August 22, 2005
Other
Question from Florence, South Carolina, USA:
I have a student who is twelve years old. She was well known to the school nurse last year because of type 1. The student frequents the health room. She has headaches, stomach aches, dizzy spells, or just feels that her sugar is high or low. The nurse last year fed her problem, in my opinion, and the child phoned her mom almost daily. Her sugars, so far, have been on the high end. We are to check her before lunch. I did send a note home for mom to check with her doctor to see about changing her insulin dose and maybe see about getting a pump for better control. The student came in today and had a perfect 88 mg/dl [4.9 mmol/L] sugar, but nonetheless, she was already complaining and wanting to call her mom. The child states she has been a diabetic for one year, but has not had any teaching. She does not have specific guidelines for meals here at school and eats whatever they serve in the cafeteria for both lunch and breakfast.
I am concerned that the child, and maybe the parent, too, does not understand the complications of diabetes and is going to have damage in the long run because of uncontrolled sugars. We do have to meet with her and her family soon, so I would like your input.
Answer:
It sounds like you have identified several things to consider. Lack of family education and the need for insulin dose adjustment are two important areas for concern. I would also wonder how the child and family are adapting to the relatively new diagnosis. The child may be feeling scared or uncertain about how to manage things and is seeking the safety of her parents even when her blood glucose is normal. Good luck this school year. Maintaining an open communication with the parents, child and health care provider will be crucial.
BS
[Editor’s comment: Keep in mind that, even though a blood sugar of 88 mg/dl [4.9 mmol/L] seems “perfect,” the child may be feeling low if her blood sugar was elevated an hour earlier. Also, some children feel low at such a level when they are accustomed to having consistent elevated blood sugars.
BH]
