A School Nurse Shares What Matters in T1D Care
I stepped into meaningful life-changing work when I became a nurse. I started my nursing career in the Neonatal ICU. It was beautifully rewarding, but intensely demanding. When I made the change to school nursing, I wrestled with doubts about this role and if this work would be “enough.” Had I traded quality time with my family for career suicide?
My first year as a school nurse, I found myself deep in type 1 diabetes with two boys. Did I know what I was doing? Absolutely not. Learning to juggle the needs of two type 1 diabetes (T1D) boys with all the other parts of this job was really hard. I cried a lot. But, this is how I approached it: If my child needed nursing care at her school what would I want that care to look like? I wanted it to look like love, determination, knowledge, persistence and to be as damn good as possible. This work is anything but insignificant. It is vital. It is necessary. It is deserved.
My boys are amazing, and caring for them is more than just a job. That is what T1D does. It binds us together in the struggle to manage it. Here is some of what I know for sure:
Good diabetes management is teamwork
One of the reasons I left the hospital was to build relationships. It is hard to say goodbye to a patient and never know the rest of his/her story. Here, I know the story. I am privileged to be a part of it. These families have been dealing with the effects of T1D for longer than I have been a nurse. You can study all you want about diabetes, but if you do not know your families, you will fail. I really try to care for my two boys as their families would. I am their advocate and their number one cheerleader throughout the school day. I have learned how to truly carb count; meaning I know that bagel really has 60 grams of carbs, but for this guy it is counts as 45 grams. I watch their trends. Every morning I look back at the previous 12 hours I missed while they were at home. Are they coming to school tired from a long night of highs and lows? Is he due for a set change? I ask for help. At the beginning, I called and texted my T1D parents all the time. I wanted to honor their experience and knowledge while building trust. This relationship is a key element to success. Please respect it, cherish it and grow it.
Diabetes is an art
There are so many variables—science blended with “let’s wait and see what happens this time.” Everyone does it differently. Parents and I have worked together to come up with school plans, but there is not always a clear answer—a glucose tab? Two? Half of a juice; a full juice? How much insulin is on board? Should I cover all of those carbs? Normal bolus? Combo bolus? I will do something one day and it will work beautifully. I will try it again another day and get a totally different result. Diabetes is frustrating! There will always be a bump in the road whether it be athletics, hormones, sickness; be adaptable. Be an artist.
I am going to get those 10,000 steps
When I came into this position mid-year, my boys were coming to the health room two to three times per day at the bare minimum. As a first and third grader, they had to bring a buddy with them too. This added up to at least 20-30 minutes of missed class time each day. The next school year, we made a change and I went to them. Is it more work? Yes. Do I sweat all day long? Yes. Is it worth it? Absolutely. This may not be possible for all school nurses, but it was an accommodation I was willing and wanted to make because it is important for these boys to move through their day with as little disruption as possible. I have become quite good at sneaking up on them in class.
Technology is a blessing and a curse … but really a blessing
Sometimes the continuous glucose monitor (CGM) makes me feel crazy. I use the Dexcom share app on my work phone. I watch numbers dropping and I want to rush in and do something. We have an established protocol for responding to CGM alarms, but I have learned (am still learning) to exercise patience. If I act too quickly, I can chase highs and lows all day long. This goes back again to knowing your kids and their trends. I have seen resistance to using this technology, but with it I have caught lows before they were really lows, caught missed breakfast boluses and been able to intervene before a high gets too high. My boys have been able to stay in a tighter range and as a result we have seen beautiful A1Cs.
Celebrate the successes and learn from the failures
These babies are not defined by their numbers and neither am I. There is a beautiful line from one of my favorite songs that says, “May we never lose in the light what we found in the dark.” What we learn in dark and hard situations is valuable and it makes the light so much brighter and sweeter. So, boys, do not be discouraged in the dark. I will help you find your light.
What Shocked Us Most—Having Type 1 Diabetes in Elementary School by Evelina Jones.