School nurse needing help...

[slawson1991]

I am a full time school nurse with 2 students with pumps. One manages herself, but the other is in 2nd grade and seems to use "I feel high" or "I feel low" to come to the nurses office...Only one time out of 30 times has she been low. I feel she is using this as a crutch to get out of class. But what do I do? Several times before, I will tell her that since she is having so many episodes of "feeling high or low", we probably need to call mom so she can call the Dr. She adamantly refuses and states no, wait till tomorrow, i am sure i will feel better tomorrow...and sure enough, she only comes at lunch as she is supposed to...how can I get her to understand that she needs to check only if she is SERIOUSLY feeling low and to stop crying wolf without jeopardizing her possibility of an actual high or low?

[MelissaC]

Hello! I am nnot sure if you have a child with diabetes or not.... I am also not a full time school nurse but it is your obligatiopn to that child to make sure that she is not high or low. She may be using it as a crutch and may need some intervention from mom or dad - Second grade is still really young - My dd is 6 and in the first grade and she is totally unaware when she is high or low so to me the fact that this child is coming to you syas she may be trying to figure out if she high or low or not....If I were you I would talk to mom - (a second grader does not get to make choices about his or health, her parents do) and tell her what is going on... maybe she can talk to her BUT if she continues to come to check her BS than you have to respect that for now - Can she talk to a school counselor???

Hope this does not come off as harsh, it is not meant too but I know that my dd struggles at school - she is one of 5 at her school and our school nurse just does not get it :)

[kel4han]

aHHHH yes. My daughter is 7, and repeating 1st grade this year. Last year she was learning what high/low felt like as she was diagnosed in December. It took her a good 3months to learn a low, and still has no idea when she is high, after 9months even though she complains of being tired, tummy hurting, headache etc. She doesn't relate the two.

Now she has been using feeling ill to get out of class this year. Sometimes every hour leaving class!! I am torn just like you. But you do have to remember she probably really does feel YUCKY alot of times, so it is best to always take her seriously. It is hard to learn and concentrate when you are high(or low) I know, I am type 1 also. We had talked alot about why she needs to be in class, crying wolf, and that if she falls behind she will be in
1st grade forever! Once she was happier in class, she no longer goes to see the nurse. The nurse would check her, if she was high, make her drink water. Send her on her way quickly.

She also was sent to see the school counselor a few times. They have a magic way with words. It is their profession to mediate with these kids. See if mom and dad will choose this route to help thier daughter. There really isn't anything you can do yourself, except make things quick in checking her sugar and send her on her way. She will learn that there is nothing there for her. Going back to school is hard, especially when you are sitting there feeling high and crappy. 2nd grade is very young still. I am sure this will pass as school goes on.

[Abby-Dabby-Doo]

I first want to commend you for coming here and being concerned enough to post.:) I bet several parents on this board would love to have you as there school nurse instead of the uncaring ones that they're dealing with!
My two cents on the situation is... I don't know the dxd date of the child and that could have a major role in the situation. The child might be fearful since they can't recognize highs or lows yet.
Second, I don't know if you or the child is new to the school but it doesn't sound like you know one another yet. This child might be fearful of you, and just knowing that you are in your office and you can care for them properly. It's a scary thing for the child to trust that someone other than there parents can care for him or her.
Thirdly, If I was the child's mother, I would want to know. I would be careful in the words you choose, just because there might be something else going on that you aren't aware of. Hopefully the parent is understanding and will appreciate the effort your doing. But I think the situation needs to be addressed, something is going on.
Lastly, keep testing them when they ask. NEVER assume they're crying wolf. That one time where they don't think they should visit you, because they aren't sure, could be a dangerous decision.
Again, I think it's great that your here and asking quesitons! Please come back again if there is ANYTHING we can answer for you!!!!! :D

[LJS118]

I would definitely want to be notified as well. On some days my school nurse callls me several times to just double check.

I do commend you for being so concerned. Their little bodies go through so much, she probably isn't feeling good. Over time I think they all just learn to get tough skinned. But 2nd grade is still so young.

