Fresno School Nurses ‘Onto’ Benefits of Insulin Pumps
Anne Federwisch
Monday April 21, 2008
School nurse Jill Barkdull, RN, PHN, helps student Allison Zulewski program her insulin pump at Bullard High School in Fresno, Calif.
(Courtesy of Sara Hyman)
With the trend toward much tighter control of blood sugar levels in managing Type 1 diabetes, more people with diabetes are using pumps to continually infuse insulin — including school-age children.“The current theory about managing kids is to keep them with as normal blood sugars as possible, which means getting more insulin throughout the day,” says Maureen Miller, RN, MSN, PHN, a California school nurse in the Fresno Unified School District who also acts as a resource person for diabetes in the district. Tighter control, she says, means more children using insulin pumps.The technology may differ from the more traditional method of insulin delivery through injections. However, the role of the school nurse is pretty much the same as for any student with diabetes — offering supervision on testing blood sugar levels, looking for signs and symptoms of high or low blood sugar, and supporting students in managing their disease.How the pump works
The specifics differ by manufacturer. However, in general, pumps — which are about the size of a beeper — work by infusing a steady rate of insulin 24 hours a day. The insulin is administered through a plastic cannula inserted under the skin. “Every three days, you put it in with a lancet device like you poke your finger with, except it pops the infusion set in,” says Lisa Monteleone, RN, BSN, CDE, PHN, a part-time school nurse in the Fresno Unified district who also does insulin pump training for Medtronic, Inc., one of the pump manufacturers. She herself has been using a pump for the last 22 years to manage her own diabetes.The pump is programmed to give a basal dose of insulin at a rate appropriate for that particular user. Some devices monitor blood sugar as well, or communicate with devices that do. Many, though, require users to still test their blood sugar levels throughout the day, which they then program into the pump. When they eat, they calculate how many carbohydrates they’re going to have and program that into the pump as well. The device then determines how much additional insulin, or bolus dose, is needed to maintain a proper blood sugar level. Devices can also be programmed to give different basal rates throughout the day, changing levels, for example, during after-school sports.Children of any age can use a pump, although younger children may need to be supervised in entering information about their blood sugars and carbohydrate intake to ensure proper doses of insulin are administered. “If the doctor prescribes it [the pump], they can be any age,” Monteleone says. “[Pumps] are on newborns, if the physician feels that’s the best therapy for that child.”One of the benefits of using a pump is not having to inject insulin throughout the day. “The insulin pump makes life easier,” Monteleone says. “You don’t have to bring out a syringe and needle when you’re going to give insulin at lunch time or anytime someone is going to eat or cover a high blood sugar. It’s more discreet than going in the bathroom or the nurse’s office.”Susan Connelly, RN, BSN, PHN, a school nurse at a middle school in the Fresno Unified district who has two students with diabetes, acknowledges the benefits of pump usage. “The boy on the pump I see much less frequently than the one who is not on the pump,” she says. “The boy on the pump does not have the lows the other one does.”School nurses’ role
School nurses may be called upon to help students troubleshoot the functioning of their pumps, particularly when their blood sugar levels are high, which may mean insulin is not getting infused properly. “We talk about what could be going wrong with the pump,” says Jill Barkdull, RN, PHN, a high school nurse in the Fresno Unified district. “When did you change your site last? Do you have air in your tubing? Is your battery low? That kind of stuff.” Barkdull has 12 students with diabetes, 10 of whom are on pumps. She may also call parents as needed to help troubleshoot or the 1-800 number listed on the back of the pump. “I think that just goes along with being a nurse,” she adds. “That’s part of my job, being able to troubleshoot, and to be able to foresee issues.”Part of foreseeing issues includes training other staff and faculty about the signs of hyper- and hypoglycemia. “I have this little sheet that I send out to the teachers that is in cartoon form,” Barkdull says. “[The sheet] tells them what to look for in their students [with diabetes].”Monteleone stresses that when students come in to test their blood sugars — no matter if they’re using a pump or not — nurses should react non-judgmentally, whether the level is high, low, or right on target. “Just say, ‘What’s your number, and what do we need to do about it?’ ” she suggests. “Just have the same reaction, so you’re accepting of whatever the information they’re bringing in to you is. Because too often, they feel like they’re ‘bad’ when their blood sugar is too high or too low.”If the students believe they’re “bad” and will receive a negative reaction from the nurse, they may avoid seeking help or supervision. By being nonjudgmental, the nurse can establish a good rapport with children with diabetes, which is key to helping them manage their disease at school — no matter how they administer their insulin, Barkdull says.
Anne Federwisch is a freelance writer. To comment, e-mail editorCA@nurseweek.com.
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