A young man

i have been asked to mentor a 3rd grader who has been a type 1 for 6 years. I met with him today for the first time and frankly I almost threw up. Here is the issue. The young man had an extremely high blood sugar. the nurse asked him what he for breakfast and he told the nurse he ate two krispy cream donuts.

now I am not food police, but i was aghast what his parent had fed him. has anyone ever been in a situation like this. Where you know the parents may not be taking food issues seriously and the child is ill. I wanted to go find them and explain look you do not do this.

so here are my questions?

should I leave it alone?
should I do something and if so what ?

Its a scarey deal, but the young man has a BG of over 400.

rick phillips

Talk to the parents have them get more involved in his care this is his life we are talking about don’t talk down to them or him of course but share your wisdom this may just be they gave him control of his diabetes and not checking in on it or he may be sneaking food and not dosing for it get the parents involved they need to keep him healthy. good luck

This little boy needs you. Two donuts for breakfast & BG over 400:( Awful breakfast even for a healthy child. Am sick with you.

How did you come to mentor this boy?

I don’t see that you have a choice but to do something. Maybe start by educating the boy about what’s good to eat & what’s not & why.

Perhaps speaking with the boy’s doctor would be a way to help educate the parents. Doc can’t say anything about his patient to you, but you can tell him what you know & that the family needs help being trained for his care. Of course, they may not happen quickly enough, if it even happens at all.

The parents had to give permission for you to mentor him, so at least you’re not an out-of-the-blue stranger. Maybe contact them to introduce yourself without any mention of his diet. Just a casual get together so you can approach them later.

Without coming across as a social worker, I’d talk with his parents. They may never have been told what to do, or didn’t understand. Not a comfortable situation at all to butt into someone’s child raising! Bet you didn’t think you’d end up mentoring the parents. Wonder if the school nurse would be of any asistance. Some people are turned off by any authority figure.

Not to play devil’s advocate, but depending on the variety of donut it might not have been too bad in terms of carbs… 2 original glazed krispy kreme donuts are only 44g of carbs. Honestly I think there’s something else going on if he was over 400 from two donuts. A more important question in relation to the 400+ after breakfast is what his # was like before.

I won’t argue that there are better food choices, but I also can’t say that I haven’t fed my own kids the same thing…

I think boy is tto young to realise the implications. The only way is to talk to the parents and I am sure they mus also be aware but would have given up considering that T1 also brings its own issue for kids… they feel why cant’ they eat what others are eating …why is he/she different.

The only way… to talk and talk with the boy and his parents…I know it is easier said than done but that is the only choice i guess… Good luck .

As alarming as this situation is, I would go slow. You’re a stranger right now and you can’t run in and start ordering changes before knowing more of the picture.

How did you come to be a mentor to this child anyway? Did you volunteer? Did someone ask you? Were you invited by the family or by an agency or a private group? The context in which you became involved should help guide you.

Ultimately you will have to talk to the family. It’s possible that no one has ever discussed diabetes care with them before. Just don’t barge in, if you know what I mean.

Good luck with this and bless you for stepping in. Let us know how it goes.

Terry

My initial reaction will be…yes, go to the parents and talk with the. However, you may not also know how they may react to this. I can assume that the parents may not be informed in the area of diabetes food management, Then again, Im assuming, the same way that you will be. They may take it that you are a complete stranger telling them what to do. And some parents does not take kindly to that.
How did you get to mentor the child at the first place? Is it a program of the school? If it is, will it be possible to talk to the child’s teacher and/or Guidance Counselor/school nurse first to get a brief preliminary history (family wise, history wise and health wise)of the child?
It is a fact though that the child may need some help. But you may have to go through proper channels first.

I would say play it sly talk to the boy get his knowledge up because at the end of the day children are better at making changes within the house.
Ask him how does he feel when he is that high? and then tell him that he could make his numbers better by not eating the donuts for breakfast as they are not good for his numbers and he should have them as treat instead after getting good numbers,I am sure then he will tell his parents this information but be ready for their reactions both postivie or negative because everyone is different.
Goodluck and well done you for being a helping hand to someone younger its great.

