After I checked my kiddos in Diabetic Land, I returned to my middle school to find Time Bomb diabetic about to eat lunch in my office. Another nurse is in charge of her now, but I happened to get back early and beat the other nurse. Imagine how fast the blood drained in me when I asked her to check her blood sugar and she showed me the number: 39.
I told her to eat, and as she inhaled her nachos with shaky fingers, I tried to impress the severity of this upon her. "Do you realize that when I called the paramedics for you the other week, they got here and found your blood sugar was 40?" All I got was an "mmhmm" in response.
By then, the coordinator, the nurse responsible for her now, was in my office. The student's blood sugar had been in the 400's in the morning, and to drop down to 39 in a matter of a few hours was more than alarming. Both of us suspected she had taken insulin (via a pen) when it was high in the morning, but the student vehemently denied doing so. As her blood sugar crawled back up, we continued to try to inform her of the importance of blood glucose control. We got nowhere.
As someone who generally has no trouble getting a kid's attention, and can lay down the law far better than one might guess by looking at me, this situation is something well past frustrating. Both the mother and the child seem to have a total lack of interest and/or comprehension, but we - the school and myself - will be nailed for it when there are consequences. I am doing everything I can: reminding her teachers about signs to look for, re-educating the staff on what to do and when to call 911, trying to implore the seriousness of this to the student, etc., but nothing gets through. It leaves me to do my best to document the shit out of all of this, cross my fingers, and try not to let it suck the life out of me - I have 2,360 other kids I am responsible for.
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A few thoughts:
ReplyDelete1) have you thought about bringing in the school social worker in to sniff out psych / psychosocial barriers to her effective health maintenance?
2) have you discussed the pros and cons of insulin pumps with the patient and/or her mother? The slow steady drip of insulin released by a pump more closely mimics the normal insulin release of a healthy pancreas and can be particularly helpful for a very brittle diabetic with rapid swings in blood glucose levels. If the child is seeing an adult endocrinologist or a family practitioner, they often don't adhere to the latest recommendations for insulin pumps in juvenile type 1 diabetics. A continuous glucose monitor may also be of benefit.
3) is it possible she is taking her lantus at the wrong time, or that she needs her lantus adjusted?
4) can you ask for updated orders from her endocrinologist in light of recent events? This might at least get them to return to the doctor for the rapid blood glucose fluctuations, which they should do anyway
5). Is it possible she is manipulating her blood sugars to feel "high" or may be intentionally getting the high sugars due to body-image and diabetes related issues such as diabulimia?
Have you offered a new pediatric endocrinologist referral?