Well, we had a scare the other night, and I wanted to share what we’ve learned in case someone else finds themselves in the same boat.
On one other occasion, Katie came close to mixing up her Humalog and Lantus pens. They are both sort of grayish, and we were storing them together with all the other T1 supplies. I should have taken active measures then, but I forgot and it never happened.
Fast forward a couple months. Katie was giddy and distracted because daddy had brought home some squishies for her as a reward for doing a great job cleaning her room. She scampered through the living room, confirmed with me how many units she was to do of her Lantus before bed, and then did her shot. She usually does the bedtime shot in the living room so I can check the pen. This time she didn’t, and it didn’t occur to me until…
“Mom….I…I…did 22 units of Humalog!”
She was teary and petrified. She realized it right away. I ran to the kitchen to confirm it. Yep.
My mind was racing, throwing open the fridge and kitchen cupboards to see what we had on hand to load her up with carbs. She was already only 107 on the meter. Thank the Lord we were able to act on this discovery immediately. If we hadn’t noticed until her alarms started going off, we would have had an even bigger emergency on our hands.
After I got her started on some juice (when we have double down on the Dex, I always opt for carbs with no fiber, fat, or protein so they have nothing to inhibit the absorption), I called the night time nurse on call at Primary Children’s Hospital where Katie was diagnosed. I got the switchboard. They told me the nurse would call in about ten minutes.
“Okay, please… tell her it’s urgent.”
Do you know how long ten minutes is in this kind of a situation?
Finally the nurse called. I told her when the shot was given, how many units, what Katie’s BG level was at that time, what her current carb ratio is for supper time (1:20), and what she was drinking right now. The nurse told me we needed her to ingest 240 carbs to offset the load of insulin. (To find that, if you need to know, multiply the number of units by the carb ratio….in our case, it was 22 x 20). We got busy.
- Two juice bags
- 1 cake gel tube
- 4 packs of fruit snacks
- 1 piece of French bread
- 2 strawberry milk bottles (I gave these after some pure sugar items had been ingested)
- half a bottle of regular Pepsi
About half way through this emergency menu, she was feeling really sick. We were afraid she’d toss it all and we’d have no idea how many carbs actually were absorbed before she lost it…and then we’d have to start all over again. Ugh.
It’s hard to take in all of that on a good day, at lunch time. When you are upset and it’s after 11pm, it makes it even harder. Poor kid.
She rose and dipped on the Dex (thank the Lord we have this tool!), but she never dropped below her low setting (70). What a relief. She finally had an upward slanting arrow that didn’t tilt down again, after about 90 minutes.
Do you know how long 90 minutes is in a situation like this?
I stayed up for another hour to make sure her BG was steadily rising and not going to play any more nasty tricks on us.
So. My take-aways from this event:
- Always have carb dense foods on hand for emergencies. Thankfully we had plenty.
- Cake gel sounds great in theory…compact and easy to dispense especially when your T1 is not responding well; but at only 14 carbs a tube, I think there are better ways that aren’t so nasty to use if you need to carb load.
- Always call the endo/nurse (call after you’ve started your carbs) to run the stats by them and so they are aware. We were rattled and underestimated the carbs Katie would need to cover the insulin she’d injected. The nurse also reminded me of the mini-Glucagon protocol (we had our kit out and handy, believe me) in case Katie could not take in all the carbs necessary. You can download Libby’s free Glucagon free app here, which walks you through the whole process with animation and audio. Very helpful.
- In rehearsing this at T1D Mod Squad on Facebook later, cotton candy was suggested by a number of members as a go-to. Brilliant! The 2.5 ounce bags of Fluffy Stuff are sold at Dollar Tree and they have a total of 71 carbs for the bag and a long shelf life. As you know, cotton candy dissolves almost instantly in the mouth so you get all the carbs without all the volume to cram into a little tummy. I have 5 bags on hand in the kitchen now.
- To prevent the mixing up of pens again, I’ve done two things. I wrapped a hair tie around the Lantus pen so it just feels different. I actually slid the hair tie over the dial of the pen so it has to be consciously moved out of the way to turn it. I’ve also begun keeping this on my bedroom dresser, far away from the Humalog pen.
I hope you never have to face this, but if you do, I trust this might help. Blessings!