I am a school nurse and I have a student who comes into the health office to test her blood sugar levels before lunch each day. Her numbers are consistently above 350 mg/dl [19.4 mmol/L]. We have called the parents. We have counseled the student about her food, insulin, etc. We have met with the family to discuss her care at school. What else can we do? I am concerned that with consistently high blood sugar levels, she is causing long term damage to her body. Where can I direct the parents to help them understand the seriousness of the situation? They have gone to diabetes camp both last year and this year. I appreciate any suggestions you may have!

What a fortunate student to have such a concerned school nurse! First, I would try to assess why the blood glucose is so high. Too little insulin, too much food, not enough exercise, and stress are common causes. However, high blood glucose can also follow a low blood glucose (rebound hyperglycemia or the Somogyi Effect). Is it possible your student is having a low blood sugar mid-morning? Is your student experiencing stress during the morning? Do you know what her fasting blood sugar is?

You have done all the right things regarding talking to the parents and counseling the child. Do you have the sense that the parents are also concerned about the high blood sugar? Do they have any insights? I would continue to keep those doors of communication open and continue to share information you can gather during her school day.

BS