After struggling through Saturday evening with keytones, we put Thomas to bed in the 300's, with keytones going down. At 9:30 things looked good, with a number nicely in range. He needed a correction (by injection) again at 11:30, but the keytones were still low. I kept the temp basal up for another hour, just to see if I could keep the keytones at bay for good.
Tom checked at 12:30 - great number -165, but he didn't check the keytones. Why, you ask, did Tom not check the keytones when the whole problem has been keytones, not BG numbers? Yeah, I don't know either.
4 AM...BG is 59 (How! Did it get. So. Low). Keytones are 1.2 (What?!?! His BG is 59). UGH.
So Thomas was treated to a 4 AM gatorade to bring the BG up (97 by 4:30, with keytones down to .5), followed by a 4:30 yogurt drinkable and an injection to cover/bring the keytones down. Assisted by a 2 hour increase in the temporary basal rate. I was treated to a few waking hours from 4 - 6 making sure I didn't kill my kid with insulin. Oh wait, that's not a treat.
7:45 AM - BG 114, Keytones 0.1. Ahhhhhhhh.
Hopefully we can stay more on track today.
If there is an upside here, I suppose it is that the whole keytone situation is easier to manage with the pump. Certainly there is no way to do a temp basal rate without the pump, and with MDI there would be ongoing concern about the IOB from a long-acting insulin. Of course, the 'freedom' of the pump seems to be what is getting us into this keytone trouble in the first place, but that just might be a whole separate post.
Showing posts with label Diabetes complications. Show all posts
Showing posts with label Diabetes complications. Show all posts
Sunday, July 6, 2008
Saturday, July 5, 2008
Geocaching, traffic and...keytones. Oh My!
It was a definite non-beach-day today, so we decided to embark on an "adventure" with the Earleys and explore some of the caches in the Nickerson State Park in Brewster.
The day started off traffic-y - which shouldn't have been a surprise, I suppose, for Saturday July5th on Cape Cod. Out of character, Tom hadn't objected when I mentioned our plan - but then again, he wasn't coming.
We did make it to Brewster within an hour, and had a great time searching for (and finding) a couple of caches overlooking Cliff Pond. A great spot, and fun finds.
Stupidly, though, I let it go too long without a big meal for TJ. (Supposedly with the pump he can skip meals, but this hasn't been our experience...those "starvation" keytones come on fast.) His numbers were great - staying right around 120 all afternoon, and he did have a snack and bolus at 2:00. But by 4:30 he was complaining, and I could tell he was getting keytones. Sure enough, his BG rang in at 126, but his keytones were climbing - technically OK, but still higher than I would like - 0.4. Mikey helped him with a bolus and a snack while we sat in traffic with a capital TRAFFIC and I found myself understanding my fathers lifelong resistance to Cape Cod.
Suzanne navigated us around a bit of route 28, and we hit a Sea Food Sams. TJ was still belly-aching (quite literally, I'm sure), so I bolused a little low for his 3 mozzarella sticks and bowl of chowder, not sure of how much he would finish (not to mention totally clueless as to how many carbs are actually in 3 mozzarella sticks and a bowl of chowder).
TJ seemed better, but when we got home (in much less traffic, I might add) he started hanging his head over the pot. UGH.
6:30 PM - BG is 446(!!!) and keytones of 1.4. Injection of 2.5 and temp bolus of 125% for 30 minutes.
7:30 PM - still a wet rag. BG is 460 and keytones of 1.7. Now we're going in the wrong direction.
A call to Joslin let us know we were doing things right, though (something I never mind hearing), and the doctor on call had us bump the temp basal up to 150% for 4 hours.
8:15 - he's down to 334 and keytones of 0.4. Phew! Not out of the water yet, but in the right direction. At least we can put him to bed.
9:30 - 143. Keytones of 0.2. Ahhhhh.....
Are we out of the woods yet? Time will tell. The last time this happened we fought keytones for a couple of days, but 0.2 I'll take.
The day started off traffic-y - which shouldn't have been a surprise, I suppose, for Saturday July5th on Cape Cod. Out of character, Tom hadn't objected when I mentioned our plan - but then again, he wasn't coming.
We did make it to Brewster within an hour, and had a great time searching for (and finding) a couple of caches overlooking Cliff Pond. A great spot, and fun finds.
Stupidly, though, I let it go too long without a big meal for TJ. (Supposedly with the pump he can skip meals, but this hasn't been our experience...those "starvation" keytones come on fast.) His numbers were great - staying right around 120 all afternoon, and he did have a snack and bolus at 2:00. But by 4:30 he was complaining, and I could tell he was getting keytones. Sure enough, his BG rang in at 126, but his keytones were climbing - technically OK, but still higher than I would like - 0.4. Mikey helped him with a bolus and a snack while we sat in traffic with a capital TRAFFIC and I found myself understanding my fathers lifelong resistance to Cape Cod.
Suzanne navigated us around a bit of route 28, and we hit a Sea Food Sams. TJ was still belly-aching (quite literally, I'm sure), so I bolused a little low for his 3 mozzarella sticks and bowl of chowder, not sure of how much he would finish (not to mention totally clueless as to how many carbs are actually in 3 mozzarella sticks and a bowl of chowder).
