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Need opinions quickly please...

Discussion in 'Parents of Children with Type 1' started by Mojo's mommy, Dec 2, 2007.

  1. Mojo's mommy

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    As per my post , Courtney will not eat, drink. She has blood keytones of 2.1 with a BS on the low end of normal.

    Called the endo, not our's (on call) he first said bed rest and fluids..okay...
    2 hours later tummy is still hurting keytones are up she still will not drink.

    Now he says use mini glucagon, I have no problem with that but she is clearly dehydrated.. should I just disregard his advice and take her for an iv?
     
  2. Mary Lou

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    She won't eat anything? Gingerale (not diet)? Popsicles (not sugar free)? she's the same age as my little guy, Andrew, and he just got over a stomach flu last week. Vomiting, fever, ketones, low BG...

    These are starvation ketones and will clear up with carbs and fluids. I was advised to get something into him and bolus for only 50%, and to err on the side of less, as stomach viruses also can interfere with the absorption of carbs.

    The only thing Andrew could get down was the full-sugar gingerale and full sugar popsicles...

    Within an hour of drinking a can of the soda and eating 1 popsicle, his ketones dropped from 2.4 to .6.

    I'd say that if you can't consume anything, then I'd be preparing for a trip to the ER, but I"d try the mini-glucagon first (something I've never done)...

    I hesitate to add: She shouldn't have a choice in this. You are her parent, and it is a safety issue. She needs to drink and she needs to do it now. Stick a straw in her mouth and tell her to suck. (I know, I'm a harda@@, but I this is exactly what I would do, and have done, no questions or regrets.)
     
    Last edited: Dec 2, 2007
  3. Sarah Maddie's Mom

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    I am not a trained nurse or Dr by any means, but my D mom gut says that she's 6 years old and need to be told that she must have fluids. If she cannot, then there is something wrong and I would take her in to be assessed at the emergency room.
    I know you must be frightened, stay as calm as you can and follow your instinct. Good luck - sending a hug:cwds:
     
  4. Abby-Dabby-Doo

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    Teri~
    If it's a struggle to get her to drink something, and you think it's best or easier to take her in than do so. Is her CGMS in and working?
     
  5. Mama2H

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    Does she look dehydrated? Is her mouth wet, eyes, lips dry? If she looks dehydrated and refuses to drink I would take her to the Er for fluids.
     
  6. Flutterby

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    if you think she's dehydrated I'd take her in as well.. its not just the ketones that are the problem right now.. mini doses of glucagon will help a little but only with the ketones, you still have a problem with dehydration.. if you have a compitent hospital near you.. take her..

    i have done as Mary Lou has stated.. put the straw in the mouth and told her to drink.. and the poor thing sits there and cries, but does drink.. i also tell her that if she doesn't we WILL have to go to the hospital for an IV.. that usually does the trick..
     
  7. Momof4gr8kids

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    Maybe she would suck on a popsicle, or an ice cube?

    The other day Julia had a tummy bug, low bg, and active vomiting. She always goes at it good and wont stop. A big reason is that I always try to raise that low with food to soon after the vomiting. Then I found out my other kids, and I myself go low at that point. We also run high ketones from not eating. Soooo, if there is no dehydration I'd go with the doctor. An E.R. is a horrible place for a kid with diabetes in my experience. They've tried to kill Julia almost every time we've been. Our expirience with the stomach flu and the hospital was so bad that our endo that was opposed to stopping the vomiting with meds actually gave us them after that.
     
  8. kevin@diabetech.net

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    Glucagon causes the liver to dump glycogen (processed sugar in the form your body needs in order to be ready to be absorbed by the cells). Glucagon does not directly address ketones but will raise blood sugar almost instantly and will stop the body from breaking down protein as its source of energy to protect the brain.

    Sounds like the doc said use the Glucagon. Let's be careful about the kind of advice we give on this forum.
     
  9. Sarah Maddie's Mom

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    IMO advice given so far has been reasonable and appropriate.
     
  10. Flutterby

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    I'm not sure what you are getting at.. I didn't go against the dr. advice.. I simply stated that the glucagon will help with the ketones, but not the dehydration.. if she can give glucagon, and insulin to counter act each other, it will help with the ketones..

    not sure why you pick me out.. I've said the same thing everyone else had and in NO way was going again dr. advise..
     
  11. kevin@diabetech.net

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    It was the part that said "...mini doses of glucagon will help a little but only with the ketones" which imo someone could take to mean that glucagon is used to bring down ketones and sounds like it might help only a little as far as bringing blood sugar up. It would be terrible if someone decided to not follow the doctor's advice because they read something here that makes it sound like no big deal. That's all. Nothing personal just thinking about the child on the far end of this typing back and forth.
     
