter.

I do not have ketone strips, only in brothers kit. But we cannot test without an order. Yesterday her grandmother was here so I asked if she could test her, she showed a trace of ketones.

I am going to talk with mom about it, I just know she is overwhelmed right now with a new dx.

Supernrse01, BSN · Mar 24, 2016

All of my diabetic kiddos see the same physician in our small little town and none of them have orders for Ketone checks. ZERO.