From Flushing, New York, USA:
I am a school nurse working in an intermediate school. We have a 12 year old diabetic who has had very fluctuating blood sugars for 3 years that I am aware of. I think she is manipulating her blood sugar. Today at 7:00 A.M. her blood sugar was 110. She states she took 17 NPH and 3 Regular. She ate a bowl of cereal, slice of toast, and milk. At 8:30 A.M. her blood sugar was 550. Incidents like this happen often with this child. Could that small amount of food intake have resulted in such a high blood sugar?
People with Type 1 diabetes can have fluctuating blood sugars. Some contributing factors would be how much and the type of food eaten, whether the insulin was the right dose, exercise patterns, sick days, growth and hormonal changes of puberty, variability in insulin absorption, never mind the psychosocial issues of having diabetes. The current nutritional guidelines do not "forbid" any foods, but rather encourage people to factor the foods into their overall routine.
I would recommend getting permission to talk to your student's diabetes care team to discuss the situation. School nurses offer invaluable information to the team that only sees the child a few times a year. If she is not followed by a diabetes team (which would include a pediatric endocrinologist, nurse, dietitian, and hopefully a mental health provider), talk to her and her family about such a referral.
I would also recommend checking urine ketones when her blood glucose is over 300 mg/dl and to report positive ketones to the family/ health care team immediately.
Last Updated: Tuesday April 06, 2010 15:08:56
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