What do you think about this situation?

What do you think about this situation? UPDATE

Update:
DD had her 3 month appointment today so we asked about them. He told us that his pump was malfunctioning and they kept changing sites, but not correcting by syringe when they saw corrections weren't working, so he got super high, running ketones etc. He stayed in the hospital overnight and went home the next day, I'm guessing with a new pump. We got a nice lesson about what to do if/when we have ridiculously high numbers that we can't seem to fix via site change, insulin change etc

We just had a crazy T1D time at Sam's, and not with our own child!

We were sitting at a table and a woman and a boy came up to us. The woman told us that her son remembered Molly from diabetes camp last summer. Molly didn't remember him, because he was 2 years older and in another group, but he remembered her face.

The kids start talking and comparing pumps and we start chatting with his mom and his dad, who had come over. About 10 minutes later he comes over and tells his mom he's doesn't feel good. She takes him to another table and they sit and she starts having him drink some soda they have, he felt low I guess. They didn't have their glucometer on them at that moment, it was in the car.

He went downhill crazy fast. His mom starts panicking because he got super pale and basically catatonic. His eyes were open, but he wasn't really responding to anything. I gave her a couple of Quick Sticks, but before she could give them to him he started projectile vomiting. She is freaking out and said he needed glucagon but they didn't have one. We had ours in Molly's bag so we gave it to them and they gave the whole thing to him.

Dad is finally back, because he had gone off in the store shopping. He tells my DH after giving him the glucagon that he had been running in the 500s for a few days and they were having trouble bringing him down. He'd been 520 in the car on the way to Sam's and they'd corrected him and given him insulin and fed him lunch. Right after the glucagon they ran out to the car to get the glucometer and checked him and he was 186. He's been vomiting on and off for about 10 minutes at this point.

I don't really know much of what happened after that because I pulled DD away after he started throwing up because it was freaking her out.

They called the doctor (our doctor too) who said he thought it might be a stomach bug and not D related, but to head to the ER anyway and he'd meet them there. I think they got him stabilized enough and my DH helped them load up their stuff and get on the way.

I guess I'm just wondering what everybody else makes of it. I was thinking it doesn't sound like a stomach bug, it sounds like ketones to me, with the 520 BS and staying that high or near that high for a few days. Then he did comes down quite a bit really fast, 350 pts in like, 45 minutes...can that make you THAT sick, that fast? I've also been wondering if the glucagon was the right move or not. I'm not criticizing what they did, it was so overwhelming, just looking back in hindsight and wondering what was really going on and thinking through it, what we would do if it was our DD in that situation.

We have no idea what came of it. They got our info from my DH while he was helping them load the car so they could tell our doctor and they wanted to replace our glucagon kit since they used it, but we didn't get their info.

 

I don't know what to make of it, myself. I will say, however, that Kira has run extremely high (mid to high 400s) for multiple days and not had ketones above .04 the entire time. I imagine that they'd been checking him for ketones all along, but you can only assume.

Is it possible that the soda could have brought him up too fast? I would think that maybe if you're dropping super fast and you are feeling very sick, a sudden reversal could be traumatic enough to the body to make you start vomiting even if it's not glucagon. If he was already a bit ill (which would follow with him being in the 500s and not coming down), and suddenly his sugar had a dramatic reversal, it might be enough to trigger the illness into vomiting.

 

Wow how scary. I really don't know but I'd think dropping that fast wouldn't make you feel good. It could be a stomach bug too.

I know when we've had those kinds of highs they were pretty hard to get down.

I'm glad you were there with the glucagon and were able to help them. I hope he's doing ok now.

 

At the risk of sounding judgmental, I'd hazard a guess that most of the folks who frequent CWD haven't ever had a period of days long bgs in the 500s. To me that's tantamount to neglect. Yes we all have bouts of highs and difficult highs but the scenario you describe is one that I can't even begin to unpack. Far too many variables with which I have no experience.

I think you did the right thing offering to give them your glucagon. Whether that was the right medical decision I can't begin to say.

I hope the boy is alright.

