To my resident experts...

[Carrie]

Our whole household has been struggling with the crud this past weekend (colds, fever, aches). Our daughter with diabetes struggled with ketones yesterday. Today she woke up at 336 and 0.5 ketones. Corrected through the pump. She has dumped around all day and hasn't ate really anything. About 3:00 this afternoon, she started complaining that her tummy felt yucky. From there, she proceeded to throw up about 4 or five times. From 3:00 until now, her BG numbers have been: 107, 151, 172, and 140 (better then her non-sick days!!!). Since 3:00, her ketones have hung around 0.7. She now has about a 102 degree temp and just wants to be sleeping. :(I just rechecked her and her BG is 143 with 0.8 ketones. Around 6:00, I started running her at 110% basal. I now upped it to 120% thinking that they might be climbing. I'm pretty sure they are starvation ketones. The next time she perks up, I'm going to have her drink pop so I can get insulin into her.

My question...her hourly basal rate is about 0.2. Do I dare go more then a 120% basal, or ride it out for the next few hours? I feel so guilty not calling the endo, but I figure that I have to take control of this stupid disease at some point. :rolleyes: I'm doing everything thing that they'd be telling me to do.

Thank you in advance for your "advice".:D

[WestinsMom]

Sounds like you are doing okay. That is good. I think I would give pop too and give that extra insulin! Anything with sugar so you can bolus.

[wilf]

We too have had some good BG numbers on sick days..

You're doing just what we would do :)

We find flat ginger ale (stirred/shaken to get the bubbles out) is our best bet for an upset stomach.

[Carrie]

Thank you for you quick responses! I was just telling a friend of mine yesterday, "anything but vomiting"! I hate fevers, but I was so thankful not to have kids vomiting. And of all the kids to get this sick, the one that has enough struggles without being sick gets it!:( I'm just hoping to stay out of the hospital.

[Brensdad]

Don't forget the mini glucagon shots if it comes to that. Like you said, anything to stay out of the hospital!

[WestinsMom]

I think staying out of the hospital is always the ultimate goal. At 5 though it is a lot easier, as I am sure you can attest, than when they are younger. We have had an awful month too. Now Westin has a fever....it never ends :)

[Carrie]

Well...we couldn't avoid the hospital. Tuesday night was terrible. She was totally passed out with a fever and wouldn't eat or drink. Her BG continued to stay under 200 and her ketones stayed right around 0.8. At 5:30 in the morning, she was a 501 with 1.3 ketones. She was due for a site change yesterday, so I gave her an injection and let her sleep. By 8:00, she was 175 with 0.4 ketones. Our biggest concern was that from like mindnight until nine in the morning, she had not gone to the bathroom. So to the doctor we go. I was already planning on telling him if I couldn't get her to drink, I wanted her admitted to the children't hospital (where our endo is) about an hour from our house. He already had the same thinking when he checked her out.:) She had a nasty ear infection and strep test was negative. The doctor's suggestion was to put her in our local hospital just to try to rehydrate her and get labs done to check for a bacterial infection. He said he would not admit her. If it came to that, he would send her to the children's hospital. Whew! I was to a point of exhaustion. I wasn't only fighting the bug, but I was fighting what the bug was doing to her diabetes.

I had brought EMLA cream with me! When we left the doctor's office, I slapped it in every potential IV spot she had on her little arm!!!:D The nurses (we were in the outpatient surgical unit) were laughing and cheering when they saw EMLA! They said they wish they would use it more often for little ones. Never having an IV before, our daughter was pretty apprehensive, but didn't even flinch. The nurses and lab tech were quite impressed at how she brave she was. It made me quite sad knowing that she has to "be brave" every day with all the pokes she gets.

We knew both of the nurses from me growing up in church with them, so I think that helped to get a little extra attention! But...I was bound and determined to be an "Amy" (That's a compliment, Emma'sMom!!). I was going to stay in charge of the diabetes part of it, and they could handle the hydration. Come to find out, that's the way it worked out because they didn't even try.

Here are a couple of things that made be chuckle through our experience. I told my husband that it didn't make me mad that they didn't know this stuff, but I was just really surprised that they had no clue!!

1) The main nurse has been one for quite a while. I had taken our daughter's pump off to get rid of some air bubbles in the tubing. I laid it next to our daughter until the nurse was out of the way from taping down the IV. She says, "what's that?" I said, "That's her insulin pump." She waited a few seconds and said, "What's that do?" (SHE'S KIDDING, RIGHT?!?!?) I said, "Well, there is insulin in here (unscrewing as I talk) and this is pre-programmed with her carb to insulin ratios. I punch in how many carbs she eats and it pumps in the correct amout of insulin." "WOW!"

2) While she was going over medical history with us, she came to the part about any prior surgeries. I said, "none". A couple questions later, she stops and says, "So...you said no prior surgeries. She doesn't have that site surgically inserted?!?":eek: After chuckling to myself, I said, "nope...it's along the same concept as the IV. The needle pops in a little catheter, and we pull out the needle. We move it around every three days."

