- advertisement -

School Nurse Trouble

Discussion in 'Parents of Children with Type 1' started by Annie1378, Sep 23, 2014.

  1. Annie1378

    Annie1378 Approved members

    Joined:
    May 26, 2010
    Messages:
    8
    My daughter just started middle school (6th grade, T1, diagnosed age 4, insulin pens -Humalog/Lantus), and we are having tons of trouble this year with the nurse/health aide. The nurse covers a few schools, so she has a health aide instead most of the time. We are having more trouble working together than any year since Bella has been in school. It doesn't help that she is having these unexplained highs. Today, for instance, she was at 96 before she went off to school - ate nothing in between as far as I or the school can tell, and was 500 at lunch. I told the health aide what Bella had eaten for breakfast (eggs and 15 g. sized glass of oj to treat the low number she had previously), and her breakfast number, and said "I can't explain it! Do you have any ideas?" hoping to brainstorm how we can keep this from happening, and she basically said, "I don't know," and hung up. I can't tell if she doesn't care, or if she thinks that I stuff Bella's pockets full of candy corn and tell her she has to eat it all every day. Her lunch was 35 carbs (a Lunchable, carrots, tomatoes), and the health aide said, "That's a very big bolus. Do you want me to give her all that insulin?" There isn't really an alternative, if we want her sugar to come down! She seems to disapprove of the amount of insulin Bella gets, but she's on a 1:4 ratio, per her last doctor's visit, so really every bolus is fairly large. She was having lows in the morning at the beginning of the year, so the nurse and I discussed changing her ratio to 1:5 for school, and I thought we had done it, but just today I found out that they had only used the changed dosage one time, because they feel that any change at all requires a new doctor's order. Yet when I call the endo to tell them this, and ask for advice, they say that the orders they sent specify that parents are allowed to modify ratios by 5 units either way, and that I should "develop a relationship with the nurse/aide and let them know that we are all on the same side". I don't know how, since the nurse/aide appear not to trust me, and the doctor won't speak with them. I am at my wits' end.

    They are so weird that we discussed low snacks at the beginning of the year and last year's nurse (same district) had recommended Smarties, which this year's nurse said were a good idea. I sent them in at the beginning of the year, but the nurse on the phone today told me that they hadn't been using them because this year's state guidelines only specifically mention Sweet Tarts. Argh!

    Does anyone else have experience dealing with difficult school situations? This is so frustrating, and I don't know what to do!

    Annie
     
  2. TanyaD

    TanyaD Approved members

    Joined:
    May 28, 2013
    Messages:
    10
    I'm sorry to hear that you have to deal with this.
    We have a new nurse this year and I have been to her office many times already ,apart from the phone calls we have.
    I don't know if you're working during school hours but if you can visit her (as many times as required ) I have found that conversations face to face have the best effect on developing the relationship.
    It will require patience but let her know that you are the person that knows how to control your child's diabetes the best, and her job is to help you do it.
    I'm sending sticky notes to school specifying the amount of insulin my son needs for the the range of BG he has before lunch(under 100;100-150;150-200 etc.) and in the doctor's orders says "follow parent's note first" and she will have a hard time going against that.

    I assumed that the health aide doesn't test your daughter before a snack because she doesn't give her one but I would insist on a check 2h after breakfast no mater what (this also should be included in the doctor's orders)to catch any unexpected BG change.
    My son is a veggie lover so I would send him celery or carrots as well as almonds ,pistachios and walnuts for a free snack and his ratio is 1:20 -1:25 so he's doing well without insulin to cover those 5-10 carbs.
    Maybe some protein type of snack will keep your daughter full and will help the Lantus deal with the highs ?
     
  3. TheTestingMom

    TheTestingMom Approved members

    Joined:
    Mar 5, 2010
    Messages:
    417
    Honestly, the last person I look for advice or troubleshoot with about T1D is the school nurse. She's there to perform the orders that I and the doctors put in place not change or question them.

    Last year I was so frustrated with her, she had a really hard time not "getting" that I do not run every pump change through the Endo and they don't want to know either!

    She knows how to save his life if necessary - everything else is none of her beeswax :D
     
  4. Beach bum

    Beach bum Approved members

    Joined:
    Nov 17, 2005
    Messages:
    11,315
    Our school nurse has limited input into our child's care plan. This input is to tell us what time PE and lunch would be. Other than that, they have no say. You need to have written into the care plan "parents are allowed to adjust dosing amounts when needed at anytime without question without the need for new orders each time." "Caregiver is to treat child for lows with provided candy/food." If school is insistent on treating with a certain brand, then they can pay for it themselves!
    Some districts are so afraid of being sued that they follow the orders down to the last period. They won't go into any grey areas. This is why it is so hard to create a good working relationship with staff.
    As for this:
    Do you have any ideas?" hoping to brainstorm how we can keep this from happening, and she basically said, "I don't know," and hung up. I can't tell if she doesn't care, or if she thinks that I stuff Bella's pockets full of candy corn and tell her she has to eat it all every day.
    IMO, she has no ideas because she really has no idea how to deal with diabetes other than to treat. She probably doesn't have a clue when it comes to breakfast spikes, exercise etc. and because of this she probably just doesn't care. She probably thinks "she had insulin, she should be fine, so this shouldn't happen, I've done what I needed to do." Honestly, I wouldn't count on her for anything other than making sure your child gets her insulin, tests and is safe.
     
  5. Sarah Maddie's Mom

    Sarah Maddie's Mom Approved members

    Joined:
    Sep 23, 2007
    Messages:
    12,521
    6th grade is a great year for increasing independent management and self-care, it's also a notoriously good year for "sneaking" food (aka junk), at least it was for us. :wink:

    To rise 400 pts in a few hours pretty much shouts, site is shot or something "yummy" got eaten and not covered. Have you brought your daughter into the discussion? Maybe she would like to be more responsible for checking and bolusing (with whatever supervision you feel she requires).

