Please carry glucagon, you never know...

I totally agree.

I personally don't think the nurse is doing this to keep her job - even I think that's a bit far fetched. However, the nurse said she saw an "11" on the meter and we know that's not possible. Numbers on meters are large - it would be very difficult to confuse a 31 with an 11. It also isn't as though this nurse is overworked and inundated with patients that could lead to mistakes being made. She is in charge of 1 student.

My personal theory is that the child didn't eat - which isn't the child's fault as they get busy talking during lunch and maybe her mind was focused on getting that ice cream. But it was the nurse's job to make sure she ate and she dropped the ball on that and then it spiraled from there. Again, just my theory.

The bottom line is that the relay of events from the nurse is a mess, and that alone would cause me to be concerned.

 

I don't have much to add, just want to second this. I think it's plausible BOTH that she confused the time of 11 with the bg, and that administration of glucagon was warranted. If my kid passed out, I don't think I'd be upset with school personnel for assuming it was low bg and going straight to glucagon. And the subsequent 31 seems to confirm that decision.

 

But how long does it take glucagon to work? My son has been in the 20s twice this week at school and has not passed out and we have not used glucagon, but I've now triple checked with our school nurse and the diabetes aide that they know how to use it. It sounds like she was 31 immediately after the administration of glucagon and my understanding is it does not work instantly?

 

Hmm. So all we know for sure is that glucagon was administered at some point and that BG at 11:19 was 31. Can anyone corroborate the timing of the fainting incident? Was it at 11:19ish? Then I could see the 31 being related to maybe missing lunch (OP says that is unlikely for her DD but that would be VERY likely for my DS!), causing a severe low and the glucagon could be administered either immediately before or after that BG reading. If the fainting really did occur at 11:00 that would be weird for two reasons. First, why would the blood sugar be so low? Second, why would glucagon work that slowly!

Something doesn't match up.

 

Just wondering if you were able to get any more information about the indecent?

 

Was someone indecent?

 

Nope - I think she was auto corrected from Incident...

 

After reading all 11 pages, my thought is that she ate her lunch, but not her ice cream, and that she went low because of that (Because that was a 40 minute prebolus). I don't think she was 11 and came up, I think the lowest she got was the 31. I don't know about the fainting because of low, she could have slipped on some liquid on the floor, hurt her knee, passed out because of that.

My first grader (and his whole class) devourers their lunches in 10-15 minutes. If they have cold lunch, they have almost 20 minutes. But if they have hot lunch and wait in line, by the time they sit down, they only have 15 minutes, and that's including time to clean up their trash, wipe off the table, and fold their hands nicely, try to be quiet, get called to line up, and actually line up. Yes, they get 30 minutes in the lunch room, but only 15 to eat. If the little girl was getting ice cream, she probably shoveled her lunch down in 8-10 minutes.

My first action would have been to go talk to the other kids in my son's class. "Did you see Mrs. xxx finger poke and test little girl before she gave the glucagon?" "Did you watch Mrs. xxx give the glucagon? Where did she put it? Who was in line in front of little girl? Did you see it?" School staff always check up on subs or nurses or whoever by "innocently" asking the kids. I just watched my son's teacher do that yesterday. (Why didn't you get a second recess?) I would definitely be asking the other kids about what they think happened when she bumped her knee.

 

Yes, I think it was because of the ice cream too. I know you all don't know my daughter and her insatiable appetite but everyone who does know her knows how much she loves food. She could continuously eat if we let her. She is never full. I have no doubt in my mind that she ate her lunch. Another teacher did see and helped out my dd's nurse so I do have corroboration. I was going to ask if they had cameras and if they do, to see them but I thought that might not go over too well...

PLUS, one of the moms I'm friends with asks me the next day "OMG is she ok!? G told me M (my dd) couldn't breathe" I'm guessing this is a 5 year olds version of passing out.

 

That's nice the friend was concerned!

 

Did you ever find out how much of the bolus was for lunch and how much for ice cream? I assumed 1.5 units for the ice cream, but am interested in whether you ever got a breakdown.

 

Well, here is our experience. My daughter had a 1:1 in elementary school. Dd never needed Glucagon at school. The aide provided professional, neccessary support and I am glad dd had that at that time.

 

She added the carbs and bolused for them. It was 50 something grams that day. So with a 1:15 ratio at school, a little over 3 units was given total (or maybe just about) I can't look in the pump for that day, she's too busy playing right now lol

Right, just because my dd is the only one with a nurse at her school doesn't mean she might never need glucagon. Really, I could've given it to her a few times but I was able to get her up with juice. I'm talking low 20s so in reality, I probably should've given her the glucagon. I'm told the other K student with D runs high and his parents come in and bolus for lunch and snack, or whatever they need to bolus for. I'm not going to run her high just because I fear lows in school. I hope the other parents eventually realize that it's a bad idea too.

 

How often in the last year have you seen low 20s?

If it's more than once, then I think you need to run her a bit higher or make some other adjustment to the regimen.

 

I sort of agree with Wilf.

There is one thing to try to have great control, but another thing to be having a young child haveing severe lows when not associated with sickness.

The few 30's and 40's we have had over the last 8 ish years have been scary enough.

I wonder if your dd's insatiable appetite makes her eat often and there might be a misbalance between basal bolus that is not seen unless something stops her from eating?

 

Well, hopefully your 1:1 wasn't prebolusing your child and then not making sure that she ate. Honestly, this nurse's entire job is to follow this girl around, so I do not understand how this particular Eff-Up happened. I see how it happens in a "normal" situation like my son has, where the nurse is in her office, and he goes and eats and then reports back to her. But this nurse doesn't have any other duties but to be "eyes on" this girl at school.

So, yes. I would be very concerned that the child needed glucagon in this situation, and very concerned that the story the nurse told does not match up with the meter. I suspect she was hanging out in the corner, gossiping with the noon aides, or whatever, and is now covering her own butt. Yeah, I get that it's a boring job for an RN to just watch a kid all day that doesn't need your attention about 98% of the time, but I assume she's being paid well for it, and at the very least, she should make sure the child eats all of the food they are dosed for.

 

a few times BUT most of the time (probably all) it was correcting a high that was on it's way down. Like if she ate pancakes, cereal something like that. That's why we don't do it anymore. So, definitely my over eager fault.

We have basal tested also but things change so often it's almost impossible to basal test as often as is necessary. We should be on the new insurance come June 1st that will HOPEFULLY let us get a cgm then I hope things will get better.

 

I totally 100% completely agree with this statement. You want a kid to grow up and run high for their entire (shorter) life... let them run high as a kid. You want to lay a foundation of control... lay a foundation of control. If you look at the DCCT study, those people in the group who brought down their A1Cs... kept them down when the study was over.

 

why don't you back up your statement with some facts. I think your ( ) of shorter is uncalled for. Your DCCT study has NOTHING to do with the longevity of the subjects at all.

 

Your child was dx'd just a few months ago, correct? Glad to know you've got it all figured out already.

I would also like to see the facts supporting your "theory".