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Endo visit today

Discussion in 'Parents of Children with Type 1' started by SandiT, Apr 8, 2013.

  1. hawkeyegirl

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    Why is your husband angry that she is not at school? That is honestly a very odd reaction to a sick child with a fever.
     
  2. SandiT

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    She goes to private school and it's quite expensive. So to him, if she misses school, what he sees is money wasted.

    And I get that. I don't think he's a bad person because of that. But it doesn't feel nice to feel like he's second-guessing me on whether or not she should be made to go to school. I'm not being casual about the expense and just keeping her home because I feel like it, which is how it feels like he sees it.

    It's more me upset by his attitude than anything to do with Kira. He doesn't decide, I do. I just don't like being treated like I'm doing something bad because she's sick. :mad:

    I'm really not feeling supported by him in this. But then again, we were in family counseling prior to this. The need for it hasn't changed, we're just no longer doing it. :rolleyes:
     
  3. sooz

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    How would he feel if other parents sent their children to school sick and infected your DD? it is only common sense to keep your child home, not to mention common decency and common courtesy.
     
  4. Lee

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    Make sure you are checking ketones.
     
  5. SandiT

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    But with all of these wrong things she's telling us (which apparently includes 'diabetic kids take longer to get over illness'), the idea of trusting her on anything makes my stomach knot with anxiety.

    Thank you for the reminder, I did actually forget at her 10 am check because I got focused on arguing about sugar-free popsicles, lol.
     
  6. Megnyc

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    Are you feeding her sugar-free popsicles? You probably already know this but sometimes the artificial sugar they have can cause an upset stomach. Also, they still have carbs in them.

    My parents used to dilute juice with water and freeze it to make popsicles-- you still have to bolus but it is less of a spike then with a typical popsicle.
     
  7. SandiT

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    Not to worry, he has a very healthy double-standard on that one! Though indirectly... he thinks other people shouldn't come to work sick and get him sick and thus make Kira sick.

    Which would be reasonable, if he wasn't so particular about her going to school come hell or high water, lol.
     
  8. SandiT

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    Well. I'm trying to do what my endo (that I don't trust, lol) told me to do.

    Kira's adjustment factor is .5 for 100. So 1/2 unit drops her 100 points. The endo doesn't want me to give her a correction until she's at 300. So she wants me to give her sugar free popsicles until about 10 minutes before her every 2 hour tests. Then I am to give her a sugary popsicle and drive her sugar up so that I can give her an adjustment at sugar testing time.

    She wants me to get her sugar up enough to give her insulin at every single testing period.

    I don't think it's the popsicles making Kira's tummy feel bad, I think it's the flu bug. She was feeling that way prior. On the other hand... when she's not sick, she doesn't get popsicles unless we make them at home. I just hate to give her "sugar free" stuff, especially aspartame (which is the only thing we can find around here for sugar free popsicles).

    The last time that she was sick was right after leaving the hospital, and Boston Children's had me deal with it differently.

    So I don't know. I just don't know.

    We don't have any ice trays right now, and have lost the tops for our popsicle makers. I'm thinking about making some popsicles with the sticks she's getting from these popsicles, though.
     
  9. danismom79

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    Why? Are the ketones going up? And she wants you to correct every 2 hours?
     
  10. SandiT

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    Ketones aren't going up. Her ketones are staying at .01-.03, no more. The doc wants her to be always getting "plenty" of insulin, though. And if she's not eating, the doc wants me to give her sweet pops so she can get her insulin.

    I don't know, this doc is big on "daily recommended dosage" of insulin, apparently. So if she's not eating, she's not getting "enough" insulin, apparently. So sugary pops will bring up her sugar and thus she'll require corrections and thus get enough insulin.

    Which doesn't make sense to me since she's in honeymoon, but I don't know what else to do so I'm just doing it her way. :(
     
  11. danismom79

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    She got her NPH this morning? If so, she's getting insulin. What you'll need to watch out for is the peak. If her ketones aren't increasing, and she's not running high, she doesn't need the corrections. My daughter got her first stomach bug 2 weeks after dx and she was on NPH. The problem I had was getting sugar in (and staying in) because she was running lowish the whole time. Her ketones were fluctuating (highest was 0.4, barely anything) because she wasn't really eating. I wouldn't send her into a cycle of highs and potential lows the way your endo is instructing you.

    In addition, correcting every 2 hours will have you stacking the insulin. You'll be correcting a high that is still being affected by the previous correction. I'd call Children's and see if anyone can help you before your appointment. Maybe not, but it's worth a shot.
     
  12. SandiT

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    Yeah, she's still getting the NPH. She's running high at noon, though, the last 3 days.

    I'll ask our nurse educator at BC and see what she says.
     
