- advertisement -

Need help--ex lg ketones

Discussion in 'Parents of Children with Type 1' started by WendyTT, May 9, 2010.

  1. WendyTT

    WendyTT Approved members

    Joined:
    Jan 7, 2008
    Messages:
    343
    I have a question--Lindsay has been throwing up since around midnight--throws up about once every hour. Her blood sugars were pretty low during the night--we checked every hour and they were anywhere from 66-80ish. We were giving her regular sprite but she couldn't even keep that down. At 3am she had just trace ketones. Now at 9am her blood sugar hovers around 130 but we have extra large ketones with nausea and vomiting. I think the nausea is now from the starvation ketones, not the virus. I know the ketones must be treated with insulin but she just won't drink much of the sprite nor does she feel like eating anything. So just how do we get rid of the ketones if we can't give insulin? And at what point do we go to the er?
     
  2. Lawana

    Lawana Approved members

    Joined:
    Oct 6, 2008
    Messages:
    383
    This is a potentially very serious condition. you need to be in contact with your endo on call. Do you have guidelines for sick days? Generally, ketones need insulin. Even with bg 130, you need to be giving insulin. Can she eat popsicles? Little sips of drinks with carbs? You need to be agressively pushing carbs.
     
  3. SarahsMum

    SarahsMum Approved members

    Joined:
    Dec 30, 2008
    Messages:
    47
    Ive been in this situation before

    We give a "rescue dose" of glucogon, for us its 4 units of glucogon which is enough to raise her sugars enough to give a small bolus of insulin to clear out the ketones.

    I would be calling your endo, the vomiting is most likely from the ketones.

    How high are the ketones?
     
  4. selketine

    selketine Approved members

    Joined:
    Jan 4, 2006
    Messages:
    6,057
    Under this circumstance I would go on to the ER - if nothing else to get her hydrated with i.v. fluids.

    Call the pedi endo immediately if you haven't yet.

    If she has thrown up that many times I'd be at the ER. Ketones are more immediately dangerous with high blood sugar but even with low blood sugar you can develop a serious situation.
     
  5. Mike&Dans.Mom

    Mike&Dans.Mom Approved members

    Joined:
    Apr 2, 2009
    Messages:
    388
    I would take her to the ER. This is a pretty serious situation.
    We've been in this situation before - nothing we could do at home worked.
    She probably needs an i.v. to help flush out the ketones.

    Our endo says large ketones and vomit = er room.

    Good Luck
     
  6. WendyTT

    WendyTT Approved members

    Joined:
    Jan 7, 2008
    Messages:
    343
    I don't know how high the ketones are--we don't have a blood ketone meter--just the urine sticks. She gets ketones very easily--but always from a pump site gone bad and we treat the high bs with insulin and can manage everything at home. We've always avoided the ER with ketones since we can manage the high bs. I just don't know how to treat when the bs is in range. I did manage to get her to eat some Froot Loops with no milk and she drank a good bit more sprite just now. She says that helped her stomach--I'll give all that some time to get the bs up enough to treat with insulin. Does that sound about right? Anything else I can do at this point?
     
  7. Colleen

    Colleen Approved members

    Joined:
    Apr 18, 2008
    Messages:
    805
    With the ketones you need extra insulin. It is based on her TDD of the insulin. Call the endo to get the recommended amount of extra insulin you need to give to flush out the ketones, and keep her drinking fluids.
     
  8. Ladyboss

    Ladyboss Approved members

    Joined:
    Jan 17, 2010
    Messages:
    7
    Hi Wendy - first, a big hug going out to you, Lindsay and the family. Hang in there. My son just recovered from a 5-month rollercoaster of illnesses that sent his Diabetes into a tailspin. One of his recurring issues was "normal" BG's but large ketones. For him, it usually meant something else was "coming on." Does your clinic have an endo on call? If so, I would light up his/her phone frequently. I do agree with others that this may be an ER issue but if your clinic is like mine, we jointly prefer to home manage - if this is the safest option. Thus, during one of Jordan's "spells" I had regular phone contact with endo and our assigned nurse practitioner to manage. When he is unable to eat, popsicles, non-dairy smoothie w/ added carbs, once we had to use glucagon, and my favorite - Pedialyte. Love, love, love it!

