Monday, March 7, 2011

Today, 'Diabetes Is A Big Fat Turd' ~ Joe Maher (2010)

I had a "clever title" of "Oh NO, Not Chicken Marguerite On My 550-Thread Count Sheets!" ... and ... somehow I wanted to add into the title that a massive blizzard hit and there are a couple of neighboring counties declaring a state of emergency.

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.

Here goes...

Sunday 3/6/11

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".

Monday 3/7/2011

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'.


Alexis Nicole said...

Im so sorry Joe is sick and D is preventing him from playing in the snow :(

Sounds like you did an amazing job as usual.

Tell Joe, Justice said last week 'You ever realize how much DIIIAAAbetes and DIIIIIAhrrea sound alike?"

HUGS For you both!

Sandy said...

Love that title :)

Heidi / D-Tales said...

You crack me up! "Vomit Comet" and "Emesis As Their Nemesis" -- too funny! But a NOT so funny subject! I hate, hate, hate stomach bugs!

Hope Joe is all better soon!!!

Sysy said...

Awww....SUCKS! I hope he is back to himself really soon. Stomach viruses are the worst...but if I had one, I would like you to take care of it. I love how you always have awesome detailed data for us and add much needed humor. I may start calling you "the golden pancreas"

Jonah said...

Well, hopefully staying inside is good for recovery from stomach bugs anyways, right? Hope he feels better soon.

Ann said...

Wow, sounds like a tough night. I've been lucky in that I haven't gotten any stomach bugs in the 8 years I've been diabetic. It amazes me how much being sick can affect blood sugar levels. Those lows were so persistent on poor Joe and then even after a meal with no insulin, he was still in the 130's! Hope he's all better!

Penny said...

Oh you are the BEST mother pancreas that Joe, or any kid for that matter, could have. You are the best at managing this and I SO very much appreciate you sharing what you do with Joe, cause it's only a matter of time before each of us are hit in our own little way
Hope he is feeling better.
YOU are awesome.
And so is Joe.

Amy@Diapeepees said...

So, you actually administered the glucagon, right? I couldn't tell if you only drew it up or also administered...sorry, I need every last detail. By the way, I was thinking of you because my son often makes lasso motions with his hands and tells me he's a cowboy...

Unknown said...

Yes, I did...sorry Amy. I did not make that clear. I just edited it to add that I gave it Sub-Q (just like and insulin injection). It was easy and it only took one dose to spank those BGs back up for business.

Sarah said...

I'm glad Joe, whom Ethan refers to as GI JOE, is okay...maybe more snow tomorrow? Poor guy and you these are the crappy moments of parenting when you feel like not only did you have to care for a sick child in a way you don't want to, but then you have to tell them no to something fun, too. I appreciate your sharing this, yes you not a doctor, give some of the most wonderful and insightful advice - much more than many MD's I chat with about d business :)
And ewwww about the bed, hope it's all cleaned up...I think puke on the bed is just beyond gross and have actually bought a new set of sheets to replace ones that got ralphed on, psychological issue I guess!

Anonymous said...

Poor Joe! Having the vomit bug sux and feeling low all day is the worst. Hope he's feeling better...and you manage to get some sleep ;)

Anonymous said...

Great big hugs to you and Joe. I hope tonight will be peaceful and vomit free. As for the snow.....
it is kind of a turd as well.

Renata said...

Sheeze...what a ride. Does Joe get to go out tomorrow? The part that REALLY upset me, that REALLY got the shoveling snow shit. What in the hell is wrong with you? Can't the boys just pee it down?

sky0138 said...

I hear ya Reyna...we had the exact same thing with Emma last week...stomach/vomiting illnesses do not play fair with diabetes. i despise them! You are friggin awesome though in how you are handling it! I have never done a mini-glucagon dose...scares the crap outta me for some reason...UGH! Hope he is feeling better soon!!

Shannon said...