Whoa, wait a minute here. Rick … you’ve just met this boy for the first time, and you’re going to judge the parents based on one breakfast and one blood glucose reading? Did you ask the nurse if he’s like this often? Personally I haven’t given my T1 daughter more than 3 doughnuts in her lifetime and she’s never had 2 at once. But I don’t think it’s unreasonable for a type 1 child to be allowed a treat now and then. My daughter rarely goes as high as 400, but it does happen sometimes. It’s usually the result of sickness, or allergies, or a simple error on my part. Kids can be unpredictable and BG readings will vary a lot more in a T1 child than a T1 adult. As long as it’s not all the time you just correct it and try not to let it happen again.

What you should have done was turned to the nurse and asked if he’s like that a lot. Or wait a few more days and see if this is the norm. Did you ask the child what he had for breakfast yesterday? If I were his parents and you attempted to lecture me with only the little bit of information you have, I would be furious.

To clear the record a little.

Yes the young man run high all day most days. I watched his lunch and he ate mashed potatoes, corn chips, pretzels, a very sugary fruit juice type drink,(something I have not heard of) and two chocolate milks. The nurse said he consumed 64 crabs and to me tha tis the schools fault not his or his parents.

He is nine years old and weighs less than 65 lbs absolute skin and bones.

Now, I was asked to mentor him by the school, who sees him slipping away in his studies. He tests very bright but also has gotten nothing better than a c this year. When the parents were told I am a diabetic, they were thrilled to have a positive male role model (lord I cannot believe i am thought of as positive anything) who is a diabetic.

Also as a former school administrator if I had seen this in my former school I would have called child protective services and made a report. But I am not a school administrator anymore, so I no longer have that legal obligation.w

Fist I asked the school principal if he would mind having the nurse chart the BG numbers. They take it twice a day, just before and just after lunch. They are instructed to not report the numbers to the child, which to me also makes me angry, and they are not allowed to treat on a sliding scale for highs. Something I do understand (but do not necessarily agree with) since kids are so darn volatile.

I suspect what they would find is that behavior inappropriate days correspond to high and low sugar days. That is fairly common with kids. I hope what I can do is arm the school with enough knowledge to approach the parents, or file a CPS report if that does not work.

In terms of feeding kids donuts. I have done it myself with my kids, but of course neither were type 1’s. If an outside such as me approached me as a parent of a diabetic about food choices I would also go through the roof. I mean hey, kids and parents are not machines they do a lot of things well and some things not so well. I get that.

Some more info on the kid. He has been on two ping pumps and currently does not use one. According the school nurse the first one was defective, and the second was to much of a hassle for the parents and kid to control. Often driving him low at night. The young man said his mom said he could try another one when he is 21 and no longer lives with her.

I resisted a pump for years, largely because I did not want my doc to know that I was ignoring my diabetes. When I got so sick i had to take control I got a pump. My issue here is of course, that I am so concerned that 9 year old kid cannot make those decisions. They are really hostage to his parents and I understand that. but I see this little kids future being ticked off largely as a result of a don’t bother me syndrome.

I understand that, made that choice for myself once and actually appreciate it if people make that choice on their own. What I cannot hardly bear is the thought that a parent makes that choice for a kid out of ignorance or neglect. As you can tell based on my own personal history this one stuck pretty deep.

In addition, I hate being the food police. I always have, for diabetics or others. I despise food police. I don’t want someone telling me how to eat, and if someone talks to me about it, I would likely just explode. Unfortunately for nine year old diabetics the parents are the food police. It just comes with the territory whether or not it is fair, it is what happens. In my opinion parents of diabetic kids cannot advocate that position because it is hard or it interferes with a life style. It is the same with education. Parents are the protectors of kid education that cannot give that up because it conflicts with the choices of parents. Parents cannot advocate that responsibility, whcih is why all 50 states have attendance laws.

Ok so recap, I talked to the principal and left it in his hands. I told him as a former school administrator I would have felt the need to call CPS, based on what I saw. Now it is in someone elses court. and I can move on helping the kid and yes, worrying about him, because good school employees worry about their kids, all of them. Even what they eat for breakfast.

Thanks for everyones input, and thanks helping me cool down a bit.

rick

I think you should get an idea of the bigger picture first. Agreed donuts are not the best breakfast items…what to talk of 2 of them at the same time… but there can be lot of possibilities: may be he forgot to bolus, or my be he didnot confirm his bolus delivery if using a pump ( happened to mykid once, she entered everything but forgot to hit the confirm button, didnt hear the beeping from the PDM as she put it in its place, and lo she was 450 in 2 hrs.), or may be sneaked on the food. Parents may be doing their best but mistakes do happen. Eduate yourself of the situation and if needed educate the boy and the child.

