- advertisement -

No ketones for three years - now ketones twice in two weeks when switching to the pen!!! HELP me und

Discussion in 'Parents of Children with Type 1' started by grantsmom, Mar 4, 2011.

  1. grantsmom

    grantsmom Approved members

    Joined:
    Jul 29, 2008
    Messages:
    1,243
    Finally switched to the Endo I have been trying to get into for three years. Great visit two weeks ago...they immediately switch us to the Pen (Lantus in am, and Humalog as needed for food and corrections we have eliminated NPH).

    Wednesday at school he feels sick to his stomach and sure enough he has moderate ketones. HE has NEVER had ketones (even trace) in three years since DX. This morning he wakes up sick to stomach and sure enough...small to moderate ketones again!!! WTH is going on??

    Of course old Endo is the one on call this morning and she told me to "Have him sip water, give normal correction and use the syringe not the pen to deliver insulin this morning...the pen may not be working".....NEVER gave a dose to correct the ketones ONLY the higher BG.

    I have an urgent call in right now to his new Endo.

    Please anyone with insight into why this is happening, or if it happened to you I would appreciate it....
     
  2. Nancy in VA

    Nancy in VA Approved members

    Joined:
    Jul 16, 2007
    Messages:
    7,308
    What was his BG at these times?

    When you change from NPH to Lantus, you'll have to adjust your Lantus and Humalog doses until you get them right. If he has been running perpetually high b/c you don't have the doses right, that could result in ketones. Perhaps your ratios and your Lantus dose need to be changed
     
  3. DsMom

    DsMom Approved members

    Joined:
    Nov 9, 2010
    Messages:
    1,700
    Could be a number of things but, wow, I am so impressed you've avoided ketones for so long!! You should feel really good about your D management skills. My son was sick with a fever and sore throat last week, and we had to deal with Large ketones a couple of times in one week. It used to freak me out, but I treat it much more routinely now (although it still makes MY stomach cramp). Lots of liquids, correct (he's on a pump), and I add about 10% to the correction for the ketones. Usually works like a charm and the ketones are gone in a hour or so (sometimes longer for the Large). We find ketones hard to avoid when he is sick with a bad cold--I'd love to know how you do it.:)
     
  4. grantsmom

    grantsmom Approved members

    Joined:
    Jul 29, 2008
    Messages:
    1,243
    Nancy,
    220 at lunch
    330 this morning. But he went to bed at 143 and was 220 at 3am. He went up 100 points in three and a half hours.

    His numbers have been in range 80 of the time on the pen. Definite improvement over having NPH.

    Please excuse my frustration....his D has been difficult to manage since day one. We have been to three different Endo's in three years. I am so so so so tired of hearing....this is odd...we do not normally see this...there is no pattern.
    BIG SCREAM!!!

    Nurse has not explanation as to why this is now happening...she will ask the Doctor and call back
     
  5. Nancy in VA

    Nancy in VA Approved members

    Joined:
    Jul 16, 2007
    Messages:
    7,308
    If he went up with no food and no fat spike (or other explanation), then he needs more Lantus. If he woke up at 330 after running high all night, that would explain the ketones.

    Sometimes there are just not patterns or reasons. If you are looking to find those and make everything "even keel", then you'll just work yourself into an early grave, because some kids are erratic even with tight management, and some are "easy sailing" even with little management
     
  6. grantsmom

    grantsmom Approved members

    Joined:
    Jul 29, 2008
    Messages:
    1,243
    Nancy,

    The challenge is his waking numbers have been in range every morning for a week except this morning...This is where I struggle.

    Why increase Lantus if it has been working for a week? I do not mean to challenge you...I scares me to change and then have a severe low. He had two unexplained middle of the night lows one and a half weeks ago....that scares me.

    I am faxing her his weekly numbers and the doctor will look at them and advise what to do...


    Thanks everyone...I guess I just need to vent. I have been off the board for a while because I have been so frustrated with D.
     
  7. grantsmom

    grantsmom Approved members

    Joined:
    Jul 29, 2008
    Messages:
    1,243
    DsMom,

    Well..I just always assumed his body just was not prone to Ketones...which did give me some comfort. It was definitely nothing I did..trust me! We have struggled with numbers since DX.

    Hoping new Endo and team will help. I just find it odd that removing NPH has caused ketones twice in two weeks?? SIGH.
     
  8. Mom2dirty

    Mom2dirty Approved members

    Joined:
    Oct 24, 2010
    Messages:
    28
    My son just went through a horrible two weeks with high BG and ketones. He was using a pen Novo Nordisk Jr. We noticed each time he injected his insulin there was a small drop of insulin on the pen. At first we thought it was normal but it turned out it was not. He has switched back to syringes and surprise no ketones high BG. The CDE told me they have been seeing this type of problems with insulin pens lately.
     
