Help Please Dr. not returning call!!!

Yesterday my son was coughing and had a slight fever. I kept him home from school and although he was high he was eating and had no ketones. This morning he said he felt a little better but I let him stay home for one more day of rest! His fever was gone and he had 2 slices of toast for breakfast! #'s stil a little high, 205, but he has been for about 2 or 3 weeks( not sure if he is growing or coming out of honeymoon or what) Anyway, after breakfast he checked his ketones and LARGE!?!?!?!?
What do I do?????
I have a call into the endo but that was an hour ago!
Advice?

 

I have him drinking water but I don't know what else to do !

 

Did the endo call back yet?????

 

Whenever Kayla has had large ketones (which was twice) her endo said drink lots and lots of water and give extra insulin as often as 2 hours. We've been lucky that the water and inslin have taken them down fairly quickly. I fogot how many oz to have within an hour (I think I usually have her drink 4-8), but I'm sure you have others chime in with some advice.

 

He needs more insulin to combat the ketones. Depending on his blood sugar, you should give more insulin with a carb drink if too low or just with the water if he is high. Keep checking blood sugar often to make sure that the ketones go away and no low will occur.

Good luck and I'm sure the doctor will call soon--maybe try again

 

Jolene,

You have the right idea about giving him water to flush out the ketones. Good thinking! He also needs more insulin to get rid of the ketones. If he is tolerating food give him something to eat and give insulin. If he will not eat try giving him something like ginger ale or some other liquid with carbs. I didn't notice if he is pumping or MDI. You may need to increase his insulin to clear the ketones as well.

I am sure someone else will chime in soon with some other ideas. If you do not hear back form endo soon I would put in another call to them.

 

No word from the Dr. yet! Pushing the water. He had his insulin with breakfast but just what he would get on the slidding scale we are still on! Just checked ketone and now they are small!!! BS 217

 

pee stick ketones? Or blood strip?

And did he eat much yesterday?

 

pee stick!
He has been eating normally!

 

That's great!
Small on the pee stick *COULD BE* negative with the blood ketone strips.
Do you have any of those?
Anyway, the fact that he's down to small is great!
Can't believe your endo isn't calling back though!

 

Hey there:cwds: Looks like things are starting to settle down.
You're doing well. Keep checking BG as usual.
I hope the endo calls you back asap. It is so frustrating when we feel nervous that we don't get someone at the other end of the line. But you're doing really fine, and hopefully BGs will keep going down.
With ketones, there is some insulin resistance, so more insulin is needed to bring BG down. Very scary to be aggressive at these times. I know I always feel nervous.

Definitely try to get the Precision Xtra Meter - it tests blood glucose and blood ketone levels using DIFFERENT test strips. The strips are pricey, so see if they are covered at all under insurance.
Here's a link about it:
http://www.childrenwithdiabetes.com/d_0n_030.htm

Good luck and hang in there!

 

OK, down to a trace !!!!

Is that normal?
To go from Large to a trace within 2 hours????
No call back yet!
Very annoying!
Thank goodness for you guys though!

 

The pee stick is telling you what went on in his body hours ago. If he's feeling better, eating and not complaining of nausea or stomach discomfort, then I think you can relax and just concentrate on regular old sick kid comforts.

 

I'm thinking he had starvation ketones. Usually when my daughter is sick, she gets starvation ketones really easily because her body is working so hard to fight the illness. Feeding and insulin usually clears starvation ketones REALLY QUICK - we have cleared them in an hour easily. With the pee stick being so behind, you were probably seeing ketones that were there overnight.

Usually with large ketones, add 20-30% insulin on top of what you are giving for carbs to treat the ketones - the ketones will take the insulin away from the food, which is why the highs.

 

See thats why I finally convinced our endo to get us a blood ketone meter. I want to know whats going on in his body now, not hours ago. If you test w/ urine strips now and it says large, and thats from say 3 hours ago, if you treat the large ketones that really arent there anymore with insulin, couldnt that result in a severe low? See, that confuses me.

 

I just wanted to add that my understanding is that water does not flush away ketones. The only thing that gets rid of ketones is insulin. Someone correct me if I'm wrong, but I think the reason that they tell you to push water when ketones are present is because usually you see high BG with ketones, and your child is likely dehydrated from the high BG.

So water, while not harmful, will not clear ketones. Only insulin does.

 

Can't thank you all enough!
Still no call from Dr. and we are NEG !YAY!
I gave a little extra insulin with lunch so now I guess I'll just watch for a low !
You guys really are the best ! Thanks for being here when the Endo isn't ! <3

 

Perhaps the ketones came from not eating overnight (of course) and that he is sick - sort of modified starvation ketones. You can run ketones and have a low blood sugar too - it gets complicated.

The Precision Xtra meter is great - we pay OOP for ours and it is worth it.

I would seriously expect your pedi endo has some explaining to do. If he/she isn't around to return the call then someone should be covering. Unless he/she had some major personal emergency going on at the same time I would look for another doctor. You can't be left like that if you really need them. If he is ever vomiting and large ketones and your doctor wouldn't respond within about 10 mins - I'd go to the ER right away.

 

I'm not so sure. I hope someone knows.

I would think that the water does actually help clear them (besides preventing dehydration) because when fat is broken down and ketones result, I think this happens in the kidneys too, so water would actually help "flush" them, right

Don't take my word for it. Just trying to think about it

 

I'm not 100% sure either, but I think that while water may get the ones out of the urine faster (by producing more urine), it doesn't stop the body from making the ketones. Only insulin does that. The making of the ketones (the breaking down of fat for energy) is what you want to stop. Once they're in the urine, the damage is done, to my knowledge. So technically, yes, water may get them out of the urine faster, but I don't think that's particularly helpful. Does that makes sense?

ETA: Paula, I'm going to start a thread on this so that maybe others who wouldn't necessarily see this thread, but might have some knowledge will chime in.