Monday, January 24, 2011

Illness and the Type 1 Diabetic child

We're sick again.
And I'm getting sick of it.
I mean, really?
We haven't been to our Pediatrician in a couple of years, and I almost broke down Saturday morning and took in my two oldest who are sick for the second time in 3 weeks!
Over the New Year's Day and the following week, I think you'll remember we had a nasty "barf-a-thon."
Now, this last Tuesday evening, my oldest red-haired daughter began coughing and complaining of a sore throat.
She didn't get out of bed until this morning.
And she's been running a fever, has laryngitis, and a congested, wracking cough.
On Saturday morning, it was my second daughter.
She woke up with a fever and sore throat, and began losing her voice more as the day got older.
My husband and I took turns going to church with the well ones on yet another Sunday.
Pray for us?

It's always stressful and wearisome to have a sick child, but especially so when she has Type 1 Diabetes.
Until we started living with this disease, I had absolutely no idea how ignorant I was to what our bodies just do for us.
I had no idea that your pancreas spills out insulin throughout the entire day and night whenever your body needs it.
When you need insulin.
When you move and exercise and run around, you need insulin.
When your body gets cold or hot, you need insulin.
When you get especially need insulin.
I was IGNORANT to how many things the pancreas regulates in your body.
Just another grace.

But when your child doesn't have a functioning pancreas, you have to learn how to think like a pancreas.
Believe me, this has been mind-numbing.
Questions like these overwhelmed me when we were trying to take in all this information"

"You mean, people actually have to do this??"
"You mean, I have to know how many carbohydrates are in every morsel of food that goes in this child's mouth?"
"REALLY?  We have to check her blood sugar THAT many times a day?"
"I'M the one who has to do all the math to figure out exactly how many units of insulin to give her
at EVERY meal?"
"Wait.  There's more than one KIND of insulin and they work completely differently?"

And it only gets more complicated when she is sick.
See, when she's sick, she has to have insulin.
But if you give insulin, you have to expect that to affect her blood sugar.
Fine if her blood sugar is already high because of the illness, but tricky if it's in normal to low ranges.
Then she has to get some carbohydrates in her to offset the insulin.
No fun when you're vomiting and can't keep anything down.
So we had to learn the liquids she could have that contain carbohydrates....popsicles, soda, jello, juice boxes, etc.
But our problem has been that she hasn't wanted to eat.
So we haven't checked her blood sugar, or if we did, it was within normal ranges.
She started feeling exceptionally bad then.
Another thing we had to learn about.....KETONES.
Here's what our information defines these as:

"When the body can not use glucose (from carbohydrates) for energy,
it will break down fat cells for another source of energy.
Ketones result from the body's attempt to use fat cells for energy.
Ketones are acids, and can make your child sick."

In other words, an ill person with a healthy, functioning pancreas will just continue to put out the insulin necessary to convert carbohydrates into energy to keep that sick person's body functioning (brain, bladder, heart, lungs, etc.).  
Yet another grace.

But a person who has no pancreas has no insulin to get the sugar (glucose) into the blood stream for energy, so their body will try to convert fat into energy.  The resulting acid waste from that spills into the urine and are called ketones.
We have test strips in our house now to check her urine for ketones every two hours when she is sick. 

Because of this latest illness, we are becoming a little more used to having to handle these ketones.
At first, we sort of panicked.
When you're told that if her ketones measure "large" you may ultimately have to take her to the hospital,
you take it very seriously.

So she feels terrible, we pull out the test strips and see the dreaded PURPLE color.
Large ketones.
I call the doctor on call at Children's Hospital for instructions, and here's what we are told to do:

Check her blood sugar and urine for ketones....every two hours:

If her blood sugar is ABOVE 250, she can't have carbohydrates (think diet soda or proteins):
In addition to that, if she has:
Large Ketones- We give her 20% of her total number of units of insulin (both Humalog and Lantus).
12 units of Humalog

Moderate Ketones - 15% of total units of insulin for the day
9 units of Humalog

Small Ketones - 10% of total units of insulin for the day
6 units

Trace ketones - Use her correction scale (another chart we have to follow on well days)


If her blood sugar is below 250, she can have carbohydrates.
We were to start by adding in 45 grams of carbohydrates with large ketones.

Oh, and don't forget the 8-10 oz. of water every 20 minutes.

Thankfully, we have found her to respond quite positively very quickly, and all her numbers drop back to normal/safe ranges within a couple hours.  
I can't tell you the relief and security I've found in the lifeline at our Children's Hospital and how quickly they return our calls, and how encouragingly they coach us along!!  
We never feel like we've done the wrong thing, or that we were calling because we are hypochondriacs!

More grace.
A sigh of relief.

But I'll be so glad to be able to put the notebook and ketone strips away.
And to get back to the outside world.


Jill said...

Prayers going up for you all! (((HUGS))) I'm so glad you found my blog! Welcome to the D-Family! If you need anything, you can reach me over on my blog or you can look me up on Facebook! Hope everyone starts feeling better soon. I'm off to read more of your blog get more familiar with your family! :) Take care!

Brenda said...

Hi Jill!!
I've been a fan of your blog for awhile now and I even had the blessing of "winning" one of your giveaways awhile back. I still use the flowered pump pack that your mom made for my cell phone (since we're still using pens!)! I've gotten some wonderful information from your blog and was so excited to see that you have your own "badge" now!! Way to go!! You are an encouragement to me!!