1/08/2011

2451 hours

I have waited 2451 hours to face my greatest fear of Ellie T1 Diabetes.  It has been hiding in the corner, a veritable dark shadow, licking it's lips in anticipation of just the right moment.

That right moment arrived Thursday at 10:30pm when Ellie's 2-hour stubborn 'low' ended with a a slurry of juicy juice, grape glucose tabs, a beef stick and 2 peppermint candies thrown up into a plastic red bowl.

The Stomach Flu.

Why the fear, you ask?  Because a person with T1 Diabetes needs a fine balance between glucose and insulin; and when one of those two is being hurled into a bowl at 90 miles an hour, the other is left with a wide open playing field.  Blood sugars plummet, ketones rise and DKA can take over over in the blink of an eye.

Our first hint that something was wrong began on Thursday night at 9:20pm when Ellie had been in bed for about an hour.  She knocked on my door and told me her tummy hurt.  This is Ellie's way of knowing her sugars are too high or too low, so I didn't immediately worry that she was getting sick.  We tested her blood sugar and found she was at was 55, so she downed a 4oz box of Juicy Juice.  We retested 15 minutes later and she was only up to 65, so she slurped another 4 ounces of Juicy Juice.  Another poke read 67 so we went for 3 grape glucose tabs and a beef stick (for some protein to make the sugar 'stick') and we threw in a couple of peppermints for good measure. 

Another finger prick yielded a measly 91 from the meter.  At this point I call my Diabetes Angel, Stef, and ask her why Ellie's numbers aren't through the roof with all that sugar in her system.  Stef told is to give her another peppermint and then recheck in 10 minutes. 

A whoppin' 118 says the mini meter.  What the?

I text Stef and she replies "I hate to tell you this, but Ellie might be getting sick.  As in grab-a-trash-can-she-might-just-vomit sick."

You can guess what happened next.  And again and again and again until bile was the only thing left for her tummy to toss.

This was not all, though.  In addition to worrying about how I was going to keep Ellie's blood sugars stable without the help of glucose, I knew I needed to get her into the bathroom to test for ketones. 

The first test read "small".  Okay, I can handle small.  Push water and . . . . crap, how can I push water when she is puking? 

A couple of hours later, Ellie retested and the ketone strip read 'Moderate' and I have to admit, my first thought was that we needed to bundle her up and take her to the hospital.  It was 4am at this point and while that shouldn't have swayed my decision, it did.  Here was a sick little girl who was still vomiting every hour and I knew if I told her we needed to get up and leave for the hospital she would get very upset.  As in s-t-r-e-s-s-e-d.  As in stress = potentially lowering her already unstable blood sugars.

So we stayed put and I pulled out my instruction binder from the Endocrinologist.  "If ketones are small-moderate, inject give 10% of the total daily dose usage of insulin (we are on Humalog/Lantus MDI).  Repeat every 3 hours until ketones test negative."

Okay.  I can do this.  Insulin without any glucose in her system, though?  How does that work?

It didn't.  By 7am her ketones were "Large" and once again I turned to the binder.  "If ketones are Large-Xtra Large, inject 20% of the total daily dose usage of insulin and repeat every 3 hours until ketones are small-moderate."

Deep breath.  Okay, I can do this.  More insulin in her body, yet still no intake.  The last time she puked was 6am.

Another couple of hours go by, this time without any more vomiting.  Her blood sugars are miraculously hovering around 160-170 despite the extra insulin.  In addition, we had dosed Ellie her Lantus (24-hour controlled release insulin) the evening before, so we had no control over what was already floating around in her blood stream. 

At 8:15am I call the Dr.  I know, I know.  "Why didn't you call before????" You ask.

Well, several reasons.  1.  I had my Diabetes Angel, Stef, who is a mother of a T1 herself and has been through it all before,  2. I had the instructional binder from the Endo's office,  3.  The DOC (diabetic online community) had provided stories and examples of 'been there, done that'.  and  4. I just knew in my heart that staying at home was the best place for us to be .... at that time.  

Would I repeat that advice to anyone else who asked?  Heck no.  You do what YOU need to do, what works for YOU in the situation.

The nurse confirms we were doing all we could do and to keep at it.  If for any reason we feel uncomfortable, or if Ellie's blood sugars dropped and she continued to puke, then we should head for the hospital.

Well, the seconds turned into minutes which turned into a couple of hours and Ellie slowly began to improve.  Sips of water stayed down.  Dry heaving stopped.  Ketones moved down to Large-Moderate.  And finally, Ellie and I slept.


This is Ellie about 12 hours into being sick.  By this point she had puked over a dozen times, poked for BS readings 20 times, and kept down some frozen 7-up chips.  What I notice most is her lips finally had some color at this point. 


Part of our arsenal of weapons against those nasty germs.  That red bowl saw more action that night than a prostitute in Washington DC. 


The hubs hit the couch so Ellie and I could have the bed.  Used test strips were strewn EVERYWHERE! 

The infamous instruction binder . . . . with more used test strips. I am still finding carnage from the bloody battle.


Ketone test strips with a guest appearance by Juicy Juice in the background.  Ellie pees on a strip and we compare the color to the chart on the bottle.  At one point her ketone strip was almost as dark as the darkest color available.  Scary sh*t.  (the color of the strips in the photo are old, and they lose their vibrancy.  Kind of like an old pregnancy test.  What?  You totally know what I mean)

Even now, 44 hours after getting sick, she still has 'small' ketones.  Those buggers are hard to flush out.

It was ugly, it was messy, it was terrifying, it was . . . . . . it was as bad as I feared it would be


But today we are on the other side and we survived. You can bet I made certain the door smacked the stomach flu's ass as he walked out the door.