[LJS118]

Just another thing that I forgot to mention. My son is in 5th grade and has had D since he's 2 years old. He tries to avoid going to the nurse any more than he has to, he checks his blood sugar at least 3 times during the school day and goes back to bolus after he eats his lunch, so he's in the nurses office a minimum of 4 times a day. With that, he doesn't like to feel different and much rather not go if he doesn't have to. The point I'm trying to make is, my feeling is this student isn't trying to get out of class~i think she's genuinely not feeling good.

[momofphoenix]

My son tried to pull the "I don't feel well" game last year. Thankfully we had a decent nurse who called me and I went up to the school, the nurse and I both spoke to my son and explained that if he is really not feeling well he needs to go to the nurse but if he is just not liking math or doesn't feel like reading and he says he feels low just to get out of class that isn't ok. Last year he was in 1st grade now this year he has not tried to play the "I don't feel well" card. Altho IMO every time she comes in check her, it could be a serious high/low but if it continues and she is in her "good" range call her parents/guardians and ask for a meeting. Most parents would want to know what their kids are up to....
I think it is great you posted here and you are concerned with her wellbeing

[jules12]

I would check her each time....like others have mentioned you will need to choose your words carefully because you want the child to come to you if they aren't feeling well. Our school nurse tells my son (a second grader) to tell her anytime he doesn't feel just right - better safe than sorry.

Also talk to the Mom. Do you send a note home each day or week? Our nurse sends it home each day so that I know each time he was in the nurses office and what the outcome was. Also, call the Mom - I would want the nurse to call me - somedays I talk to her minimum of 3-4 times other days not at all.

[slawson1991]

Thank you for the responses:)...I see the importance of always checking...
I do send a note home each day to her mother telling her each check and bolus' etc. Mom has another 5 month old child, a boyfriend and I am not sure how much attention the daughter gets.
I have considered leaving her glucometer in her classroom, and will speak with her teacher about time issues...my office is upstairs, her classroom is downstairs, and someone mentioned she was seen in the hallway at the water fountain and basically just lolly gagging in hallway on her way back to class. She gets to bring a friend to my office also, in case she has a crash on the way to my office...and of course this makes it fun for her too...Again, thanks for the responses...it has helped me see it from a different perspective.

[Momof4gr8kids]

I agree with keeping the meter in the class. My daughter who is in first grade, and on the pump tests, and treats lows in the class, and then moves on. Her teacher has a sheet that she uses to see what the numbers mean, and how to handle it. It really takes the fun out of missing class out of diabetes. She hasn't tried that yet, but I think this will hamper that. To keep lows, and highs from happening we also make sure she tests before activity like P.E., and recesses that are not at lunch.

Good luck. I hope you can get it worked out :cwds:

[BrendaK]

Had to chime in on this -- my son is 7 and very often feels low at school when he is not low. We struggled with this at the end of last year and now this year. What we're finding is that he feels low when they're having "carpet" time where they're all sitting down on the rug listening to the teacher. He is so bored!!! And no one thinks he's trying to get out of class. He just wants to stand up and move around -- little boys can't sit still for that long. You know that feeling you get when your really bored and tired at the same time -- kind of fuzzy head droopy feeling? I think that's what's happening.

But he still ALWAYS gets checked, at this point. Last year his teacher let him stand up and move around a little and that really helped.

We're moving soon, so I'm hoping he'll be more academically challenged at a new school

[Mama2H]

I agree with everyone else. I just wanted to add that now may be the time to start the inclassroom testing. If she can test by herself just have the teacher call for an "off" number and if she is not maybe have the teacher call when she feels she needs to test. In my opinion it would make it alot less of an "excuse" if there was no where to go. Does your school have a beeper system? Maybe get her a beeper where she can page you if she feels high/low and tests out of range? Talk to the mom and see what her thoughts are but keep up the good work! I wish our nurse was so involved!