As a health care provider, I agree COMPLETELY that the dietary education patients get today is not always the best. Today i saw a pregnant gestational diabetic with a 2 hour PP of 200. She had a pure carb meal (60 grams of sugary cereal and skim milk - uuugh) for breakfast - was not taught that all meals should contain some protein and fat to slow absorption of carbs. She’s not on insulin so diet is her only treatment and consult was brief and poorly done. I also have some patients on insulin who are told they can eat ANYTHING they like as long as they bolus for it. That never works for me. I am a big fan of the small input-small mistakes theory. I think carbs should be tightly controlled - I always miss the mark with meals over 40 grams, no matter if my counts are perfect. But many docs and dieticians are very permissive in their training of people who carb count, allowing them to cover ANYTHING.

CPS. What a joke. As a law enforcement officer, I have personally taken children in need of supervision to their office only to find out that someone took them home within an hour after being dropped off. I found this out because as soon as the child got home, they ran away again and was gone for over a month.
I have not heard of a Ping Pump, so I cannot comment in it. I loved Medtronic and the Omni pod. There is more freedom for daily changes. If he is running high constantly then maybe he is not getting enough basal.
It might be time to reevaluate his treatment.
Some parents are in denial and don’t know how to deal with it. I personally went to school and became an EMT-intermediate after my son was diagnosed. I never want to feel so helpless again.
Ignorance is bliss and Education is the answer. See if there are any other D children at the school that could buddy up with him as well. My son has been a big help to some newly diagnosed students in his school. When he was diagnosed, he was the only one at school and really felt like an outsider. He enjoys helping others, which of course, helps him.

This is a delicate situation. A young child with type 1 needs their parents full attention. Their is no room for denial, or embarrassments!! Firstly, I come from a mixed/multicultural African American background… I know that most of us show our love through food. therefore, it’s an unfortunate fact that, the more sweeter, fattier, greasier, saltier foods you give/or prepare, you are showing ultimate love because these foods taste good.

Parents of type 1 children MUST understand and be aware that, there is a fine line between showing your love through food (especially when your children are good, and you want to reward them for good behavior and such…), and knowing when is too much. Damn she should have at least cut the donuts in half, and have a fruit or something added to it.

A child should not have to make these kinds of very adult decisions, especially when they are overwhelmed with the stresses of being a kid in school. I parent MUST take control, and not make any excuses. Yes it is a delicate situation, yes we don’t wanna judge people prematurely, etc., etc., but let’s face it guys… Two donuts in the morning are not good choices.That child’s body is already facing high levels of sugar before his body ever gets a chance to develop. You have to inform the parents!! At least bare minimum let the parent know it’s a medical concern (and it’s not about telling the parents how to raise their child (although I think they may see it that way, anyway…)). Because the parent may, or may not actually understand she/he is allowing to happen with their kids…

Just my humble opinion.

I agree with what many have said, but on principle only. Of course as a parent I’d be furious if someone came to me criticizing the way I raise my children, BUT if what I was doing to them was harmful then someone better speak up for the child than stand in fear of offending me.

I’m sorry but Crispy Cream doughnuts (and 2 of them) are not an appropriate breakfast (diabetes or no diabetes). They’re yummy, easy, convenient and the rest, but they offer NOTHING at all nutritionally and are nothing more than a step closer to a shorter lifespan (and a miserable one at that).

But none of this is the point here. What is more alarming is the child’s condition itself. Skin and bones with that kind of diet and those BG numbers is indicative (as we all should know) of constantly having very high numbers. The fact that he tested as intelligent and yet gets poor grades is just icing on the cake. I know what that’s like because I tested abnormally high on an IQ test when I was young and yet I was in danger of having to repeat a whole school year because my grades were so poor. Then I got tested for diabetes and we found the cause. You simply can’t concentrate well enough in school when your BG is high all the time.

This kid is living in an abusive household and needs immediate intervention. The abuse might not be purposeful (I’m not saying the mother or father know what they’re doing and like harming their child) but they are doing it nonetheless.