  9. grantsmom

    grantsmom Approved members

    Joined:
    Jul 29, 2008
    Messages:
    1,243
    Thanks for that info! We are headed to the ER because even though he now has trace ketones he is having trouble breathing. BG is 225 and we are correcting. First trip to ER since DX almost exactly three years ago.
     
  10. dejahthoris

    dejahthoris Approved members

    Joined:
    Jan 28, 2011
    Messages:
    514
    God bless and let us know he is ok when you get back so we dont worry.
     
  11. Mom2dirty

    Mom2dirty Approved members

    Joined:
    Oct 24, 2010
    Messages:
    28
    My thoughts and prayers are with you.
     
  12. MTMomma

    MTMomma Approved members

    Joined:
    Jun 2, 2009
    Messages:
    242
    Pen needles

    Okay just a thought but is the injection with the pen going well? Moving from NPH to pens would mean changing to pen needles. We had to try a couple different types or needles (various lengths) and new techniques for injection when we went to the pens. I agree with the others who posted about needing to change Lantus and Humalog doses because that sure could need adjusting. (Seems like we are always adjusting) yet it could be an insulin delivery situation too. Sometimes when DS was on small doses via pen (even a unit) I don't think the pen delivered those exact amounts as well as it does now that he takes bigger amounts. We had to be cautious to prime (air shot) enough that any air in the pen resevoir was out with little doses. I want to encourage you to keep trying. I think we went through some time at first using the pen with a short needle that DS was injecting into his upper skin layers and the insulin was not getting in enough to be absorbed correctly.
     
  13. hawkeyegirl

    hawkeyegirl Approved members

    Joined:
    Nov 15, 2007
    Messages:
    13,157
    I would switch to syringes and see if you have the same problems. But I have an irrational hatred of pens. ;)
     
  14. DsMom

    DsMom Approved members

    Joined:
    Nov 9, 2010
    Messages:
    1,700
    I'm so sorry and hope you're both okay!:( Let us know.
     
  15. grantsmom

    grantsmom Approved members

    Joined:
    Jul 29, 2008
    Messages:
    1,243
    Well, I am back from ER...son and hubby still there.
    No Ketones in urine when we got there (yeah) Chest Xray clear. Started an IV and drew blood for full blood work. Did a breathing treatment which increased his lung capacity. Hubby is waiting in ER for blood results and he should be released right after as long as all is ok.
    Doctor is stumped as to cause of breathing issue. He said it is not classic asthma but wants us to go to a specialist and get tested since the breathing treatment increased his lung capacity quite a bit.

    Our son LOVES using the pens. He even injects in sites he would never even consider before. He is using the mini short version...which he loves...but maybe that is causing the problem??? I just do not know.

    I faxed his weeks numbers to the Endo and am waiting to hear back if they want to change his doses.

    Thanks everyone. I have been away from the board for a while...and I just needed to post somewhere that I knew somebody would understand.
     
  16. hawkeyegirl

    hawkeyegirl Approved members

    Joined:
    Nov 15, 2007
    Messages:
    13,157
    We had big problems with the mini pen needles, in that we got a lot of leakback and I was never sure how much got in. We had the same problem with the "regular" pen needles, but not as bad with the short ones.
     
  17. grantsmom

    grantsmom Approved members

    Joined:
    Jul 29, 2008
    Messages:
    1,243
    Thanks Karla...I do have a box of the short needles...I may try them and see if there is a difference. My son will not be happy though...he LOVES the mini
     
  18. hawkeyegirl

    hawkeyegirl Approved members

    Joined:
    Nov 15, 2007
    Messages:
    13,157
    I know. I loved the mini too, especially since at the time Jack cried and fought shots like the dickens. :( I was so bummed when they didn't work for us.

    I guess try the shorts and see if it solves the issue. On the one hand, I hope it's so easily fixable, but on the other, I feel bad that your son has to give up the minis. :cwds:
     
  19. wilf

    wilf Approved members

    Joined:
    Aug 27, 2007
    Messages:
    9,652
    This is obviously not directly D-related.

    We wish you good luck.
     
  20. redheadmom

    redheadmom Approved members

    Joined:
    Mar 26, 2010
    Messages:
    104
    Just a head's up. I'm not sure if the ER told you, but if the breathing treatment contained steroids, your son may run high for a while and require much more insulin than normal. My diabetic nephew runs into this whenever he gets a breathing treatment, and it can be quite frustrating trying to control his blood sugar.
     

Share This Page

- advertisement -

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
    Dismiss Notice