October 11, 2000
Daily Care, Social Issues: School and Daycare
Question from Indianapolis, Indiana, USA:
I teach in a child care center where we have a young, undersized two year old with diabetes. We have tried to follow the diet suggested by the parents and routinely monitor his blood sugar levels. We do not administer insulin.
Everyone loves this little boy and tries hard to do the right thing. Our frustration seems to be with the parents. When his blood sugar measures high, sometimes 600+ mg/dl [33.3 mmol/L], we call them immediately, but they just say give him water and let him exercise, he’ll be fine. They have told us their doctor says to only be concerned with low blood sugar. This has been happening often lately. Our director asked them to come pick the boy up the other day when it was over 600 mg/dl [33.3 mmol/L}, and the parents seemed very upset at us. We only want what’s best for him, and are afraid the parents are not getting good advice from their doctor. Are they correct? Are we just over-reacting to numbers chronically as high as 300-600 mg/dl [16.7-33.3 mmol/L]?
Many doctors do not like to chase all high blood sugars, but like to look for patterns and adjust the insulin accordingly as long as the child has no ketones and is not ill, although a blood sugar of 600 mg/dl [33.3 mmol/L] can quickly lead to ketones. Many doctors will give extra insulin for 600 mg/dl [33.3 mmol/L] without ketones even though may not give extra insulin for 300 mg/dl [16.7 mmol/L].
I suggest you ask the parents for written guidelines from their doctor regarding what to do when the blood sugar is high. In any case, I would recommend testing the urine for ketones if the blood sugar is over 300 mg/dl [16.7 mmol/L]. If the ketones are positive, this is a potential emergency, and, you must either administer extra insulin in school, or send the child home for the parents to monitor.
In any case, you will feel more comfortable having written guidelines from the child’s own physician.