TJ seemed better, but when we got home (in much less traffic, I might add) he started hanging his head over the pot. UGH.
6:30 PM - BG is 446(!!!) and keytones of 1.4. Injection of 2.5 and temp bolus of 125% for 30 minutes.
7:30 PM - still a wet rag. BG is 460 and keytones of 1.7. Now we're going in the wrong direction.
A call to Joslin let us know we were doing things right, though (something I never mind hearing), and the doctor on call had us bump the temp basal up to 150% for 4 hours.
8:15 - he's down to 334 and keytones of 0.4. Phew! Not out of the water yet, but in the right direction. At least we can put him to bed.
9:30 - 143. Keytones of 0.2. Ahhhhh.....
Are we out of the woods yet? Time will tell. The last time this happened we fought keytones for a couple of days, but 0.2 I'll take.
Friday, April 4, 2008
Seeing the Future
When Thomas was admitted to Children's Hospital almost a year ago, the constant message from the doctors, nurses, social workers, and child life staff was "you can do it." A large team of (very-well paid) cheerleaders, the CH crew made it their goal to drive home the message that life with diabetes was manageable, even swell.
Part of this, I'm sure, is survival on their part. There is a lot that parents (and children) need to absorb in a short time. In order to confer the most basic and important information, and be sure it sticks, the staff needs to focus on it and only it. The checklist is out during every meeting, and the staff is slowly but surely checking off all the requisite skills: drawing up insulin - check; treating a low - check; counting carbs - check; planning a meal - check; and the list goes on an on. There is just not time enough in the three or four days to dwell on anything but the necessary, and in order to do that, they need to keep parents in an up-beat "you can do it" frame of mind.
But even with all the cheerleading, the concerns creep in. At first, my concerns fell into one of two categories - self-centered or Thomas centered. Will we be able to eat out? Will we be able to leave Thomas with a sitter? Will he be able to play at his friend's houses? Will I have to quit my job. The worrying was endless, but it was all about our lives at the time.
Now, though, almost one year later, my worries have grown to those topics that were pointedly avoided at Children's: the life-long complications that diabetes carries with it. Although no doctor has laid the "risks" of type 1 out for us, it has become clear that there is not a part of TJ's body that is not open to the devastation that D can bring with it. Dentist appointments and check-ups - previously a nagging but minor concern - are now at the front of my mind. Diabetes advertisements that were background noise before are now red flags. The ubiquitous "ED" ads that once made me blush now remind me that if, in fact, I don't keep those numbers under control the consequences will resonate in every part of TJ's adult life (even the parts I would otherwise choose not to think about.) "Will he be able to go over a friend's house" has been replaced by "Will he see his grandchildren?"
In reality, none of us can see the future for our children. There are many tragic endings all parents avoid thinking about. Will diabetes ultimately get the better of Thomas, or will there be a cure in 15 years. No one knows. Each high or low number on the meter (heck, each test on the meter) stands as a reminder that we might not be doing enough to keep these complications at bay. But, today, almost one year in, Thomas is a healthy, happy boy who happens to have diabetes. And that is as far into the future as I can see.
Part of this, I'm sure, is survival on their part. There is a lot that parents (and children) need to absorb in a short time. In order to confer the most basic and important information, and be sure it sticks, the staff needs to focus on it and only it. The checklist is out during every meeting, and the staff is slowly but surely checking off all the requisite skills: drawing up insulin - check; treating a low - check; counting carbs - check; planning a meal - check; and the list goes on an on. There is just not time enough in the three or four days to dwell on anything but the necessary, and in order to do that, they need to keep parents in an up-beat "you can do it" frame of mind.
But even with all the cheerleading, the concerns creep in. At first, my concerns fell into one of two categories - self-centered or Thomas centered. Will we be able to eat out? Will we be able to leave Thomas with a sitter? Will he be able to play at his friend's houses? Will I have to quit my job. The worrying was endless, but it was all about our lives at the time.
Now, though, almost one year later, my worries have grown to those topics that were pointedly avoided at Children's: the life-long complications that diabetes carries with it. Although no doctor has laid the "risks" of type 1 out for us, it has become clear that there is not a part of TJ's body that is not open to the devastation that D can bring with it. Dentist appointments and check-ups - previously a nagging but minor concern - are now at the front of my mind. Diabetes advertisements that were background noise before are now red flags. The ubiquitous "ED" ads that once made me blush now remind me that if, in fact, I don't keep those numbers under control the consequences will resonate in every part of TJ's adult life (even the parts I would otherwise choose not to think about.) "Will he be able to go over a friend's house" has been replaced by "Will he see his grandchildren?"
In reality, none of us can see the future for our children. There are many tragic endings all parents avoid thinking about. Will diabetes ultimately get the better of Thomas, or will there be a cure in 15 years. No one knows. Each high or low number on the meter (heck, each test on the meter) stands as a reminder that we might not be doing enough to keep these complications at bay. But, today, almost one year in, Thomas is a healthy, happy boy who happens to have diabetes. And that is as far into the future as I can see.
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