[jendean]

I know it seems like kids use that for an excuse. If she in fact is... then what you need to do is find out why she does not want to be in class. Do her classmates need education on Diabetes? Is she allowed to test in class?
What is "not low"? if she was 300 and is now 180, she may be crashing, which will simulate the feeling of being low.
You can NEVER EVER doubt her feelings of being low.
Why would any kid come to poke her finger if she did not feel she needed to?
It hurts. Do your fingers ten times a day for a week and see if you think its worth it to spend time in a cramped office with people who dont really want you there in the first place.
You have to take it seriuosly. Your licence is at stake.
It is your job to figure out just what you need to do to amplify this kids learning experience and make school an acceptable place for her with her diabetes.
Every kid with Diabetes is different. I have seen kids with bg's of 80 go into seisures, and become unresponsive.
I have seen kids walk and talk with bg's of 28 and pop a couple of glucose tabs and be on their merry way.
Take this opportunity to get some of your CEU's on Type 1 Diabetes.
GO volunteer at Diabetes camp for a week in the summer, see if you can earn some CEU credit for that.
Or do it just to be a better nurse.
Good luck.
JenDean
RN, mother of Type 1 Nolan, age 10. :)

[wilf]

Thank you for the responses:)...I see the importance of always checking...
I do send a note home each day to her mother telling her each check and bolus' etc. Mom has another 5 month old child, a boyfriend and I am not sure how much attention the daughter gets.
I have considered leaving her glucometer in her classroom, and will speak with her teacher about time issues...my office is upstairs, her classroom is downstairs, and someone mentioned she was seen in the hallway at the water fountain and basically just lolly gagging in hallway on her way back to class. She gets to bring a friend to my office also, in case she has a crash on the way to my office...and of course this makes it fun for her too...Again, thanks for the responses...it has helped me see it from a different perspective.

So impressed by you posting here. I would work towards seeing if she can handle testing in class. Less disruptive for all to be sure, and should still provide the info needed.

[wilf]

Every kid with Diabetes is different. I have seen kids with bg's of 80 go into seisures, and become unresponsive.
I have seen kids walk and talk with bg's of 28 and pop a couple of glucose tabs and be on their merry way...
JenDean
RN, mother of Type 1 Nolan, age 10. :)

We all use BG meters and they are great. But I am having trouble with the concept of someone having seizures and becoming unresponsive at 80.. The meter needs to be tested in a case like that. General rule of thumb is that what you're seeing on the meter is plus or minus 15% from the real value, but even then I'm hard pressed to imagine seizures at 68 (the theoretical bottom end value). I know YDMV but this seems very unusual indeed.

[yeswe'rebothD]

I know we had issue when school began last year, that Grace felt low a lot. Early on after dx, one of her main low symptoms was hunger, and so even though she wasn't low, she equated hunger with being low. I supplemented her breakfast with more protein and she usually gets a morning snack (really small, teacher gives it to the whole class, like 3-4 slices of banana or small handful of pretzels or animal crackers) to tide her over till lunch time. We also instructed her to really examine her feelings, and that hunger doesn't always mean she's low. She quickly figured it out and we didn't have many issues with it for the rest of the year.

I think we're running into it again this year though... Makes me consider year-round school... ;)

[Ellen]

I would find ways to empower this patient by commending her for recognizing something didn't feel quite right and wanting to check her blood glucose level to see if it's in range or not and whether or not those feelings had anything to do with blood glucose. I would also help her to identify what feelings, sensations etc. she feels, which alert her to know she feels high or low or not quite right. Helping her to identify those sensations may be very productive for her. Empowering a child to tune into the body's messages is a good thing.

[Momof4gr8kids]

We all use BG meters and they are great. But I am having trouble with the concept of someone having seizures and becoming unresponsive at 80.. The meter needs to be tested in a case like that. General rule of thumb is that what you're seeing on the meter is plus or minus 15% from the real value, but even then I'm hard pressed to imagine seizures at 68 (the theoretical bottom end value). I know YDMV but this seems very unusual indeed.

Wilf, I agree. I can't see a seizure with a bg of 80 being diabetes related. Maybe this person has another condition such as new onset epilepsy, or a head trauma?

Everything I've ever read about the subject says that a seizure from a low starts at 40 and below. Like you said you still have to consider that 15%, but by the time you are that low it is what, 6 pts?

[wilf]

Wilf, I agree. I can't see a seizure with a bg of 80 being diabetes related. Maybe this person has another condition such as new onset epilepsy, or a head trauma?

Everything I've ever read about the subject says that a seizure from a low starts at 40 and below. Like you said you still have to consider that 15%, but by the time you are that low it is what, 6 pts?