 

I agree, I don't think it's at all normal to have multiple days struggling with 500+ blood sugar, but I have no idea what could be going on in their lives. He's 9 so maybe hormones started, maybe a virus? Who knows, right? I did question that in my head though. They also said he could go through up to 3 sites/day with his pump, it was an Animas or Medtronic. I can't tell them apart and I didn't get a good look at it, just enough to see it was a tubed pump. It sounds like he is really rough and tumble. I know if we had to change Molly's pod that often she'd be nearly impossible to bring down because of pod change highs, but they said he goes low with site changes, not high.

So many possible variables, it was a crazy, overwhelming situation.

 

Wow, that's scary crazy. The thing that stuck out to me is I wonder how they knew he was low/needed glucagon vs having some sort of DKA type reaction. I know that doesn't cause the catatonic type reaction you described but I personally would have been scared to give glucagon to a kid who had been stuck at 500 for days. What if he was still high vs being low and you gave glucagon, couldn't that have been really dangerous?

It seems like a weird situation for sure. I've got no insight, sorry!

 

Some kids run really high when they're ill. As I mentioned in another thread, also, when my daughter was sick and we were seeing the endo at CHaD, she actually told us to push Kira's blood glucose UP right before snacks and then give her a correction for it. Of course, she also told me that Kira should be on 15 units of insulin per day and that I needed to be feeding her enough carbs to push her usage up to 15 units.

So before judging them as negligent, you might consider that they were doing what they were told to do by their endo. From having gone from one endo to another within the space of a few months, I promise you that they don't all do things the same way.

It sounds like he was sick to begin with, and then they gave him soda and made his blood glucose reverse direction quite suddenly and radically.

I see frequently on this forum where some folks can tell the symptoms of a high versus a low, and where most can tell the difference between when they're dropping fast versus when they're low. If their son is one who can tell his lows from his fallings from his highs, then I would hazard a guess that they were listening to him and to his body.

I find it a little unnerving that the automatic default answer is neglect by the parents. It certainly upsets us all when parents are accused of neglecting or mistreating their CWD when they give them chocolate or ice cream or other goodies... I'm not sure it's the best idea to point "neglect" fingers at these folks without more evidence of it.

It's easy to drive someone else's diabetes from a back seat, it seems, but it can be a lot harder when you're the one struggling with days of 500s that just won't seem to come down, no matter what you do... and you finally get him down, only to find the next thing you know he's vomiting in a restaurant just when you thought things were finally back on track.

Maybe it's just me, but it seems that the "YDMV" shouldn't be only when it's convenient or when we don't understand what the other people are going through.

 

I don't consider the parents neglectful but I can't imagine an endo in the entire world who would be comfortable with being in the 500s for days on end. This is not a case of following endos orders, of that I am fairly certain.

My son has crazy highs while ill, so trust me, I know about this. If he were ever near 500 and it was sustained, he wouldn't be at Sam's. He was still 520 in the car on the way to the restaurant, it wasn't a case of "finally got him down/back on track."

I don't think there was negligence, I don't know enough about it to come to that conclusion. I know people whose kids run that high fairly regularly and it's less negligence as lack of knowledge.

 

I agree that my daughter wouldn't be out and about if I could help it while her numbers were that high and refusing to come down. I was just saying that some folks are pointing fingers claiming negligence, when it may not be the case. Perhaps since his numbers had finally come down, they thought he was better.

I don't think I would have handled their situation the way that they did, but then again, my daughter wouldn't know a low from anything else, so perhaps I would if I could trust her to know she was super low.

I do agree the situation in general sounds strange, I just hope that the OP gives the family the benefit of the doubt, as it sounds possible it could be at least a friendly acquaintance-ship, which could be helpful to the kids involved.

 

Yeah, no.

There is no scenario in the world in which a kid is running in the 500's for days and is out and about eating lunch and whatever one does a Sams and there's no bg tester handy and YDMV applies. Not one.

 

Your daughter is currently on Lantus & was on NPH prior to that? Generally speaking, you're not as likely to see higher ketones when using long acting. The child in question is on a pump, so no long acting. Since you seem to be moving towards pumping, that's important info to keep in mind.