  13. mamattorney

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    I'm new like you and just learning. What your endo is telling you is quite different than what the CDE is telling me, but then again, my daughter is on a different regime than yours (no NPH, just Lantus and Humalog).

    But . . . as an outsider looking at the difficulty you are having measuring the correct dose, do you think that your endo could be pushing the carbs for now in order to allow you to more confidently measure her dose?

    I can't imagine being a new patient/parent and having to estimate insulin to the 1/8th of a unit or less. Our pen only measures to the 1/2 unit and so even when we use a syringe, we round to the 1/2 unit and sometimes it takes me a while to be satisfied that I've got that 1/2 unit just right. Being new, between user error/wet injections etc it must be a real struggle to get it right - Maybe she's saying, run her a little high so you can give her at least 1/2 a unit and make it easier on everyone involved.

    I've read the thoughts about diluted insulin and think that that would be brilliant - if the insulin was one quarter strength, it would be so much easier for you.

    I don't know if it's best practice, it's certainly not what I'm being told, maybe that's the thought? IDK.
     
  14. danismom79

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    How high, and is she staying there, coming down, or going up afterwards?
     
  15. SandiT

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    Her sugar was 429 just now an hour after lunch (ketones 0.01), and she didn't eat very much. She had about 30 carbs because she didn't want to eat.
     
  16. MommaKat

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    Can you not switch to BC until May 30, or can they not get you in for your next appt until then? If it's the latter, I'd ask them if they're taking over Kira's care effective immediately and use their on call staff / phone triage RNs for times like this. Chances are you'd be more comfortable with their recommendations, and they might explain things differently in a way that makes sense vs the current endo who seems to like issuing mandates.

    The term daily insulin regimen makes the hairs on the back of my neck stand. It's just so old school. However, that said, that's how NPH was handled - you had a specific amount you gave at set times everyday and forced your child / PWD to eat a set number of carbs at each meal. See the motivation for developing fast acting insulin analogs. Kids don't do well with that sort of regimen.

    As a previous poster mentioned, correcting every two hours will lead to stacking. Also, fever and high BGs can both cause insulin resistance, and both viral and bacterial illnesses cause glucose levels to rise b/c that's what both organisms 'feed off of' so to speak. I know what your endo is saying feels counter intuitive, but sometimes you really do need to provide some carbs along with insulin in order for it to work bringing down bg, especially when ketones are present. If you have access to the pink panther book, there's a really good yet simple discussion of this aspect of sick care.

    Not sure if this would help with your hubby, but many of us have health plans that state a high BG limit at which children should be home under the care of their parent. My dd's is 275 - if she goes over 275 (basically 300) school has to release her to my care without penalizing her for the absence or missed work. I realize it may work a bit differently with your private school, but endos include this in health plans b/c kids who have T1D and are sick do require closer monitoring, ie testing every two hours.

    More than anything - huge hugs to you both. Hang in there. It's tough when our kids are sick, more so when spouses (or in my case former spouses) don't support you. Add an unsupportive endo, and sheesh. I promise, it really does get better.
     
  17. Beach bum

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    This is what we were able to do. All files pertaining to D from the hospital were forwarded by our ped (we worked through the hospital and our ped, didn't even involve the other endo staff) and we reported all numbers weekly until it was time to physically go in for an appointment.
     
  18. SandiT

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    Well, I'm not sure about how transferring immediately like that would effect our attempts to get onto a pump. We already have no choice but to wait until May 1, or I'd have pushed for it right away.

    So I just don't know what direction to go with getting the pump, which I feel we need sooner, not later, with Kira's sensitivity and extremely low numbers.
     
  19. SandiT

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    So, Kira's blood sugar at her snack was 578 / 347 /456... these all taken right in a row. I gave her extra insulin for her breakfast, which I admit was a super unhealthy choice breakfast (I let her have some sweet things on some weekends, so she doesn't get to the point where she tries to sneak them, and so she can feel a little more 'normal' with all this).

    But the box says they're 30 carbs each, I gave her two. Her carb ratio is 1:60. I gave her 1.5 units of insulin. She has never reacted to these quite this strongly.

    She was 224 at breakfast.

    I've tried to get ahold of the endo department at CHaD, and no one has called me back. I finally decided to give her another unit of insulin (1 unit drops her 200).

    But I'm so frustrated right now because I can't get a call back from anyone and BC doesn't have her current records yet.

    *rips hair out*

    Those readings are all high, but all different from each other. I took them 1 after another to be SURE she was almost 600 (oh dear!). She has no ketones, at least. Yet. :(
     
  20. Beach bum

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    Did it happen to be Pop Tarts? Most of us here are in agreement that they are evil when it comes to blood sugar management. Even though we dose correctly, pre-bolus (aka dosing about 15-20 minutes prior to consuming) we still see major spikes that take a fair amount of time to recover from.
     

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