Oops

First, before I acknowledge my (big) "booboo" last night, as I said to K, let me describe my state of mind and crazy afternoon: I hadn't gotten more than six interrupted hours of sleep in about a week (forget about uninterrupted) and the night before was especially bad. K was sleeping on a slow leaking air mattress in her brothers' room because my dad got to town that day and was sleeping in her bed. She slept HORRIBLY - and was awake and upset for a good two hours during the middle of the night. Long story short: I was exhausted.  So, as for my crazy afternoon: my oldest son had a basketball game at 5:30 PM. At 5:00, I drove him to his game location, as we were told to, and then, upon arrival, learned from his teammates standing outside that they couldn't get onto the court until 5:30. I then brought him back home so that his dad could just take him at game time (when he got home from work). Luckily, my dad was here to stay with the other children during that misadventure. --the other kids included our other two, plus a six year-old friend who had been with us all afternoon. Our middle child had a 6:00 little league game but had to ideally be there at 5:45. When I rushed in the door after the basketball snafu, I yelled at the little leaguer to change into his uniform and told K to put warmer clothes on. --and I still had to feed them. She spent all afternoon in a leotard - and when she does this, she has to wear her pump outside of her clothes. I undid her pump so that she could get out of the leotard. She picked a warm, flouncy dress and tights to wear which I helped her get into. I then checked her BG, *dosed* her for the awesome (ha ha) dinner of yogurt and noodles and soon fed both kids (basketball player had already eaten). Our guest smartly waited to eat with her family. Hubby came home and immediately left with oldest child and my dad. Continuing to rush, I soon gathered up the rest of the kids, and headed to the nearby park where the game was being played. K played at the playground with our friend until her mom picked her up there - and then she and I headed to her brother's baseball game. Once there, she found other little friends to play with and was running all around. Because of her activity level, I actually worried about her blood sugar going low, so I gave her a little bread that someone else had brought.

When we got home after 7:30, K was ready for bed. She changed into pajamas, brushed teeth and picked out stories. I read her stories and tucked her in. I then stupidly remembered that she had an early dinner and her BG needed to be checked. It had been a good two and half hours since she ate and closing in on 3 hours since I *dosed* her. I'll get the ** in a second...

Her BG at 8:15 was a whopping 397 mg/dl. I was flabbergasted. Her BG had been great ALL day! why now? and she had been running around at the park?? I checked her inset (the piece that sticks to her bum where the insulin goes in). It looked fine - oh wait, no, the pump is not attached to it??!!! It all came back to me - I never plugged her back into her pump after she changed before we went to the baseball game!!!  I felt horrible and realized how important those little drips of insulin are that she gets throughout the day (called basal)- but it still didn't explain a BG THAT high...  Brain was still working at super slow speed and I was trying to piece it together, even asking K, "what where you wearing when you ate your yogurt??!"  Holy moly - I took off her pump BEFORE she ate, and more importantly, before I dosed her for food (bolus). Because I can dose her remotely with her meter, the meter was communicating with her pump, sitting on her bedroom dresser. Her flouncy dresses hide her pump so well that I never would have noticed it missing. Of course, we dosed her down, with me apologizing to her for several minutes, and also telling her to let us know when she doesn't have the pump on (shows how little she notices it, I guess!). She fell asleep soon after (amazingly) and I went to bed within the hour, needing sleep and feeling like the worst mom EVER.

I blame all the distractions I mentioned in the first paragraph - but there's sincerely no excuse. I'm also thankful for my partner for showing me grace and understanding the distractions and not blaming me at all, telling me "she's fine" and "accidents happen". I need to remember that because I don't know if I'd be as understanding if he made the mistake... 

Sick Kiddo

It's been a tough week (and probably plenty of typos because of it):
K started coughing on Monday and fever came later that day. On Tuesday, I took her to her pediatrician because of cough and wheezing. Pediatrician assumed it was a virus and she's been on her asthma meds since, as well as Tylenol/Motrin to keep her fever down. Her BG was high ALL Tuesday because of the combination of all these things. We increased her insulin, but it still wasn't enough. By 7:30 at night, she had moderate to large ketones. I had spoken with K's case manager an hour before and she told me what to do if her ketones were at this level. Big learning curve this week, and remember, I'm no expert (far from), so here's a definition of ketones from webMD:
A ketone test checks for ketones in your blood or urine. Ketones are substances that are made when the body breaks down fat for energy. Normally, your body gets the energy it needs from carbohydrate in your diet. But stored fat is broken down and ketones are made if your diet does not contain enough carbohydrate to supply the body with sugar (glucose) for energy or if your body cannot use blood sugar (glucose) properly.

Our protocol is that when her BG is consistently high, we should test for ketones. We have done this several times over the last several months, but this was the first time the test strip changed to a dark color, indicating "large ketones". Panic mode set in; here's why,  from the ADA:
Ketoacidosis (key-toe-ass-i-DOE-sis) is a serious condition that can lead to diabetic coma (passing out for a long time) or even death. When your cells don't get the glucose they need for energy, your body begins to burn fat for energy, which produces ketones. Ketones are acids that build up in the blood and appear in the urine when your body doesn't have enough insulin. They are a warning sign that your diabetes is out of control or that you are getting sick. High levels of ketones can poison the body. When levels get too high, you can develop diabetic ketoacidosis, or DKA.

So, the goal over the last few days now has been to keep her from going into full-blown DKA. We upped her insulin even more and hydrating, hydrating, hydrating. Testing, dosing and hydrating her through the night. Her BG came down well Tuesday night and the ketones were "trace" by 12:30 AM.

Everything creeped back up again Wednesday: her BG, her fever and her ketones. She had large ketones before bed, again, and her BG was going up, not down. At that point, I called the Endocrinologist on call and she was helpful and supportive -reminding us not to overdose K, as much as we wanted to quickly bring her BG down (over time, she'd be TOO down, as she had been the night before).  Her BG did come down that night and we missed the opportunity to check her urine in the middle of the night but when I checked her urine the next morning, her ketones were moderate. Although she had a high mid-morning BG, keeping her hydrated and dosed heavily (of insulin), combined with her fever not being quite so high, her BG later leveled off and her ketones were trace again. Her BG was great through Thursday night/Friday morning (comparatively).

So, although she's certainly not "healthy" at this point, the fever seems to have broken, and she's slowly on the mend. Phew....