 

Perhaps what a person knows at 6 months past diagnosis doesn't really lend itself to determining what is normal diabetes management. There is YDMV and there is basic management. And in this situation I see a lot of things that are so far off basic management that it's hard to say "oh it's just diabetes."

But for the OP - I'm not really sure we can know for sure what happened. I mean.. who knows. If they let the kid run around in the 500s for days yet strips were left in a presumably warm car, can we really know that anything else they were doing was accurate? Counting carbs?Checking sites? Checking ketones?

Who knows. What I do know is that giving glucagon when it's not needed can never hurt. Not giving it can. So you did the right thing.

 

Is this really true though? If he had been in the 500s still and NOT low, what would glucagon have done? Not being snarky in any way, trying to understand if giving glucagon when in doubt is always the best option. Had a situation once where couldn't find a meter that worked, wasn't sure if kid was high or low, couldn't rouse him (different situation altogether, stayed up all night situation), freaking out, etc. He was HIGH, not low.

Asking for input here, is glucagon ever dangerous, given to a kid who is high?

 

I'm pretty sure we were told when in doubt glucagon. But then the whole hospital thing is kind of a blur.

We don't know specifics. If my kid were running that high I wouldn't be out and about but that's just me. And we have left a meter in the car here and there on accident so things happen. I don't carry glucagon on me either.

Very good question on the glucagon if it were a high though. Hopefully someone knows.

Edited to add: The pink panther book mentions glucagon may cause vomiting.

 

well, maybe "never hurt" wasn't entirely accurate. Maybe "not do serious harm" might be better? I'm more than willing to edit the above if we can figure out what the best terminology would be... (and I know you're not being snarky or challenging. I'm happy for the discussion.) We've always been told that it is the best option though, when in doubt. But now that you mention it, I don't think i've ever really thought about it too much.

If you think about it, if he's only "just high" then glucagon is only going to make him higher it isn't going to start any other body chemistry that will make a high situation any worse. If there are already bad high problems (ketones, ketosis beginning etc) then the glucagon isn't really going to exacerbate that - it will just make BG higher. But the real trouble has already happened. On the other hand, NOT giving glucagon to a person who is low and unconscious might actually be the turning point in a life or death situation.

 

The vomiting could have been from illness/stomach bug, due to the sudden drop or who knows what.

My daughter is very catatonic or blank stare dazed with a high or low BG.

Recently, my dd had been "stuck in the 200's" for days. Lots of adjustments and she was finally staying in range. One night, she awaken and called for me feeling very nauseous and felt that she was going to vomit. I checked her BG and it was 99. BUT my gut told me to check ketones anyway. It was 4.2 on the Blood Ketone meter or very large. In spite of the 99, I gave insulin to clear the ketones. Good call - her BG climbed over 200 within 15 minutes but the ketones came down to 2.? She never vomited - just laid in the bathroom floor moaning. Gave more insulin and then ketones reduced to 0.1 within the next 2 hours.

Why? Who knows the diabetes educator was stumped. Sometimes diabetes is weird and has no rhyme or reason.

 

Sometimes you just have those sucky highs. At Easter time we were traveling to see family and no matter what we did we could not get Taylor out of the high 400's. Granted it wasn't a few days worth of highs but it was over 8 hrs of highs. You just cant judge what is going on in other peoples lives.

 

He was throwing up before the glucagon, but I was worried afterwards that it was going to exacerbate the situation.

We have the same endo so I have a pretty good idea the suggestions that they would have gotten from our doc and running high for days isn't something he would ever condone. I am not assuming they were negligent necessarily, but watching and experiencing the situation has me wondering what was really going on an what we would have done in a similar situation.

 

Yeah, I agree. They were treating being stuck in the 500s for days WAY too casually for it to be an uncommon occurrence for them. I don't know exactly what happened, but I'd bet you dollars to donuts it was neither the first time he was stuck in the 500s for days nor the first time they have used glucagon.

 

I'm not going to judge any parents management of diabetes,but thank goodness you were there any so willingly gave them Molly's glucogon.
Is it normal to go out without a meter,insulin,or glucogon? Sophie has a backpack with all of her supplies and we never go anywhere without it