Ugh.....the stomach flu is one of my worst fears. I SOoooo miss the days when it was only a minor inconvenience. It just scares me so much to think of either dka or using the glucagon. I usually go to the hospital if he throws up more tha a few times and has large key tones. So I'm thinkin it would be good to really understand how to handle without the IV because of thing.s like blizzards. I hope you get some rest tomorrow.

Jess said...

i HATE stomach bugs! any time any of my students gets sick with the stomach flu, i get all paranoid and panicky! yuck!

glad joe's feeling better! if you can find fruit packed in heavy syrup, it's good to have on hand. couple tablespoons of the syrup has some carbs and i can usually keep it down.

hope you can all stay well for a while. you deserve a break!

Michelle said...

Ugh...vomiting bugs are the worst! Hope the worst is over for you all and he's feeling better soon! Btw, love the "emesis as a nemesis" line!!!

Jules said...

Thanks for the laugh! Hope joe s all better soon xx

FeltFinland said...

Vomiting, no fun. Vomiting with T1, cue grey hairs! First time ended up in hospital, second time we rode it out at home and won. Get well soon Joe!
PS we still have shed loads of snow but it is like concrete, unshoveable!

Heidi =) said...

Thank-you so much for sharing this, I know it is only a matter of time before we have to deal with a puke bug. I love how you handled it all! I hope Joe is well enough to enjoy the fresh snow tomorrow. You are both awesome!

Jules said...

I just came back to say, I LOVE your original title, and your revised title, both made me laugh. Love reading your blogs its like sunshine in my part of the world :)

Karen said...

Diabetes IS a big fat turd!!!! I'm sorry Joe (and you!!) went through such an ordeal. However, I have to thank you for mentioning doing the mini-gluc with a normal insulin syringe. That was one thing I missed when I was doing my emergency mini-gluc research while feeling half dead last week. After looking at the size of that needle, I love the though of using a regular insulin one instead!! (Yes, apparently even after injecting for over 31 years, it is still possible to be scared silly by SOME needles.)

:) Tracie said...

Sounds like that whole ordeal sucked! Poor guy, no snow play....had to hurt, but I would have done the same thing. (except with snow here in Southern California)
We've been fortunate not to get sick around here, outside of a stuffy nose. Instead, we visit Urgent Care and get casts! :)
Glad things are on the up and up! Now go get some sleep!!

Lorraine of "This is Caleb..." said...

Okay. Seriously. ENOUGH OF THE ILLNESS! What on earth is going on????

Please tell us today is better.

Hallie Addington said...

Diabetes is a big fat turd sometimes. Hope he's feeling better - and he can flush it down and go play in the snow today!

Rachael said...

So Sorry you guys are still sick, but I'm not going to lie. I laughed my A** off when I read this. (I know it's not funny) Hope you guys get feeling better! :)

Unknown said...



But...I'm...kinda laughing...sorry 'bout that too.

I hope all is well now.

Eff the fat turd.

Anonymous said...

Sounds like the week from hell..... How much longer can this last? Hoping the bug has run its course and that all is well in your household. In the meantime, you better call on some Cow hands, because at some point you are going to need some rest. You need someone to spell you out. How you manage to make this whole scenario humorous boggles the mind. In more than five years with D we have never had a stomach bug; only a diarrheal illness once shortly after dx and her blood sugars were fabulous; we were just advised to feed seven grams of broth or soda every hour or so. I am going to book this post. Praying for you, Joe, hubby and rest of the kiddos. P.S. As your significant others recover, I would start pressing them into service as cow hands. No body would be off limits if I were in a similar situation.

Tracy1918 said...

Oh Reyna. Wow. I'm so glad you posted this. I'm glad Joe has you taking such good care of him!

My husband and I were just going over this the other day. I know a yucky bug is going to come around and I want us to be ready.

I love your story...and the one Caleb's mom, Lorraine posted recently. At the hospital, I learned to fear glucagon. "I hope you never have to use it!" We heard that over and over.

But glucagon is a good thing. It shouldn't be scary if you know what to do.

Thanks for posting this.