My big concern is now the poor nurse (plus anyone else reading that entry) is going to worry about possible seizures at 80, which is just not at all plausible. 80 is the lower end of the "zone of perfection" for the normal range of blood glucose (80 to 120 mg/dl), and I am never happier than when my daughter is 80 because it means she's good for a snack with no need to inject or worry about going high..

[Ellen]

Isn't it possible the person had a seizure at a lower bg, and then the counter-regulatory mechanism kicked in and the liver provided glucose from the stored glycogen and started to raise the bg by the time the bg was checked and found to be 80 mg/dl? There is also the possiblity of meter error which does occur.

[Momof4gr8kids]

Isn't it possible the person had a seizure at a lower bg, and then the counter-regulatory mechanism kicked in and the liver provided glucose from the stored glycogen and started to raise the bg by the time the bg was checked and found to be 80 mg/dl? There is also the possiblity of meter error which does occur.

Yes, I'd have to agree that that is possible. My point is that if a person is 80 at onset on seizure then the seizure is not due to a hypo. In other words, if you check your child's bg and it is 80 then treat as directed by doc, or leave if that is in range, but don't worry about a seizure from a bg of an 80. KWIM?

[wilf]

Isn't it possible the person had a seizure at a lower bg, and then the counter-regulatory mechanism kicked in and the liver provided glucose from the stored glycogen and started to raise the bg by the time the bg was checked and found to be 80 mg/dl? There is also the possiblity of meter error which does occur.

Ellen, I salute your worthy effort to find common understanding.

But here again is the quote:
"I have seen kids with bg's of 80 go into seisures, and become unresponsive."

My concern is that this is akin to misinformation. Kids don't go into diabetes related seizures with a BG of 80.

There are lots of possible reasons for what the poster wrote, such as:
- meter error;
- reading the meter incorrectly in the heat of the moment;
- remembering the reading incorrectly;
- typo;
- seizure and unresponsiveness being caused by much lower BG, with counter-regulatory response having raised BG to 80 by the time the child was measured;
- seizures and unresponsiveness occurring for reasons completely unrelated to diabetes and low BG, such as epilepsy or injury.

367 people have viewed this thread, and it will likely be quite a few more before it fades away. I want to make sure that the people who come here for information don't get the wrong impression, and start thinking that a BG of 80 can lead to seizures caused by low BG. It is my understanding based on everything I've learned from medical professionals and reference texts and experience that it can't!

[sammysmom]

while I do agree that it is almost impossible to go into a seizure at 80bg, I can see it possible if the child was having a very quick drop in bg. I have seen it happen to my son when he was younger (and on the ultra lente and regular insulins) He would be 300 one minute and then a quick drop happened in about 30 minutes and he would go into a seizure...so an 80 can be problamatic if it is a very quick drop......of course, most children are not on the older insulins anymore so it probably does not happen as much......but I agree, I would not want to scare anyone into thinking that 80 is cause for concern...

shannon

[3js]

We treat 4 as a low, and 80 in the US system is 4.4 in the Canadian/UK system. My son often FEELS low in the 5`s (90), I guess from dropping quickly? I think it is possible.

[Heather(CA)]

After running it by mom, I was thinking you may be able to go to her for a while...If she's low, I'm not sure I would trust her to read the numbers properly yet. If she's doing this to get out of class, she will figure out quickly that she wont be leaving. Of coarse this will mean some extra running around for you, but, my guess is that it wont last long once she realizes that by calling you, she wont get to leave;) At the same time, she will be safe...Because like you and everyone stated...You can't not test. Also, if this is happening to get out of class, it might be a good idea to find out why she wants to leave. Is she struggling? Is she bored? Is someone being mean? It would be good to find out..Maybe fixing the issue will help the problem too:D

[jendean]

WOW,
I think everyone is taking this a little too far. First of all, the "poor nurse" is a medical professinoal, give her some credit. She would know that patients vary. She already knows a good deal about D from being a nurse, and should be well versed in insulin actions. What she may not have is first hand dealings with D kids.
Lucky for those kids, and the kids to come, she is one nurse who is willing to learn more, and wants to know what is going on.
Whenever I get a patient that has something I dont deal with a lot, I go straight to the patient and ask them about it. Then I research it on the internet, and in my nursing books. Sometimes I never get that patient again, But that is what a good nurse does. And that sounds like that is just what she is doing.

