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Something to Consider RE: 504's

Discussion in 'Parents of Children with Type 1' started by kidsmakes7, Apr 30, 2011.

  1. kidsmakes7

    kidsmakes7 Approved members

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    We had a learning experience this week that we hadn't really considered before when talking about glucagon administration by "third parties" (trained to administer glucagon, but not necessarily very informed about T1 as a whole).

    We learned that, in some cwd's, in certain situations, dka symptoms can be easily confused with symptoms of a hypo to the uninitiated. We also learned that it was important to include a blood check, in order to confirm that he is experiencing a hypoglycemic episode, prior to the administration of glucagon in his 504 plan.

    Case in point. Our son was 2 hours away participating in an 800m track event. Half way though he was visibly in distress and on completion fell to the ground, was half unconscious, very confused, and lethargic. His coach promptly rummaged through the teams first aid bag, produced his glucagon, and was on his way to our son.

    It's rare that at least one of us can't make a meet, but luckily, his younger brother also participates in track and had the presence of mind to poke his brother before the coach got to him. He was 470.

    His brother was able to dissuade the coach ("you'll kill him!") from hitting him with big red, called dad, helped his brother with his novolog injection, helped him get hydrated, and got him to eat a bit. He was positive for ketones, but within a half hour was feeling better and was able to stay for the remainder of the meet (although he didn't participate in any other events). Once home, he still had trace ketones, but we were able to flush them over the next hour or so and get his bg's under control. He was sicker than a dog all night and the next day, but none worse for the wear.

    Long story long--- He had been feeling pretty cruddy all day and had been fighting persistent highs, but exhibiting the logic of a typical "almost 18" year old, had decided that "A", he had to stay in school that day in order to participate in the meet, "B", there was no way he was missing a regional meet, "C", he knew he was higher than we would want him to be, but since he would be physically active anyway, it would be manageable, and "D", if he didn't do a bg check when the meet started then mom and dad wouldn't be able to see he was out of range and went to the meet anyway.

    As for the coach, he did exactly as he had been instructed. He quickly reviewed the chart we had provided for identifying a hypo, noted that our son was semi-conscious, lethargic, sweating, confused, and was fully prepared to administer glucagon, call 911, then call dad.

    As for his brother, he did exactly as he has been instructed. Any time his brother is acting out of character, ask him to do a blood check, or do it for him.

    Granted, illness on top of dehydration on top of extreme physical exertion on top of poor judgment isn't a common occurrence, but adding a 10 second bg check prior to administering glucagon to his 504 plan doesn't seem like such a bad idea to us.

    I shudder to think about what might have happened if his brother hadn't been so quick on the draw to poke him. :)
     
  2. hawkeyegirl

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    Well, the glucagon wouldn't have harmed him, but it certainly wouldn't have helped, either.

    I don't know that I want a BG check in the protocol before administering glucagon. If my kid is seizing, unconscious, or so out or it that he can't take glucose by mouth, I feel pretty comfortable with going right for the glucagon. Glad it worked out for you, though.

    YDMV.
     
  3. dejahthoris

    dejahthoris Approved members

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    Thank Goodness his brother was there, and was so awesome in helping his bro out. I am not type 1 but I bet at 470 your son was feeling a bit fuzzy and needed the help! And kudos for the coach's wonderful good will and helpfulness. I appreciate your sharing this real life story, especially as my son is about to get involved in some sports himself. Thanks! The wonderful thing about these stories is we can learn more about what to do and what not to do from each other's experiences:)
     
  4. mmc51264

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    Thank goodness his brother was there, but that is how the school systems are taught: treat the potential low first then worry about fixing it if it isn't.
     
  5. selketine

    selketine Approved members

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    I agree - the glucagon wouldn't have killed him (hope little brother didn't think that - I'm sure that would freak the coach out to think it also).

    I'm glad your son came out of it alright.
     
  6. irishmom

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    wow....glad things turned out ok.....My son also runs track...he does 110 meter hurdles, 4x200 relay and 4 x 400 relay....we have awesome track coaches...Patrick tests at the beginning of every meet, and prior to every running event he is in..and sometimes they test him after ..and always before he is dismissed...he is in 8th grade and with 90 track athletes I am so grateful our coaches are on this...they know that he will not always remember....and that he will avoid it as well...last night we had a huge conference meet..last relay of the night after 6 hours of events..and I watched Patricks coach have his meter on the track to test him..and check the meter....track has been very challenging for us...but glad that you have some pretty awesome coaches
    as well..
    Marcia
     
  7. TheFormerLantusFiend

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    For Jack, they could just look at the CGMS. Although I can imagine it saying 100 when he's semi conscious from a low, I would be really surprised if it would say 290 or HIGH when he's that low.
    Looking at a CGMS if the person wears one strikes me as a very reasonable thing to do before administering glucagon, but I've had a lot of difficulty getting certain people (namely, my parents) to figure out how to use the meter and check my blood sugar, and actually once had a nurse in the hospital struggle for twenty minutes with a hospital meter to get my blood sugar (it turned out the strip was in upside down).
    So I wouldn't add a blood sugar check as a necessary thing before glucagon because giving glucagon while a person is in DKA is a more minor mistake than not treating a low.
     
  8. kidsmakes7

    kidsmakes7 Approved members

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    Sorry if I gave that impression. I assumed most folks around here would know better and take it as a ''tongue in cheek" moment. :)

    His brother knows better as well, but also knows it would have only made matters worse. The coach wouldn't listen to him and seemed bent on following through with big red, so he said that for shock value. Sure got the coaches attention but quick. lol
     
  9. Lisa P.

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    The first time I checked a bg in the hospital I got a drop of blood, soaked it up into the strip, and inserted that side into the meter. Made sense to me. . . . !

    To the OP, I'm wondering if maybe it was a low and he had a very dramatic rebound. Essentially, his own body did what the glucagon would have done. In which case, I wonder what the effect of a glucagon shot would have been, maybe not much?

    Just this morning (like, 2 a.m.) the CGM read Selah at 138 with two arrows down, I gave her two glutabs and within five (? I was kinda sleepy) minutes the dex was all ???? and she tested at 370. It might have been a bad CGM reading, but my guess is that she rebounded before the tabs even hit her. I would be surprised if a 470 could cause your son to lose consciousness, but I'm sure YDMV, especially with the conditions of dehydration, not feeling well all day, etc. Just a thought!

    Anyway, the takeaway I got from this thread was about family. And very, very encouraging. Good on your kids, and thanks for sharing, I love to hear about family having each others' backs.
    :cwds:
     
  10. Lisa P.

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    Sharp kid.
     
  11. PatriciaMidwest

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    I can see how this could happen. I hope you don't take this the wrong way, but I'd still rather see someone use glucagon and be wrong then have them NOT use glucagon and be wrong.

    I don't want any one to refrain from giving my DD glucagon because they are afraid of making a mistake, or they can't find a meter, etc.

    Your son probably helped him avoid feeling even worse, though, that's for sure.
     
  12. GaPeach

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    KUDOS! I loe to hear that a family member was tuned in and responded well!
     
  13. mmgirls

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    I think this needs to be a learning moment for your almost 18yr old son. He needs to understand that running high before great physical activity can be very dangerous. He needs to be checking for ketones when he can not get his bgs under control prior to a meet. If ketones are present he needs to get them in check and if he can not then he should not compete. There is a difference between running high and no ketones and running high with ketones, the situaution probably could have been avoided.

    I would not rule out a rebound if a large correction was given in attemps to get bg in range prior to the meet.
     

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