    I would stop looking to the nurse/aide as a brainstorming partner, she isn't, she's a school aide. I would probably encourage my 12 year old to rely less on the aide and invite her to help you figure out the big spike. Also I'd try very hard to reframe the relationship with the aide; you can't ask her to brainstorm and then be surprised when she gives her unwanted advice on lunch choice and carb ratios.

    Good luck!
     
  6. sszyszkiewicz

    sszyszkiewicz Approved members

    Joined:
    Dec 24, 2013
    Messages:
    842
    This is a dad perspective.....

    1) It doesnt matter what they subjectively think about the quantity of insulin, at all.
    2) You likely know 10x what the aide knows.....confidence!
    3) get an additional data point between breakfast and lunch to help see what is going on.

    If you are still stuck with these highs, I bet if you post some details here you will get great advice.

    I hope it gets better!
     
  7. Sarah Maddie's Mom

    Sarah Maddie's Mom Approved members

    Joined:
    Sep 23, 2007
    Messages:
    12,521
    Is there something gender specific about this comment that I'm missing?
     
  8. mamattorney

    mamattorney Approved members

    Joined:
    Apr 9, 2013
    Messages:
    1,076
    Trust me, I know how it feels to want to bounce something off a real live person sometimes - especially something that's especially puzzling like a giant skyrocket like that (which could have been a lot of things, including sharing that Red Bull on the bus that a friend brought, a breakfast that took longer to "hit", maybe she just realized she forgot to study for a test and she panicked and had an adrenaline response, bad site or maybe just some flukey thing). And the school nurse/aide seems like the perfect person to talk to about it. But you'd probably get the same level of advice from the aide as if you asked your best friend because the school nurse/aide job just doesn't allow for in depth knowledge of each and every condition that they treat. They are really there just to follow your and your doctors instructions and to keep your child safe.

    I agree that I would start over with the nurse in your own mind. See them as a person carrying out your requirements, not as a "treater" of your daughter and just go from there. It stinks - sometimes I'd give anything to have someone I could call on at anytime and just talk over some of my D concerns.
     
  9. jenm999

    jenm999 Approved members

    Joined:
    Apr 30, 2014
    Messages:
    855
    Lay down the law. Be a hard ass for a few weeks, then bring her flowers once everything is going smoothly.

    I don't get this fear of insulin that some people - especially medical professionals - have! I have had people ask if he really should take "all that insulin" as if it's harmful. He takes what he needs, and if he didn't have diabetes his pancreas would be providing it. It's not a drug, it's a hormone that we need to replace because his body doesn't make it. You don't get points for low doses.
     
  10. Annie1378

    Annie1378 Approved members

    Joined:
    May 26, 2010
    Messages:
    8
    Thank you, everybody, for your advice and comments! So, here's what we've done: I called this morning and instituted a mid-morning check so I can see if her sugar is rising before it gets to an out-of-control number at lunch. It was high at 11:00. For today only, the nurse and I decided to check again at noon, since she'd already gone back to class (aide said, "Oh, I sent her back. I thought you just wanted to check it. Maybe she's not drinking enough water."). At that point, I'll run over and correctively bolus her myself. Talked again to doctor, who gave us a new breakfast plan, and from now on, we're going to check mid-morning every day. Daughter is going back to the doctor earlier than scheduled, and we're going to discuss the pump again (we used to pump, and Bella wanted a break, but new pumps with CGMs sound awesome).

    I agree, Sarah, that I'll bet Bella's sneaking yummy snacks at some point during the morning. Unfortunately, she seems to be in a place where she will do whatever she can to avoid another poke. I've told her 1,000 times that it's ok to eat as long as you bolus, and she knows how to do everything herself. I bet the aide would not be pleased if she came down to the office for an unscheduled shot to cover an unscheduled snack, and she isn't allowed to carry her own things, but I'm also not sure that she would take the step of doing it herself if she were allowed, since it's like pulling teeth lately to get her to take her shot as it is.

    I totally agree, jenm. I don't get it that a lot of people seem to feel that your goal as a diabetic is to eliminate insulin, as much as possible. Maybe this comes from confusion with type 2 and type 1, so that they feel that if type 1s were controlling their diabetes better, they wouldn't need more insulin? I can understand not getting the distinction if you didn't know many people with diabetes, but if my job were to care for someone who had it every day, I'd make sure to be really informed! Then again, I've heard that schools aren't letting kids with asthma carry their inhalers anymore some places because 'it's a drug'. I'm not an anti-rule person in general, but I really don't get schools these days. If it weren't so frustrating it would be funny.
     
  11. Lenoremm

    Lenoremm Approved members

    Joined:
    Mar 9, 2011
    Messages:
    145
    Why isn't she allowed to carry her own things? Does she have to go to the office to check and bolus every time? That seems like a lot of lost instruction time. Assuming you are in the states, legally she is allowed to carry her supplies and it seems like that may solve some of this problem for you. If she doesn't have to go to the office to get her insulin she may just take the insulin for what she eats. She may appreciate having more control of her own situation too. She should be able to check, calculate and bolus. If there is an issue with any of that she should be allowed to double check with either you via text or call. Sometimes school nurses make problems bigger than they should be.
     
  12. rgcainmd

    rgcainmd Approved members

    Joined:
    Feb 6, 2014
    Messages:
    1,369
    It sounds like your daughter is sick of shots. (Who can blame her!?!) Have you considered pumping?
     

Share This Page

- advertisement -

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
    Dismiss Notice