Yes, I really have seen two different people sieze at high numbers. One was exactly 80, one was 70 something. Both were girls, neither had ever been diagnosed with seizure disorders, and the one who seized at 80 had been known to do that.
I NEVER said that it was common, or even suggested that it was something to look out for.
BG can drop fast with any type of insulin therapy. That is why CBGM's are such a great tool.

I know how to check a meter, and while I do make typos, I did not in that case.

I am not trying to scare anyone, and I think that most people on this board are a little more reasonable than to decide after one post that this will happen to thier kid.
But I also think it is important for parents and caretakers to understand this.
Diabetes is unpredictable.
Sometimes even the most diligent work to regulate yeilds unexpected results. That is the nature of the beast, and to suggest that there is anything "Normal" about diabetes is just plain ignorant.
Diabetes follows no rules.
How many people knew that a persons blood glucose can get high from excercising?
A lot of medical professionals do not know that.
Most of the parents here, on this board have diabetes knowledge that would dwarf that of thier GP, the nurse practioner, the nurse, and just about anyone not working in endocrinology.
I assume you got your information from endos, which is great, but does not make me a liar or someone who would hold meter upside down and read it.

OK that said, thanks to those who feel like defending the idea a little, It is nice but not necessary, sometimes people dont believe something until they see it themselves, and I suspect that is sometimes what it takes.
Not really of concern to me, I am secure in what I say and I dont post things to scare people, but I also dont sugar-coat my conversations about Diabetes either. I dont believe in that. (no pun meant by the sugar coating part)
;)

[jendean]

WOW,
I think this is going too far. First of all, the "poor nurse" is a medical professional, give her some credit. She would know that patients vary. She already knows a good deal about D from being a nurse, and should be well versed in insulin actions. What she may not have is first hand dealings with D kids, but they dont jsut go handing out RN's to anyone who can put on scrubs. It is actually pretty tough. :cwds: You have to be pretty smart and pretty studious to get there in the first place.
Lucky for those kids, and the kids to come, she is one nurse who is willing to learn more, and wants to know what is going on.
Whenever I get a patient that has something I dont deal with a lot, I go straight to the patient and ask them about it. Then I research it on the internet, and in my nursing books when I get home. Sometimes I never get that patient again, But that is what a good nurse does. The next patient will benefit from my learning.. And that sounds like that is just what she is doing.

Yes, I really have seen two different people sieze at high numbers. One was exactly 80, one was 70 something. Both were girls, neither had ever been diagnosed with seizure disorders, and the one who seized at 80 had been known to do that. Usually it was from coming down. (yes meters were qc'd daily at camp... No I did not forget the number)
Certianly it could be after the liver has kicked out some glucagon. I wondered about that myself, but it did not save her from seizing anyway.
My point is that the number is sometimes useless.
I NEVER said that it was common, or even suggested that it was something to look out for.
BG can drop fast with any type of insulin therapy. That is why CBGM's are such a great tool. That is why so many people want one. :cwds:

I know how to check a meter, and while I do make typos, I did not in that case. Thanks, though. :rolleyes:

I am not trying to scare anyone, and I think that most people on this board are a little more reasonable than to decide after one post that this will happen to thier kid.
But I also think it is important for parents and caretakers to understand this.
Diabetes is unpredictable.
Sometimes even the most diligent work to regulate yeilds unexpected results. That is the nature of the beast, and to suggest that there is anything "Normal" about diabetes is just plain ignorant.
Diabetes follows no rules.
How many people knew that a persons blood glucose can get high from excercising?
Even a lot of medical professionals do not know that unless they really think about it... excercise... adrenaline.... OH yeah! Not that it DOES all the time, but it can, and we know that why??? because it has happened to people.
Most of the parents here, on this board have diabetes knowledge that would dwarf that of thier GP, the nurse practioner, the nurse, and just about anyone not working in endocrinology.
I assume you got your information from endos, which is great, but does not make me a liar or someone who would hold meter upside down and read it.

