I posted our sick day protocol about a week or so ago, but things hit the fan two days after the post. Things were looking like we might get off easy with a little tummy upset and some fever. The storm came after the calm in this case.
So what does it look like when you are fully engaged in helping your T1 get through a stomach virus? I assure you it looks different than you imagine beforehand when you think you have all your supplies stocked up and instructions printed out.
No one likes to see their child suffer illness…but we as MODS know that flu is a very different thing, a sometimes very dangerous, even fatal thing for our kids. So I thought I’d post what things looked like in our home as we worked our way through this episode with our super hero, to help calm fears and maybe give some helpful information.
The flu has many different faces this time around, we’ve found. Katie got a tummy bug with vomiting, then a cruddy cold. Our oldest daughter got a MAJORLY cruddy cold/fever/chills but no tummy bug, I got fever, aches, headache and tender tummy; my husband has fever of 102 currently, with vomiting and very bad respiratory issues. Not fun.
So when you have to think on your feet, what do you do? We thought we were doing pretty well managing things, trying to get our T1 to drink to bring down her sugar levels (which were over 400, then in 300’s but never under 250) and help eradicate ketones. The Zofran had worked for about a day and a half. Then she started throwing up, and I began to think in exclamation points.
Dehydrating Illness with High BG
Katie was topping out at about 102 degrees fever. I treated this with ibuprofen, as acetaminophen (Tylenol) can mess with Dex readings. She stayed high in her numbers, even with the vomiting, so we never needed to navigate the dangerous lows sometimes associated with this kind of sickness. Still, I wanted to be prepared. Our dx was in May, but we’d already seen how quickly things can change and numbers can dive or sail. I printed out the sick day protocol I linked to in the previous post.
We went from small to large ketones in a matter of two hours (her tummy felt raw and she was really not interested in drinking volumes of liquid…hence, ice chips), so I began to get concerned with her BG numbers so high as well. Our protocol said to check BG every 3 hours (we have an edge on that, having just gotten a Dexcom), and to correct with one and a half times correction if she was high. But we came up on bed time and I wasn’t sure if I was supposed to do that increase of insulin through the night. I called the nurse at the Diabetes Clinic at Children’s Primary (where Katie was diagnosed and treated). I was told that I should check every three hours through the night, and continue the one and a half times correction through the night as well. Keep as hydrated as possible (we used mainly ice chips, but had low calorie Gatorade, sugar free apple drink, and diet Sprite on hand as well). We told our daughter that if things did not improve and she did not choose to drink more, we’d need to take her to get an IV so her body would have the liquid it needed. That was tough talk. Not a vain threat. And it motivated her. I tried to have her check her urine for ketones every three hours as well. We were told when ketones were trace, and numbers were holding in range, we could go back to normal insulin dosage.
Dehydrating Illness with Low BG
This never happened with us, but I got a plan from the nurse just in case. We are 45 minutes from the ER, and 3 hours from our Children’s Hospital, so “information is power” in a big way here.
In the event of vomiting/diarrhea plus large ketones, we were told to give enough carbs (15-30)to bring her up into the range where we would normally give her insulin (over 200 in our case). Then give insulin (because it is needed in addition to hydration to control ketones).
If she got so low that she was not responding, we could do a mini Glucagon shot. Essentially, you mix the Glucagon as per the instructions, and then use a syringe to draw out a small dose. One unit for every year–so, for our ten year old, we would draw out 10 units. Administer in outer thigh. Wait 15 minutes. If still not responding, the dosage can be doubled (20 units in our case). I think at this point I’d also be calling an ambulance while doing this. Our nurse told us that this double dosage can be given 3 times. Like I said, with an unresponsive child, I’d be calling 911 while drawing up the syringe. In theory, by now the BG should be up in range again. Then you can continue with hydrating measures to reduce the ketones if present.
Happily Ever After–The Relief only a T1 Mama Knows
After Katie made the choice to start drinking more, her ketones backed down in a hurry. Inside of two hours she was back to small ketones. Within about 4 hours (by now she had stopped vomiting) her numbers were coming down into the 200s again, and she was nearing a normal body temp. We had gratefully escaped without having to go to the ER.
This was about a 4-day stint altogether, from start to finish (we are still keeping an eye on ketones, but her temp is normal, BG pretty much normal, and no more flu symptoms). This scary sickness could have been much scarier. Thankfully it wasn’t.
Again, click here if for some reason you do not have a sick day protocol from your doctor.
Disclaimer: I am not a medical professional. This blog is not intended to give medical advice, but only sharing our own experience. Please contact your endocrinologist or general practitioner if you have questions about the management of your diabetes concerns.