Thank you.  Thank you all out there in the DOC.  You made my first experience as a fake-pancreas-tackling-puke doable.  You shared YOUR stories and YOUR experiences so I could arm myself with information when it came time to fight OUR turn.

Another 'first' with T1 Diabetes now behind us.  Good riddance!

18 comments:

Reyna said...

Hey...I need to come back and read this post...but I noticed in scanning it that you had urine ketone strips? Do you have a blood monitor? And/or do you know about them? This is my BIGGEST pet peeve with MDs...they don't tell families about the blood ketone monitor. I posted on it about 6 months ago and am planning a repost in the next day or two. It makes life so much easier when they are sick...and the blood is more accurate than the urine.

OK...I'll be back after my run to totally check out this post. (((HUGS))) I heart you big time sister!

Amy said...

Reyna,

I do know about the blood ketone strips, but our insurance doesn't cover it and the office doeasn't have samples :(. After experiencing trying to get a dehydrated girl to pee on demand, I might just save up and buy some myself. Thanks for the tip, and hope you had a rockin' run!

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

Amy! We have been going through this all week! As soon as I think we have it behind us and Caleb is up and perky, he throws up again. It really is a nightmare - particularly on day 6!!!! lol

We're trudging through, somehow avoiding ketones the entire time. I have to say the biggest benefit I've seen about the blood ketone strips is exactly what you said - trying to get a dehydrated person to pee!! We use a combo of both.

Glad you got through it. It's nice to have those firsts behind us sometimes. I think you handled it all beautifully. :)

Pam said...

Amy,
So sorry you had to deal with this, but it sounds like you handled it like a champ. Only a parent of a CWD can fully understand what you just went through. You did GREAT!

Our first bout with the stomach bug ended with a visit to the ER on day 3 with no end in sight. Believe me, you get to a point when you just know when it's time to go.

On another note, I'm glad to see I'm not the only crazy mom who takes pictures of her sick, pathetic child! Such a sad little face:(

Hope she feels better soon!

Wendy said...

WELL CRUD!

I'm so sorry you had to deal with such a beast :(

I hope things are back on track now. YOU DID AWESOME!!!!! Superb! Fantastic! Magnificent! Amazing! STELLAR!!!!

Great Job, Team Ellie!

(Now go tell the pharmacy you need the other half of her freaking TEST STRIPS!)

Reyna said...

OK...I am back and read the whole story. You are a ROCK STAR!!! I am not worthy...not worthy in a Wayne's World song-y voice...that a fellow D Mama posted on my blog the other day - LOL.

You did great. Pat yourself on the back and then get your ass to the pharmacy like Wendy said!

Mrs. Tuna said...

Tough on all of you, hopefully things improve and her blood evens out. Thinking good thoughts for you,

Roselady said...

Having never been through this, this is my worst fear. Good to read your story, so when the time comes...well, when the time comes I'll probably just panic and run to the ER ... but thanks for sharing anyway!

Tiggeriffic said...

WOW I have diabetes Type 2,,didn't realize that the diabetes your fighting is that scary.. Oh my goodness girl you did great. What a wonderful mom you are..
ta ta for now from Iowa

Wendy said...

SO stressful. You guys must be so wiped out. You did a great job!

Hallie said...

Yikes! So proud of you! Great job! We have dealt with puke due to large ketones... But not the stomach flu yet. It scares me too!

Football and Fried Rice said...

wow. Phew. I am very proud of you!

I am pretending to be a T1D Mom this week, you know. I get to say, "have you checked your BS!?" ((which makes me laugh everytime..I know..so mature))

Glad Ellie is feeling better )

muffinmoon said...

Well done on doing this without dashing to the hospital. It is such a personal thing when or if to go in and I have been in twice in the two years since diagnosis. I now wait until I have no choice as both Frank and I feel better at home. You did an amazing job. I am going to read this post again if my boy gets sick!! Big hugs to you.

Leigh said...

I am so proud of you!! I was wondering where you were when it got up to 6 days since you had posted. That just sucks, but you did an awesome job! I am still just waiting...It is just so scary to think about! But you rocked!! :)

Amanda said...

You seriously did an amazing job! I pretty much freak out when I hear of anybody anywhere near us getting the pukes because I know what it could entail for us!
We did have to go to the ER one time last year, and it was the pits BUT the Dr. gave us a prescription for the melt in your mouth anti nausea pills (I forget the name...ODT maybe?)and now we have a stash of those on hand. They have saved our butts several times since then - you just have to be careful with them because even though the barfing stops, the ketones can still go up so you have to keep testing.
Seriously, can you file an appeal with your insurance about the blood test strips?

Alexis of Justices Misbehaving Pancreas said...

Amy! Please email me your address and ill send out some blood ketone strips this week! The meter can be gotten for 20 bucks at walmart.

You def should have em. Reach me at justicespancreaticavengers@yahoo.com

you did great!!

Shannon said...

I am so impressed! How did you do that? I ran to the E.R. at moderate keytones and my son was admitted overnight. I am glad we did that, but if we could avoid it again, I would like that. My doctor's office was just so evasive with me and I am terrified of DKA (we thought he had cerebral edema at diagnoses and it scared me a LOT)... Good Work, Mom!
p.s..... Is EVERYONE getting the darned stomach flu this year???!!!

Tracy1918 said...

Okay. I know you posted this WEEKS ago....but I'm so behind on blogging! Still...I had to comment.

YOU TOTALLY ROCK! I completely DREAD Matthew getting sick. I know I will feel just like you...."insulin with no glucose....ummm...okay...."

Anyway, you did a great job!