Based on the pump story I’m inclined to believe they’re lazy parents who do know better but can’t be bothered to take proper care of their son. This is very circumstantial, of course, but it sounds to me like they simply don’t care enough about the kid.

So let’s all forget about hurting the parents’ feelings for a moment and start thinking about the young boy. I don’t know if this is a cultural thing or not but I’ve seen it several times since I moved here and simply don’t get it. I had some friends whose 4 year-old daughter was showing signs of sexual abuse by the babysitter, but they weren’t willing to investigate the matter because they didn’t want to offend this babysitter if they were wrong about it. So I made the call for them and now the babysitter is in jail because her husband’s computer had hundreds of photos of the girl in positions she never should have been in.

My point is forget about the parents. If you have reason to suspect abuse you should report it. If you’re right you save a life, if you’re wrong you’ve got a couple of strangers who are upset with you . . . big deal. Sure you could beat around the bush and drop hints, or give them information and all that, but if they don’t care they’ll do nothing about it.

Martin Luther King, Jr.:

We will remember not the words of our enemies, but the silence of our friends.

Winston Churchill:

You have enemies? Good. That means you’ve stood up for something, sometime in your life.

My 9 year old weighs 58lbs… he looks like a bean pole compared to other kids in his class (who are for the most part, clinically obese - and that is not an exaggeration) but he’s not diabetic nor is he “skin and bones” - he’s a very strong and muscular kid… he’s what most “normal” kids looked like 20 years ago.

Having a 9 year old my own, I know there’s no way I could trust him to manage diabetes. Yet it almost sounds like his parents don’t want any part of it and expect him to do far more than he’s capable of (or they rely on the school to deal with it?), or to make choices (particularly regarding food) that he is probably just not mature enough to make on his own… the resistance to use a pump really shows that pretty clearly. In my mind pumping is much less work once you get the basal rates set reasonably close to correct, but it almost sounds like they didn’t want to put in the work to get to that point. That’s unfortunate, both for him, and for them.

I haven’t had the chance to reply before now. You’ve probably made a decision already but I’d like to comment anyway. I agree with you in being angry at the school. They should be doing more to help.

What I don’t agree with is your feelings on him being on the pump. A child whose blood sugars are not being carefully monitored should not be on the pump. His parents may work long hours and may not be able to supervise him properly while he’s on it. Also you seem to have the misconception that non-pumpers are neglectful of their BG control. That’s not true at all … my daughter is 4, she’s had T1 for 2 1/2 years. She is on shots and her last A1C was 7.0, which is excellent for a small child. But then I don’t send her off to preschool, and I check her BG levels often.

Also, you should hold off calling CPS. One reason is that the person they send is most likely not going to know anything at all about diabetes. I actually had CPS show up on my doorstep over a year ago. She took notes on everything I said, but she really had no idea what I was talking about. And she didn’t try to verify any of the facts I gave her (such as checking my daughter’s meter) If I had been neglecting my child’s health she never would have known it. Also, this would destroy any opportunity you have to talk to the parents.

Talk to the parents. Don’t criticize them for the doughnuts, but do ask them if they know what those types of meals do to their child’s BG. And tell them the school can’t correct for those kinds of numbers. Be helpful, but don’t let on that you’re judging them. Then you might actually be able to help.

call social services anonymously to check it out and do a investigation on them. Seriously, talking to the parents might only upset them because it will sound like your judging them on there parenting.

I don['t think contacting CPS should be the first thing we think of. CPS can ruin the life of a child. Foster parents are not usually wonderful, thinking people that will take over his care. Many are motivated by money and have other children too. I have seen other children at school that ended up being more responsible for their care than we would like. But this is his life we are talking about. I would get him involved more in his diet, testing, and care. The nurse should be on the phone getting the parents in for a 504 meeting and hopefully can gauge their level of knowledge when they meet. We have had 3 Type 1s in my school, and two of them ran high at the advice of their doctor and diabetic educator. So a lot of fact finding needs to come first.

What a mess Rick! You’ve received a lot of good advice, but here’s one bit more: Perhaps you could have lunch with him one day, and you could talk to him about what he’s eating. Does he even know about carbs and carb counting? When first dx, we were given a chart that showed a large number of foods. Those is blue have to be counted for; the others do not. While not a completely perfect system, it was a big help to us in the beginning. The link is http://www.designersink.com/Diabetes/mealplan.htm