Sick

Tap, tap, tap "I puked."

It was three in the morning, but M was outside my bedroom door, and I had to spring into action. The first thing I ask is, "What day is this, Sunday?" She tells me it's Tuesday. Now I know I have to call in for a substitute.

I remembered that nearly two years ago, when M was diagnosed with Type 1, we were told that vomiting is very serious business that could lead to hospitalization. This was the first time in those two years that we have had to face this problem.

I remembered nothing. Oddly enough, when M and I went down to Children's Hospital for her infusion set appointment, I went out of my way to grab a pamphlet on sick day management. But where was it? Where was all the information I was given two years ago?

Braaaack

Okay, now that's twice. I am glad this child knows how to get all the way to the toilet.

She wasn't feeling better after vomiting, which is not a good sign. I mean, I usually feel fantastic after throwing up. It must be that rush of adrenaline...

BRaaaack.

Three times in less than half an hour. This is going to be a long night.

Okay, so a loss of glucose from vomiting can mean a drop in blood glucose (bg). We had better monitor this. We pull out the monitor, and with a comforting beeDEEP, we are advised that M's bg is 161. I think that's good, because it leaves us a safety net of about 80 mg/dl.

She vomits again. We test again. 172.

Again. test again, 162.

M continues to vomit every 15 to 20 minutes. It is 4:00. At this point I have pulled an extra mattress into her room, written up sub plans for my Spanish class, brought M a glass of water, and brought up enough test strips to supply a battalion for a week.

I doze between vomits. So does M. After a while I realize that a) I must call the substitute coordinator, and b) testing M's bg every 15 minutes might be excessive. I decide we will test every other time she vomits. I have a sheet of scrap paper with a long list of times that M has vomited. Next to it is the bg level.

The sub coordinator at my school is an excellent human being. He knows that I am never sick. He knows that if I will be out, I will leave plans. He know that I feel guilty if I screw something up. He understands me, because he, too, suffers from Catholic Guilt. When I call him, he gives me no indication that this is a bad time (which, I soon discover, it really was). He just says, "Okay, thanks for calling."

Having handled the school situation as best I can, I devote some time between vomiting episodes to trying to find that information about sick day management. Being that my brain is addled and I am exhausted, this is no easy task.

Two years ago, my mother had put together a binder with M when she was first diagnosed. It helped both of them to organize the information that M had, and made them both feel better empowered and informed. I locate the binder, but there is no sick day management sheet.

I look in the car, hoping I had wedged the guidelines I had taken from our last appointment in between the front seats  on my way back from Children's.

Nope.

I go back to the binder. BRaaaaack.

M's bg is 126. I bring up a Coke and ask her to take two sips. M's target is 110. 126 feels a little too close for comfort. I want wiggle room, baby!

Okay, binder. Now, let's look through each individual sheet.

I look. The only information I get is from the test strip company, that says "When to contact your doctor". Vomiting is at the top of the list.

Fine. I vow to call the doctor once office hours begin.

At 9:00 am I call the DNE, who is not in today, would I like to speak to the endocrinologist? As I wait on hold, my anxiety increases. I felt like I was fine before now, but the haste with which the operator referred me to someone else makes me nervous.

I speak to M's doctor, who tells me to watch her Ketones. Damn! I forgot about those things! M hasn't has a high enough bg to warrant checking them in a while. If the Ketones are higher than 2, Dr advises us to go to the hospital.

Now where are those Ketone test strips? M says that she doesn't know, and I sure as hell don't. I find the urine strips, but not the nice blood strips for her monitor. Hopefully she will be hydrated enough to pee. I have been forcing her to drink two sips of water every time she vomits.

I run up to her room with the urine strip. She is asleep. Sound asleep. For the first time in 7 hours, she looks comfortable. I choose to leave her alone.

After two hours she awakens. I explain about the Ketones. She says she can pee. She does, but then she gets upset. The Ketone strip indicates a 5 or a trace amount. She says, "Should I pack for the hospital?"

I tell her to hold on, I will telephone the DNE on call for the day and ask. I think "trace" doesn't sound that bad....

Before I get downstairs, the phone rings. It is Dr. She asks about M. I tell her about the trace. She tells me, "Trace is fine. Stay home. Why don't you phone the DNE on call, and fill her in, just so we have a baseline in case something else develops."

M doesn't feel like vomiting any more. The final score: her bg ranged from 126 to 202. I feel like congratulating myself. When I talk to the DNE, she does. "Good job!" she says.

She then advises me to allow M to stay a little high in her bg range over the next day or two. Also, reduce her Lantus by about 20% for tonight. After all, she has no stores on which to draw. Keep pushing liquids. Maybe see if she will eat some broth or something.

Phew! We made it through our first test.

Now for the big question: Will sick day management be easier on the pump?

Boo on being sick. Double Boo on being sick with diabetes.