3) I have spiral notebook that I use for sick days. I just have TIME, BG, KETONES, and WHAT I DID across the top. That gives me a better visual of what's going on. I had been checking every hour or two while our daughter has been sick. The nurse came in at one point and said that she was waiting for her labs to come back with her BG number and to see whether she had ketones. I spoke up and said, "I can tell you that..." She looked at the notebook and said, "Can I take this for a minute for when I talk to the doctor?"

4) Then...when they were taking out the IV, the nurse is explaining that she had put the littlest straw in our daughter's arm that she's probably ever seen. (Okay...she really doesn't know what a pump site looks like!) After pulling out the IV, she holds up this "little straw" that is quite big around and about an inch and a quarter long. She says to my daughter, "See...isn't that the littlest straw you've ever seen?" I said, "Nope...I think her site "straw" is smaller."

Anyway...just another education moment. This morning we're sitting at 81 BG with about 1.3 ketones. Gotta work on some eating or drinking in order to get insulin in her.

[EmmasMom]

I'm so sorry! I just hate it when they're so sick! :(

I'm really glad they hydrated her well, maybe that will help her fight this off faster. I'm also really glad that they let you manage everything with out a fight, (and you didn't have to act like me :p ha ha) ... it sounds like they were pretty clueless about D, but as you know from our previous experiences that is not uncommon. It's always best when they freely admit that they don't know anything about D and actually listen to the parents!!

Emma was in the ER last night for a couple of hours with breathing problems. (very scary night, she has horrible croup and her airway is swollen) It was so bizarre to be there with good blood sugars and no ketones, of course we're fighting that stuff too, but so far we're winning on that front.
She's starting to get more and more dehydrated now though, so I'm keeping my fingers crossed that she's not going to get any worse.

It's sick season!

[Boo]

Ah, on behalf of any T1's that may enconter that nurse in the future, thank you for educating her!

Sorry you had to make a trip to the hospital. I hope she is feeling better now. My D son is home sick today (and yesterday) too.

Just a thought on your original post, and someone please correct me if I am wrong. Not sure what pump your daughter uses, but if she uses minimed...if her basal rate is .2 u/h and you set a temp basal at 120%, I don't think she'll gat any additional insulin. Since .05 is as low as MM goes, I think with a .2 basal, you'd have to go to at least 125% to get an extra .05. right? :confused:

[Carrie]

See...that's why I titled it "to my resident experts".:D Since pump start a little over a year ago, we've never been told by a CDE or endo to go more then 110% with her. I figured if they've always recommended 110%, I'd risk 120%. I'll have to say that I felt really guilty not calling the endo through all of this.:rolleyes: I figure I have to take control of this stupid disease at some point. I decided I would do what they would probably tell me to do. If that didn't work, I'd check the message board and then call him. :D

[Abby-Dabby-Doo]

Just a thought on your original post, and someone please correct me if I am wrong. Not sure what pump your daughter uses, but if she uses minimed...if her basal rate is .2 u/h and you set a temp basal at 120%, I don't think she'll get any additional insulin. Since .05 is as low as MM goes, I think with a .2 basal, you'd have to go to at least 125% to get an extra .05. right? :confused:
Correct. If the basal is .2 you would have to go to 125% to increase the basal.
.2 x 20%= .4 -MM doses in increments of .05, so there is no increased insulin with a 120%, you would have to 125% to give extra.

I'm always sorry to hear when anyones child is sick. We haven't traveled down this road yet, and I learn from each and every one of you. I wish both kids (Emma) a speedy recovery.

[Mary Lou]

Sick kids with D are the worst. the most heartbreaking, I mean.

I am sorry to hear of your trip to the hospital.

I wouldn't hesitate to call your medical team. It doesn't matter how long you've been doing this or how in control you are. They are there to assist you and they've been handling ER situations for a lot longer. It never fails to amaze me how much we learn with each and every encounter that includes our CDE and endo. Relying on their expert advise is not something to feel guilty about.

Of course, the above statement assumes you have a wonderful endo and good relationship with them, which I know isn't always the case :D

I hope this flu is clearing up for you. If your pediatrician is comfortable, I'd recommend you get an RX for Zofran, an anti-vomiting medication that truly works wonders. It dissolves on the tongue and works in minutes. It is the only thing that kept Brian out of the ER the week after his brother went b/c of vomitting.

Hang in there. It sounds like you are doing everything you should be doing!!

[Boo]

See...that's why I titled it "to my resident experts".:D Since pump start a little over a year ago, we've never been told by a CDE or endo to go more then 110% with her. I figured if they've always recommended 110%, I'd risk 120%. I'll have to say that I felt really guilty not calling the endo through all of this.:rolleyes: I figure I have to take control of this stupid disease at some point. I decided I would do what they would probably tell me to do. If that didn't work, I'd check the message board and then call him. :D

I just feel bad that I didn't see your original post earlier! Sorry! :o It may not have helped you to avoid the hospital anyways, but at least you know now for the future. Whenever I use a temporary basal rate, I always scroll back on the pump to actually "see" what he will actually be getting (in units, not in percentages). It helps me to see it since I'm not a mathlete!

[Kirsten]

Sorry to hear that you ended up at the hospital.:( I hope things are better today.

Kirsten