** I Will Survive by Gloria Gaynor and Survivor by Destiny's Child can be heard by clicking PLAY at the right!**
Diabetes is full of "firsts". The first time you give a shot. The first time you count carbs. The first time you care for your child on your own. The first time you let them out of your sight. The first time they get sick. The first time they have ketones... The list goes on and on.
We had another first this weekend.
Friday night was the first time that Sweets got sick and threw up.
She's thrown up due to ketones... but this was the first time that she has gotten sick because of an illness. And that is an entirely new ballgame.
I've been dreading this.
For any readers who might now know, puking and diabetes DO NOT MIX. They do not play nicely together.
It can be very dangerous for people with diabetes to get a stomach bug. What often happens is that the blood sugar goes DOWN. Usually with illness, bg rises. But not with the stomach flu.
Ketones, however, go up. And there's the rub...
You need insulin to treat the ketones. Without insulin and water, ketones will only keep rising. This can cause DKA and all the nastiness involved with that - including more puking and a life threatening situation if not treated.
However... insulin drops blood sugar. So if the bg is low... giving extra insulin is tricky and dangerous. You need them to EAT so you can give insulin. But how do you feed a puking person?
Consider this... If your CWD throws up a meal - AFTER you've bolused for it.... They have active insulin on board.... and no food. What's going to happen??? Crashing bg.
Friday, Sweets complained that she did not feel well. She said her belly hurt. We thought maybe it was "poo" related. But she was tired. And she didn't eat dinner (Thank GOD we didn't make her). And then she was low. J gave her some juice. 10 minutes later she was lower than before.
"This is not good," I said. "I have a bad feeling about this..."
And it wasn't long until her lunch made a reappearance.
And the poor little thing threw up countless times from 7 pm until around midnight. Finally, she was just throwing up water. She couldn't even keep her sips of water down.
It was heartbreaking. She was moaning and rolling around in pain. She had to go to the bathroom - and luckily I followed her in there with the bucket. She even got sick sitting on the toilet.
"This is the most horrible day ever" she said.
We made her a little "bed" on the couch with sheets and her pillow. The kitten decided it looked like fun and was trying to play with her feet. "Spooky! This is NOT playtime" she said.
Her bg held steady for most of the throwing up at around 85-90 mg/dl.
It actually started rising a bit around midnight - but so did her ketones. She had 0 ketones when it all started. But an hour later she had moderate ketones. We went ahead and gave her extra insulin for the ketones (see the sick day flow chart under the SICK DAY tab). It brought her bg down - but never into the low range.
By 1 am, she was asleep on the couch. Bg was around 90 and ketones were now a large 1.7. She couldnt even keep down water. I was worried that she was dehydrating. I was worried that her ketones were large and we couldnt get her to keep anything down to help correct it.
We called the hospital. As much as I did NOT want to take her to the ER... I was scared. The on call doc thought that we could keep on trying at home. She told us to call back in the morning if her ketones were still large.
At 3 am her bg was around 100 but ketones had gone up to 1.9. She had not gotten sick in a few hours.
I took a gamble. I gave her the correction dose for the large ketones. And then I waited. And I watched.
Dex showed her starting to go down.
It was 4:30 am. An hour and a half after her dose. Insulin should be peaking... I checked her bg. 82. It was time to start pushing carbs.
I tried everything I could think of. This was one day that having a kid who won't drink soda was no good!
I mentally went over the mini-gluc instructions in my mind. "One unit for each year of age... put it in a regular syringe... Oh my Lord. PLEASE don't let it come to that."
I tried sips of juice. She wanted ice. I tried a sucker. She wouldn't take a lick. I tried crushed ice mixed with crushed smarties. She turned up her nose. I tried a popsicle. She said no. Finally, I crushed up a popsicle in a cup and fed her bites with a spoon.
That worked. She only took a few bites. Probably not even half of the popsicle. But it was enough. Bg started to climb.
And I exhaled.
Ketones were holding steady at 1.9 but bg was coming up. I decided to wait a bit and make sure she kept it down.
By 7, bg had gone up to 200. Nothing had come up. But ketones were up to 3.4!!!
We called the hospital again. The on call doc thought that we should try to feed her. So we did.
She kept it down. And the water and food and INSULIN worked to bring down those ketones.
That was a rough night. One I hope not to relive any time soon.
It's been awhile since I was scared about D. It's been awhile since I was panicked about D.
But Friday night, I was both.
It's easy to forget the seriousness... the reality of this disease. You get into this routine and fall into this "been there, done that" routine. And then something happens...
Something that for other children would be no big deal. Not pleasant... but nothing like the fear and anxiety that we experienced. Something like an ordinary stomach bug.
For us... it's different.
And I know that most of you reading this know exactly what I'm talking about.
It's those moments... those shared experiences... those shared fears... that binds us together.
It's kind of like soldiers who have been through battle together.
That's how I felt. By morning, I felt battle scarred. Shell shocked. Exhausted.
Without some of my wonderful D Mama pals to walk me through that night of another "first" - I would have been even more lost and scared that I was.
It's now Sunday night. She's back to her usual, active, precocious self. Ketones are still present... but very, very small.
We survived! Praise God!
You can read some other posts about how D and Puking don't mix below...
I Am Your Pancreas: ER Visit