March 14, 2004
Behavior, Daily Care
Question from Spring Grove, Illinois, USA:
I am a school nurse and participate in the care of a six year old who has type 1 diabetes. He is fairly stable with Lantus and Humalog at meals. He rarely experiences lows. He is generally cheerful and cooperative, but has some anger and control issues that mainly involve power struggles with school work. Sometimes these power struggles spill over into lunch time testing and lunch itself. He has, on several occasions, thrown his food on the floor. He gets his Humalog before lunch. I have been letting him cool off, then offering him alternative choices provided by his mother. Some of the school team feels that this is giving in to him, but I feel that he has to eat something. You can’t make a kid eat, especially if he’s thrown it on the floor, and I feel that after he is calm, offering him a choice gets him to eat something and helps him participate in solving the problem. He has also refused his noon insulin and his mom wants us to restrain him and give it. We know how to do it safely, but don’t like to do this. What are your thoughts on this situation?
Answer:
I think that this family has no idea how lucky they are to have you as their school nurse! I agree that there is nothing positive that comes out of fighting a child over food, so if he is willing to eat something after he’s upset, that’s the best option. I also think that it is inappropriate for you to restrain him to give him his insulin. Something else is bothering him/upsetting him during his school day, and it likely has nothing to do with diabetes, but impacts on the diabetes during the lunch hour. I would recommend that the school and parents look into what it is he is struggling with academically, and develop a plan that is completely focused on addressing those issues. Once that occurs, it is likely that his diabetes care in school will no longer be an issue.
JWB
