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....