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So here we are...

Discussion in 'Introductions' started by njswede, Feb 9, 2015.

  1. njswede

    njswede Approved members

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    I honestly don't know how close to DKA we were, but he maxed out the ketostick, couldn't keep fluids and BG corrections barely moved the needle on the meter. I'm going to call my endo NP right now, in fact.
     
  2. Snowflake

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    Does "newly diagnosed" really come into it? Just a reminder that not all kids honeymoon, or honeymoon to the same degree (see, e.g., http://www.ncbi.nlm.nih.gov/pubmed/16629716). In our case, my dd never did honeymoon, unfortunately.

    Like njswede, we had our first ER visit for large ketones and uncontrollable vomitting within a couple of months of diagnosis while still on MDI, despite scrupulous adherence to sick-day guidelines. Sometimes home management isn't equal to the nastiest of bugs.
     
  3. njswede

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    Thank you! Yes, I followed the sick day guidelines I got in the handout I got at dx. In other words, try to hydrate, treat highs and check for ketones. Once none of that worked and the ketostix turned dark brown, I didn't really have many options left. Which, coincidentally, was exactly what the on-call endo thought. The ER personnel told me that I did the exact right thing and that they see far too many people who wait until the ketones are already out of control. I mean, I'm not an expert, but no fluid retention, increasing blood sugars, large ketones and minimal response to insulin can't lead to anything good if not treated with IV fluids, can it?

    As for the honeymoon, he's had one and is possibly still in it. However, we've seen strange spikes lately and the endo can't figure out whether it's end of HM or just the sh*tload of viruses going around this time of the year.
     
  4. Megnyc

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    It sounds like you did everything right. For future reference though, instead of the ketostixs you can use a blood ketone meter. The ketostixs measure what was going on several hours ago while the blood ketone meter is real time. Here is a link for a free blood ketone meter. You want to choose the one on the far right. You can get a prescription for the strips from your endo or order them online without a prescription.
     
  5. Sarah Maddie's Mom

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    From your link, a weird definition of the honeymoon,"The honeymoon period was defined as a period with insulin requirements of less than 0.5 U/kg/day and hemoglobin A1c (HbA1c) level of less or equal to 6%."

    As for being in or out of honeymoon, I don't think it's one of those things that's all that easy to see other than in hindsight. And regarding my comment, most newly dxd kids are still making insulin, whether or not you would consider that to be in "honeymoon" and that, plus lantus should offer some protection from full blown DKA.

    In short, I was attempting to tell the OP that it's unusual for 6 hours of illness to result in DKA and they shouldn't fear that every stomach bug is going to land them in the ER.
     
  6. njswede

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    Is there anything I could have done different to avoid the trip to the ER? Luckily, we were pretty much the only people there, so it went smoothly, but I like to avoid the ER anytime I can...
     
  7. Sarah Maddie's Mom

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    Probably not this time around but in the future take some of the suggestions made here, i.e. get a blood ketone meter, stock the pantry with sports drinks and ginger ale, the freezer with popsicles. Have a talk with your endo about starvation ketones, go over any points on the sick day plan that are unclear or confusing and discuss a script for zofran. Sometimes the ER is obviously the only smart and safe thing to do, but most of the time, especially as you gain more experience, stomach bugs can be safely managed at home.
     
  8. Snowflake

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    At risk of sounding repetitive, sometimes an ER or urgent care visit is absolutely necessary for some stomach bugs (like all kids, some T1 kids happen to have weaker stomachs than other T1 kids, just with more serious consequences). But to second Sarah's point, a propylactic zofran prescription is a very useful tool when fighting a stomach bug. Zofran given at home can pause the vomitting long enough for the child to take carbs and keep insulin moving.

    Be aware, though, that some endos and pediatricians refuse to prescribe it when there's not an active bug. Before switching to our current docs, we were unable to get a script for it and had to hoard the dregs of an RX during her first ER visit. Our dd's current providers have been more accommodating when we made the case that zofran had kept her out of the ER a couple of times. Our insurer also declined coverage, thought the $120 OOP cost has paid for itself many times over!
     
  9. njswede

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    This has nothing to do with diabetes... Or does it? As strange as it may seem, his diagnosis has a bit of a silver lining. I feel that caring for him has brought us closer. Here's DS and I doing what we love: Playing with model aircraft, big and small.

    noahdadslick.jpg noahdrone.jpg
     
    Last edited: Apr 20, 2015
  10. deedeep

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    We are on day 8 and I know exactly how you feel. We were DKA at dx and had the 2 day PICU stay but since she stabilized it's been good. I think we're in the honeymoon suite as well. And keep waiting on that shoe to drop. The Nurse educator told us something interesting yesterday. The desired range is a goal and success has you in that range 60% of the time without having too many way out there #s. Thst made us feel good.
     
  11. deedeep

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    Ours has had many silver linings as well. Crazy how life works.
     

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