Who would have thought just 24 hours after this picture was taken at Scarborough Faire that we would be battling ketones and debating the awful trek to the hospital. This was a Sunday, and all day we were happy and playing and having a great time. We were having an even better time of keeping up with low blood sugar. We expected this due to his high level of activity.
The next morning we woke up with a BG of 495, and some labored breathing. Immediately, I checked ketones. The meter said “Lo”. I woke up with a sore throat that day, so we went on with our day. I remember calling my husband and mentioning that I thought he was getting a cold because of a snotty nose and cough. After lunch and nap (5 hours later) BG was 450. I changed site and corrected, but this time he had the funny look I associate with ketones, plus his breathing was still wonky. This time the meter read “HI”. Our meter tops out at 8.0. This likely mean’t that he was headed for those 3 little letters that any T1 hates to say..D…K…A.
Diabetic ketoacidosis is a problem that occurs in people with diabetes. It occurs when the body cannot use sugar (glucose) as a fuel source because there is no insulin or not enough insulin. Fat is used for fuel instead.
Byproducts of fat breakdown, called ketones, build up in the body. (source)
I called my husband home from work. While he was in route, I administered a sick day dose of insulin via injection. This is usually .5 per Kg. By the time my husband arrived home the BG and the ketones were coming down. We were in the 300 range and ketones were in the 5 range. It had only been an hour and half. I started to worry less, we stayed on top of the situation. Though instead administering the sick day dose via injection we did it via pump bolis. We knew that this was not the recommended way to do it, but we were monitoring so closely and it was working that we weren’t worried about doing it this way. Our reasoning was that the pump would help us keep up with the last time he was given insulin a bit better.
D went to bed about 8 or 9 and slept into the night. My husband and I went to bed about midnight checking a BG once more. At 3 AM I woke up because the bed was wet. D has been holding it through the night since he was about 11 months old. The ONLY time he wets is when he has a high BG. I knew that was the culprit here. So we had a Daddy check sugar again. I believe it was in the 400 range with ketones in the 5 range. He was given another sick day dose. Shortly after getting poked D decided to get up. So he and I went back to his bed room to watch Pixar movies. At 5:30 or 6 I checked sugar again, 500 range and 6.3 ketones. MORE insulin…
Then just as my husband was getting in his car to leave for work, it happened. I was thrown up on. This is CLASSIC DKA. We knew the signs because we had seen them all before. I changed, pulled the sheets back, while my husband cleaned up D. Off to the children’s hospital we went.
They were very attentive, young diabetic with High BG and High Ketones who wouldn’t be. After seeing us, allowing D to nurse, and drawing labs they instructed us to take off his pump and that he was getting a bed in the ICU to be hooked up to an insulin drip. His pH was 7.1 and his BG over 500. I told them then, that I was going to give him an unit of insulin for his Sick Day dose and to cover the carbs that he had just eaten. I was told not to. This was at 9AM.
At 11AM after being brought into the ICU, hooked up to an IV, and more labs drawn (yes that is 2 full hours without insulin after eating and already being high), they started the insulin. When I inquired about his Blood Gasses they said, well he is even more acidic now his blood pH is 6.9 and his BG is still over 500. Well no crap, you let the boy eat without giving him what he needs to absorb it.
The experience was as awful as ever, D was placed on NPO.
NPO [L.] nil per os (nothing by mouth).
This included breastmilk. What is the one thing that a 20 month old wants to do when he feels crappy, much less is in a scary place…nurse. So for 24 hours I had to hide. It was awful listening to my little guy cry…momma…momma. Then listening to my husband tell him that I wasn’t there. We tried to just refuse the breast and this was even more awful. He would cry and thrash about clawing for his one peace…breastmilk. Finally by the end of the night he was allowed to eat. Though for some reason the endocrinologist did not want him to nurse directly. So I had to pump, pour a bottle, and give it to my husband. I tried to comfort my little guy, and bottle feed him the second best thing in his life, but he refused and cried some more. So once again I was forced to camp out on the couch behind the bed, and listen to my husband comfort our son.
Momma isn’t here right now. This is the best we can do buddy, come on take it.
That night was awful, 3 times D woke up crying for me. Everytime I would hear my husband console him back to sleep. Sometimes it would take 20 minutes sometimes it would take 45. I am just grateful for a great nurse that not only offered a big kid bed, but brought the waiver for me to sign allowing us to cosleep as she offered. Otherwise, I have no clue how we would have survived. I know it would have happened but I have no clue HOW it would have.
The next day we were told at early morning rounds that we would be released. Then comes the parade of people. First the nutritionist that was concerned because the endocrinologist had the impression that we did not give insulin for nursing, but we did for bottle feeding. How he got this idea I have no clue, but he got the idea just the same. Then she was concerned about D’s lack of grain in his diet, she was concerned of a B vitamin deficiency. I assure you he is not deficient in any of that. Organ meat and organic meats are some of the best providers of B vitamins, both of which we eat regularly.
Then comes the diabetes nurse. This was the one that according to my husband almost got kicked out of the room. She came in to discuss his A1C,
- The A1C test measures your average blood glucose control for the past 2 to 3 months.
- It is determined by measuring the percentage of glycated hemoglobin, or HbA1c, in the blood.
- Check your A1C twice year at a minimum, or more frequently when necessary.
- It does not replace daily self-testing of blood glucose. (source)
when admitted his A1C was 10.1. This is an average BG of 254. Remember our range is 100 – 250 as prescribed by our endocrinologist upon dx. She wanted to adjust his insulin, because these numbers were indicative of a bigger problem. I explained to her that they were only slightly elevated from our previous THREE endocrinology appointments, and that it could be explained from our previous experience with MRSA. I explained that for 1 week we were dealing with BG that did not support sick day doses and ketones that needed insulin. So we were on a low, high, low roller coaster. Her reply was that 1 week was not indicative of the 3 month sampling that the A1C presented. So I went on to explain that anytime he or I have antibiotics that we have a hard time controlling his sugar, and that we were making adjustments slowly to his basal rates and correcting as needed. For the life of me, I cannot even remember her reply to that. I just remember how accusatory the whole conversation was. I remember her jumping my case for giving sick day dose through the pump, I remember her jumping my case for not calling the nurses, I remember her jumping my case about his A1C, and I remember me ending the conversation with a stern, “WE GOT THIS.”
I got so annoying at one point that, I actually woke my husband up from his nap to deal with it. The tension in the room could be cut with a knife it was so tense, the baby was upset, I was upset, and all we wanted to do was go home.
FINALLY by mid afternoon we were released. We continued to deal with High BG for 2 more days, ketones, and snot for a week more. Just this past Saturday the BG started to come back into alignment, just as D’s cough and snot started to subside. So we are back to using 3U or less a day for both basal and food corrections, and FAR more predictable sugars. That in and of its self is the biggest weight off my shoulders.
Next breathtaking hurdle, 1 year labs.