You get the picture?
Can you begin to create it in your mind's eye?
The slimy partially digested pasta, with the chunks of masticated chicken mixed with the tomato-sauce-laced-chyme (you all know I am a descriptive writer by now ~ sorry, couldn't help myself). Loads of this dish was up heaved last night; some of it all over the master bed's white pima cotton, plush thread count sheets... some of it in the stainless steel, "FBB" (family barf bucket).... I was up every hour and a half to two hours tending to vomit, blood sugar checks, blood ketone checks. I was determining when to give insulin to drive the ketones down. I was walking a fine line of safety between lowish blood sugar levels, ketones, and a barfing, somewhat dehydrated kid.
There is nothing, nothing, nothing, and I mean nothing that instills fear in a D' Rent like a Vomit Bug. Vomiting, low blood sugars, ketones, and dehydration are a slippery, messy, dangerous terrain to find yourself in. I hope that in writing our play-by-play (with 'Reyna descriptors') that I let other Vomit Comet D'Rents know that they are not alone when facing Emesis As Their Nemesis.
First off, I guess I should start with the whole I am not a doctor bit. Nor do I dream that I am a doctor bit. Nor do I ever wanna be a doctor bit. Please, for the love of God, get some medical advice if you are in this situation and are either a) new to diabetes or b) you don't know what the fuck to do. Do not say that 'Reyna, from Beta Buddies, told me to perform honey massages on my child's gum tissue while stabbing my kid with mini-doses of Glucagon'. They will think you are nuts.
Here is how things went and are currently going down: It has not been pretty between the barf, the ketones, the lows, the honey on gum tissue massages, the Mini-Glucagon Dosing, and the need to keep a very 'On The Go Joe' inside on a snow day.
5pm: Joe's BG 96 ~ The said Chicken Marguerite was consumed, all 42 carb grams worth. Joe seemed in good health. We "Pinged" him with a bolus.
6pm: Joe schooled me at Chess.
7pm: Joe's BG 101
10pm: Joe's BG 56 ~ 12 grams-worth of Glucose Tabs were "mother birded" to a slumbering Joe.
11:45 pm ~ "Beep...Beep...Beep" followed by "UhNHHH...UhNHHH...UhNhhh". Dexter was beckoning me...calling me. Joe was low. Dave had been up and checking Dexter for the past hour and a half. Dave had been continually feeding Joe sugar over the past hour or so, awaiting Dexter to give an arrow up...some sign of a "glycemic comeback".
12am: BG 85 ~... Joe was whimpering ...stating that this was the 'worst night I have experienced to date' (his verbage is mature even when times are dire). He was clutching his stomach. He was writhing in discomfort. He finally 'blew' his gastric contents all over my bed. New pants were placed on Joe, sheets were changed, vomitous was washed off the soiled sheets. The sheets were placed in the washing machine. Joe's blood ketones were 0.7. I do nothing. I wait. I have experienced a few of these GI illnesses in my type 1 kid. I was comforted by the mini-dose Glucagon protocol. I was comfortable letting the ketones hang up to about 1.o, or so. In my exhausted state I forgot that we were getting slammed by a blizzard and that "outside help" would be difficult to obtain, if needed. Ignorance was bliss.
2am: BG 110, blood ketones 1.1 ~ Joe "ralphed" again. I waited. I was still not ready to initiate the mini-glucagon protocol. I was not ready to crank up a temp basal AND I was not ready to bolus.
4am: BG 155, blood ketones 1.5 ~ The Chicken Marguerite was not very "discreet" and made yet another tomato-y appearance. I am more comfortable with the BG of 155. I am not comfortable with the direction of the ketones. I correct with 0.25 units of insulin.
7am: BG 143, blood ketones 1.1 ~ Joe was ready to try sips of water. A correction 0.25units of insulin was given.
9am: BG 85, ketones 1.3 ~ Joe wanted to try a little breakfast. For this, I was thankful. I was hoping the first WHOPPING dose of insulin would smack those ketones down to size. He ate. I waited to bolus. I waited to make sure his evacuous stomach would tolerate the food. It did. Joe stated he felt 'fine'. I bolused....I gave him a 2.9units for a 44gram breakfast. I used a slightly softer ratio than his normal setting. I was sensitive to the slowed absorption issues that a post-GI illness may cause.
I waited for the next blood glucose and ketone check, while shoveling 24+ inches of snow with Dave by my side. The winds were howling. The drifts were 4 feet high. As the sharp crystalline flakes whip and smart my face and my eyes, I barely make a dent in the mountains of snow drifts left in the wind's wake. I am faced with the fact that we are essentially snowed in. I am grateful I didn't think of this fact last night during the vomiting orgy. It is easy to forget how fragile Joe's physiological well being can be at times of illness. It is easy to fall into a false sense of security. It is easy to be deceived by "D".
Enter Honey On Gum Massage, Lollipops, and Mini-Glucagon...
11am: BG 73, blood ketones 0.2 ~ 10 grams of free carb...great on the ketones, "doh" on the blood sugar. I should know better!
11:30am: BG 52 ~ 15 grams of juice.
11:57am BG 52 ~ Apparently the carbs aren't being absorbed from his food into his blood stream. Two plans are proposed to Joe. Plan A: Mini-Glucagon Dosing. Plan B: Honey Massage on his oral mucosa. Joe was adamant about not wanting the Mini-Glucagon yet, so Honey smeared on his gums it was. I also gave him a lollipop. I thought the bulk of that would hopefully get absorbed orally and not "gastrically".
12:45pm: BG 60, ketones remain 0.2 ~ The "Oral Mucosa Plan" was determined a "fail". I am done with pussy-footing around and am ready to jab in the Glucagon. I have Dave reconstitute the Mini-Glucagon (he doesn't have experience with re-constituting it and we thought it would be a good time for him to "practice"). I drew up 7 units (1unit per age in years) in an insulin syringe and injected Joe subcutaneously with Glucagon (just like how you would give an insulin injection). I also decided to decrease the pump basal rate by a "gentle" 30% for 4 hours, keeping in mind to watch for ketones with the decreased insulin on board.
1:15pm: BG 175 ~ Joe was hungry and wanted lunch. A PB and J is "ordered" and constructed. No bolus is given to cover the 41gram sandwich.
2pm: BG 133...Dexter is "flat-lining" at a 146 ~ Still no insulin was given for lunch. Concerning? Yes. Joe was now begging me to let him play outside; to play in the 28 inches of snow. I refused. Joe bawled.
3pm BG 146 ... Dexter remains "flat-lining" at a 133, blood ketones remain acceptable at 0.3 ~ Joe was adamant that I let him outside. I cannot. I don't have faith that his blood sugar will hold.
I am a Pancreatic Cowgirl , as you guys know. I have even let a "24" Joe sled after the 24 was "mother-birded" with 16 grams. I am not a "Pancreatic Tight-Wad". It has been a tough day keeping Joe "down". It has been a tough day telling my son 'no', due to diabetes.
His eyes are shiny with tears.
A day-in-the-life of acknowledging that 'Diabetes is a big fat turd'.