  12. Flutterby

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    and right after I state it would only help with ketones, i said
    I didn't tell her NOT to follow dr. advice either. She's got two problems going on. Low bg with ketones, which the glucagon and insulin WILL FIX and the dehydration, which the glucagon WILL NOT fix. if she can't get her daughter to eat anything that is a problem.

    Her original question was a concern for dehydration as well as the ketones and low blood sugar. From her post it doesn't sound like she was just going to ignore the dr. advice, but rather asked US if she should just head to the ER.. where they'd take care of the ketones, dehydration AND low blood sugar. I simply stated that the glucagon will not help with the dehydration.
     
    Last edited: Dec 3, 2007
  13. Mama Belle

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    I'd like to point out that the following statement isn't entirely true either:

    Sometimes this will happen, but sometimes it will not. If a child has been fighting a prolonged low BG (like in this instance) no amount of Glucagon will be effective because the glycogen stores in the liver have been depleted. To make a blanket statement that glucagon will raise blood sugar almost instantly is not correct. We have used mini-dose glucagon before in a similar instance and it had absolutely no effect whatsoever. Yes, we should always give glucagon a shot first, but it is important to remember that at times it will not work.

    Having said that, my vote is to do as the endo suggested, try the mini-dose glucagon and see if it works. If it does work then you can avoid a costly (and potentially upsetting) trip to the ER for your daughter. If it doesn't work at least you gave it your best effort and you can go to the ER afterwards. While waiting for the glucagon to work, you can start to pack a few things together for a trip to the ER, so you are prepared if she does not come up soon. You can always unpack it later.

    This is a tough situation. We've been there and I would do just about anything in my power to avoid an ER trip. However, her safety is the most important concern, so it is good that you are weighing your options.
     
  14. kevin@diabetech.net

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    So how is Mojo doing this morning?
     
  15. Mama Belle

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    I am curious too!!!
     
  16. Mojo's mommy

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    Mojo is not doing so well this morning,I ended up taking her to emerg last night, they examined her, took blood ran allkinds of tests on the blood. Everything came back perfect except the keytones of course. At that point in time which was 2AM they were 2.0 with the blood keytone meter.

    They sent us home with a positive diagnosis of "Anxiety" tummy pains.

    Not sure if I buy into this or not but I guess I have to accept it for what it is.

    Now, this morning she is still hurting in the tummy, still will not eat and blood keytones at last check were 4.3...

    Not sure what to do at this point
     
  17. frizzyrazzy

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    OMG run her back to the ER - the tummy ache is from the ketones! Are they stupid!!???
    and get the endo on the phone.
     
  18. EmmasMom

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    Her tummy pains are very likely a direct result of her ketones. (This may be rocket science to an ER doc, but it shouldn't be :rolleyes:)
    What is her endo saying now? Did they give her fluids in the ER? Did they tell you what her blood PH or CO2 levels were?

    So many questions... sorry! I just think ER docs can be way too dismissive of serious ketone issues. They are often very uneducated about CWD and clueless about how to manage high ketones in a child that wont eat.

    Is she vomiting or just refusing to drink? If you can get any sugar into her she'll be better off because you can give extra insulin to help stop the ketones. (candy, glucose gel in her cheek, mini doses of glucagon if necessary) If she'll sip some sugary fluids that's even better.
    If she really can not drink, and you've attempted mini glucagon to help bring up BG and reduce ketones, your only choice IMO is to return to the ER.

    I know this is my soap box, but large blood ketones are dangerous, even if they are a result of "starvation". When a child with diabetes has 4.3 blood ketones and you can not clear them quickly at home... you need an IV. Large blood ketones are toxic, they will change your body's PH. They must be stopped and cleared from your body or you will be dealing with DKA soon.

    I'm really sorry you're dealing with this. I know how difficult and exhausting it is! :(
     
  19. Momof4gr8kids

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    Glucogon actually can take as much as 20 minutes to start working or longer given in a fatty spot as with mini doses given in a insulin syringe. Glucagon given as a inter muscular injection works very quickly, and that might be where the thought of instant comes from.
     
  20. Mojo's mommy

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    She is not vomiting, they keep saying that starvation keytones are not the same as keytones from a high sugar. They did not give her fluids at the emerg, said she did not need them.I just checked again and they are 4.2.
    She has had a few small sips of things but her BS is still in range, nothing I can give her insulin for. Her last bolus was yesterday at 1PM of 0.2 units, other than that her basal has been at 40% since yesterday.

    I am going to see if she will eat and then decide what to do from there
     

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