OK that said, thanks to those who feel like defending the idea a little, It is nice but not necessary, sometimes people dont believe something until they see it themselves, and I suspect that is sometimes what it takes.
Not really of concern to me, I am secure in what I say and I dont post things to scare people, but I also dont sugar-coat my conversations about Diabetes either. I dont believe in that. (no pun meant by the sugar coating part)
;)

[Mama Belle]

I have to kinda agree with jendean here, guys. I have no experience when it comes to seizures from a low BG, but I know the staff at our endo's office does and they are one of the best diabetes clinics in the country. They taught us to judge the lows based upon the symptoms, not the numbers. One of the pump trainers at one of our classes said that she has had patients seize/lose consciousness from low BG in the upper 70s and has seen others in the low 20s who are walking and talking and acting like all is well. Not only is each person different, but each low is also different. Because of the way the body responds to low blood glucose a plummeting low could very well rise on its own in the minutes that it can take medical personnel to respond to the seizure and test the BG.

My big concern is now the poor nurse (plus anyone else reading that entry) is going to worry about possible seizures at 80, which is just not at all plausible. 80 is the lower end of the "zone of perfection" for the normal range of blood glucose (80 to 120 mg/dl), and I am never happier than when my daughter is 80 because it means she's good for a snack with no need to inject or worry about going high..

See to me I would have a concern that someone reading your statement might assume that seizures can't happen at the higher spectrum of a low range. They can and they do. I'm sorry you don't believe it, but they do. I'd rather not have someone say, "Oh boy, she's seizing but her BG is only 77, it must not be a low BG, I think I'll pass on using glucagon." Thanks but no thanks. We will always treat a low under 70 at our house, but judge how aggressive we treat based upon what her symptoms are, not how low the number is. I think too often, in an attempt to try and feel like there is rhyme and reason to this disease, we try to search for absolutes that apply across the board. They don't with this disease, they just don't. The 1 unit per kg formula doesn't apply to everyone out of honeymoon, just like the reaction to different BGs can be dramatically different from person to person and low to low. Yes it is important to point out that it is not super common for people to seize with BGs on the higher end of low (incidentally kids of young ages often treat BGs in the 80s as low). I think we've covered that. Everyone now knows that it isn't super common but it does happen.

Where's Tom's mom (can't remember her darn username)? Doesn't she have a story about him having a seizure at a higher number?

[Mama Belle]

Where's Tom's mom (can't remember her darn username)? Doesn't she have a story about him having a seizure at a higher number?

Ah HA!! I found the thread (why could I not remember that she was MamaC)!!! Here is her story of Tom having a seizure. (http://forums.childrenwithdiabetes.com/showthread.php?p=62017#post62017)

[jendean]

Thanks Mama Belle. I do appreciate the support. Makes me feel like I am not a crazed lunatic. I know that a few people think so. :( But I do prefer to see reality when it comes to Diabetes.
I work with all ages of people with Diabtes, some people have really great control, and some dont. I get a lot of Type 1's in their later years who have had transplants (kidneys mostly) laser eye surgery, surgery to correct neuropathy. I work with people who have had amputations, and have large skin ulcerations due to diabetic neuropathy. I have seen men with implants because of poor circulation. Women who have been "fixed" because they felt thier diabetes was "too brittle" for them to have a baby. I have seen a lot in the short time that I have worked on the medical/ nephrology floor at my hospital.
I get to talk diabetes all day. :D my favorite. (I list it as my "hobby" when I am on other non-d boards or groups) But, Because my talking with them about it all the time, patients often tell me thier stories.
When I hear one that does not make sense to me, I often ask them to tell it again, or to go into greater detail, but I never doubt them just because I personally have not heard of it before, and especially not when it goes against the medical recorded data.
I suspect that I will learn more about diabetes, and that my mind will totally expand on the topic by the time I send my boy off to college, and I hope to continue learning about it after that.
The one thing I have complete faith in regarding diabetes, can be summed up by a phrase that I learned in intro to philosophy, a self negating phrase, but one that I try to live by in all of my life, and that is this.
"The only absolute is that there are no absolutes!"
Wilf, I really dont mind argument, but when you post that I might be having trouble reading a meter, or forgetting numbers, I do get a tad offended. I forgive you though, ;) hope we can be friends. :cwds:

[jendean]