    If nothing else, I would annoy the *$#* out of her endo!

    Happy Mother's Day and good luck!

    d
     
  9. AlisonKS

    AlisonKS Approved members

    Joined:
    May 16, 2007
    Messages:
    2,391
    btdt, had to go to the ER then was transported to a PICU because he needed an iv with sugary stuff and an iv with insulin-but at that point he couldn't keep a thing down. hope the fruit loops stay down! You can also try full sugar jello and ginger ale.
     
  10. Lizzie's Mom

    Lizzie's Mom Approved members

    Joined:
    Oct 2, 2009
    Messages:
    323
    Oh I hope she's doing better. We've only had one throwing up incident since dx and dd did really well. I gave her 1/4 glucose tablet to suck on every 15-20 minutes and she would sip tiny sips of water (wouldn't drink soda). One carb brings her up about 10 points, so we were able to keep carbs, fluids, and isulin in her that way. Just sucking on the glucose tablet didn't upset her tummy further and the tissues in her mouth absorbed some of the carbs, so even if she woofed part of the fluids, we could still keep up with giving her insulin.
     
  11. Lee

    Lee Approved members

    Joined:
    Oct 5, 2006
    Messages:
    9,633
    Low BS and HIGH ketones are not something you want to mess with. I hope you call your edno ASAP.
     
  12. Becky Stevens mom

    Becky Stevens mom Approved members

    Joined:
    Oct 14, 2008
    Messages:
    8,719
    Oh crud!:( We've had to bring Steven to the ER at childrens a few times for this. The ketones cause the vomiting which in turn cause the ketones to get worse. Often the only thing to do is get them IV fluids to break the cycle. Im sorry you have to spend Mothers day this way. I hope things improve in a hurry
     
  13. WendyTT

    WendyTT Approved members

    Joined:
    Jan 7, 2008
    Messages:
    343
    Thanks so much for the replies. Update--I did talk to endo. They said to give her insulin via an injection--even if her bs is normal. That scares me but I guess that's the only way to get rid of ketones. She hasn't thrown up in at least 2-3 hours but still has a bad tummy ache and at last check, ketones were still large with the urine sticks. Will check again in a couple of hours after injection. Thanks again so much--maybe I count on this website TOO much since I checked here before calling endo!!
     
  14. Sarah Maddie's Mom

    Sarah Maddie's Mom Approved members

    Joined:
    Sep 23, 2007
    Messages:
    12,521
    I'm sure you know this, but just to be sure, remember that the "ketones" you are seeing on the pee stick are hours old and you'll want to be extra cautious giving insulin based on those readings alone. I think it's always important to look at the whole child, not just the numbers when evaluating the risk of a given situation.

    Good luck! And I hope she continues to improve :cwds:
     
  15. Becky Stevens mom

    Becky Stevens mom Approved members

    Joined:
    Oct 14, 2008
    Messages:
    8,719
    Wendy the belly ache is probably from the ketones now. Did the endo say anything about minidose of glucagon if her BGs should go down after giving insulin. Im hoping she has steady improvement
     
  16. WendyTT

    WendyTT Approved members

    Joined:
    Jan 7, 2008
    Messages:
    343
    Ketones are finally negative--she's had them all day--they were down to moderate by afternoon and slowly went down since then. It's never taken so long to get them completely gone! Had to do two injections of insulin along with pump basal. She is just now getting out of bed--she is very weak of course but did manage to keep down a Subway sandwich. She hasn't thrown up since around lunchtime. Thanks so much to everyone for their advice/help--yall are awesome! Happy Mother's Day to us all! Not how I envisioned spending my Mother's Day but at least I have two wonderful children in which to celebrate Mother's Day--I feel so blessed, despite the rough day!
     

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