Oh, one more thing,
I do want to say that when it comes to diabetes, I leave as much up to theh patient as possible, and have gone to bat for them with thier doctors, and other nurses several times in my time Nursing.
I do believe that the ONE person who needs to be listened to is the person with Diabetes.
That is why I let my son make important decisions such as when to go on the pump, what type of products to use, what meals to eat. All I can do is teach him and hope... It is his diabetes, not mine. Ultimately it will be him that makes all of the decisions. I can only tell him what I know, and we learn together.
OK done bragging about myself. (lol-- I am only trying to show that I am not some crazed lunatic really. I am actually a nice person, I am sorry so many people seem to think I am bonkers)

[Heather(CA)]

Oh, one more thing,
I do want to say that when it comes to diabetes, I leave as much up to theh patient as possible, and have gone to bat for them with thier doctors, and other nurses several times in my time Nursing.
I do believe that the ONE person who needs to be listened to is the person with Diabetes.
That is why I let my son make important decisions such as when to go on the pump, what type of products to use, what meals to eat. All I can do is teach him and hope... It is his diabetes, not mine. Ultimately it will be him that makes all of the decisions. I can only tell him what I know, and we learn together.
OK done bragging about myself. (lol-- I am only trying to show that I am not some crazed lunatic really. I am actually a nice person, I am sorry so many people seem to think I am bonkers)

I don't think your crazy;):D

[wilf]

hey jendean, just back from a week's canoeing and the break has helped me maybe look at this from a better, broader perspective. Sorry if my earlier posts seemed overly critical or judgemental or absolute in their statements. We can certainly be friends, if you'll forgive the tone of those earlier posts.

I fully agree that one should "listen to the patient", not simply go by what the meter says. A reading of 80 doesn't mean that everything is fine, if your child is saying they're dizzy or is acting strangely. And I have to salute your vast experience, as well as your openness to learning from and sharing that experience.

My concern remains ensuring that people are getting good information here. I think this discussion has been very helpful in elaborating that:
- different children will exhibit "low" symptoms at different BG levels;
- in most children, severe "low" symptoms will not occur at BG levels of 80;
- in a very few children severe symptoms are possible at relatively high BG levels (eg. 70-80 mg/dl), esp. in children who usually "run high" with BG at quite high levels (say in the 200-300 range), and esp. if they are coming down fast from such high levels;
- different families consider different levels to be low: some will treat anything below a meter reading of 80, others 70, and others (like mine) assuming the child feels fine and is acting normally we would not be concerned until levels were below 60;
- based on our own experience with our children, we may be more concerned about the effects on them of lows or of sustained highs and this will colour how we respond to any given BG reading and that is ok because YDMV..

I am quite conscious of having quite side-tracked the original discussion, and would like to thank you all (and esp. the original poster slawson1991) for your patience and indulgence as this discussion has taken on a life of its own.

[akrickard]

My daughter is in second grade and was doing the same thing this year. I noticed on the nurse's glucose report form that she was down there up to six times/day. See, not only does she get out of class, but her teacher won't let her walk to the nurse by herself in case she really isn't well, so she gets to pick a friend to to too.

I had gentle talk with her and told her the story of "The Girl Who Cried Wolf." I told her that I always wanted her to go if she really didn't feel well, but asked her to please not use it as an excuse. She understood, and has been much better about it since. It was freaking me out anyway, because we're still on NPH/Novolog, and she would often have spiked up high when she checked after eating.

[czardoust]

I will tell her that since she is having so many episodes of "feeling high or low", we probably need to call mom so she can call the Dr. She adamantly refuses and states no, wait till tomorrow, i am sure i will feel better tomorrow...

I would get with her parents and set up a schedule as to when to check her during the school day. She is 7 yrs old (2nd grade), she is not in charge of whether or not her mom gets called. If its a concern of yours, no mom of a diabetic would say its bother for you to call her at home, because we are all nuts about the care of our kids. You would really benefit from a plan that is between you, the parents and the doctor on how to care for the child at school because without you feel scatterbrained and stressed out and disorganized and left wondering what to do. like you dont have another few hundred kids to worry about. :rolleyes: I'm surprised that your school system allowed this child to be enrolled without a 504 plan or whatever the equivalent is in your state, Love, carolyn