DKA

NutmeggeRN, BSN · Nov 25, 2019

Ugh...she must have felt terrible with her sugar that high. Hoping she is on the road to recovery. If she is consistntenty in the 300s her insulin (especially long acting) needs to be adjusted. Oye!

ARN · Nov 25, 2019

that is so unfortunate. My son is type 1 and I freak out when he goes above 200. I mean I try not to freak out outwardly, but I have an anxiety attack on the inside. I follow his numbers on his dexcom closely and I cannot sit and let him ride high. my background is med surg so I have seen what may lie in his future if we don't work diligently to keep his blood sugar under control. I just pray that when he hits the teen years we make it to the other side without too much damage due to hormones and potential burn out from him. He is 7.

It drives me insane when the high school students I work with don't have back up supplies/low supplies etc on them or at least stashed in my office. I always keep fast and complex carbs for them and in the event that my kiddo needs to hang with me at work for the last bit of the day. I hope I instill in my kid that he has to carry his stuff with him as he gets older.

one thing that scares me is dka with normal blood sugars. I had no idea that it could happen until I became the parent of a type 1. Anytime my kid has a sore throat, tummy ache, or anything we check ketones.

I hope mom opens up her eyes and gets it together to help her kid learn how to manage this beast better.

ihavealltheice · Nov 25, 2019

Wow! Thank you for sharing your story. Great heads up on your part!

Think of the schools that don't have nurses, this terrifies me because obviously the parent nor the teacher didn't put it together.

MrNurse(x2), ADN · Nov 25, 2019

49 minutes ago, ARN said:
one thing that scares me is dka with normal blood sugars. I had no idea that it could happen until I became the parent of a type 1. Anytime my kid has a sore throat, tummy ache, or anything we check ketones.

Wow, didn't know that was a thing. Thanks for putting it on my radar. This girl has been so well controlled since her CGM. I think mom was rounding her carbs down so she wouldn't go low (less than 120 for her) pre CGM and her daily average on fingersticks was 220. She would get symptomatic under 100. I am kind of amazed at the T1 mentality of endocrinologists to not do dietary teaching and allow them to eat whatever they want.

ARN · Nov 25, 2019

21 minutes ago, MrNurse(x2) said:
Wow, didn't know that was a thing. Thanks for putting it on my radar. This girl has been so well controlled since her CGM. I think mom was rounding her carbs down so she wouldn't go low (less than 120 for her) pre CGM and her daily average on fingersticks was 220. She would get symptomatic under 100. I am kind of amazed at the T1 mentality of endocrinologists to not do dietary teaching and allow them to eat whatever they want.

our endo doesn't have my kiddo on a limited carb intake. the nutritionist in the office said as long as he maintains a healthy weight they wouldn't restrict him. I have read about eating disorders due to restrictive diets, and kids sneaking food and not taking insulin to cover carbs. overall I think its healthier to teach them all things in moderation. An orange or a banana can wreck my kids blood sugar just as bad as a cupcake can if we don't prebolus and make sure to give the right amount of insulin (which the right amount of insulin is ever changing as he grows). Sounds like mom needs some help getting over her fear of lows and understanding that as her daughter stays in range more she will feel better at lower numbers.

not every parent adjusts their kids doses and sometimes its hard for the endo team to make accurate adjustments since they don't have the full picture (activity, macro content of food ie protein and fat have a big impact on blood glucose as well but often gets overlooked). I wonder if mom has been sending in numbers to endo for their help in making dose changes. also what age is the girl? could it be her period? I am not looking forward to teenage hormones and I am super glad that I have a boy. (fingers crossed my 4yo girl doesn't develop type 1 ).

MrNurse(x2), ADN · Nov 25, 2019

6 minutes ago, ARN said:
our endo doesn't have my kiddo on a limited carb intake. the nutritionist in the office said as long as he maintains a healthy weight they wouldn't restrict him. I have read about eating disorders due to restrictive diets, and kids sneaking food and not taking insulin to cover carbs. overall I think its healthier to teach them all things in moderation. An orange or a banana can wreck my kids blood sugar just as bad as a cupcake can if we don't prebolus and make sure to give the right amount of insulin (which the right amount of insulin is ever changing as he grows). Sounds like mom needs some help getting over her fear of lows and understanding that as her daughter stays in range more she will feel better at lower numbers.
not every parent adjusts their kids doses and sometimes its hard for the endo team to make accurate adjustments since they don't have the full picture (activity, macro content of food ie protein and fat have a big impact on blood glucose as well but often gets overlooked). I wonder if mom has been sending in numbers to endo for their help in making dose changes. also what age is the girl? could it be her period? I am not looking forward to teenage hormones and I am super glad that I have a boy. (fingers crossed my 4yo girl doesn't develop type 1 ).

She is seven, not hormonal, yet. Friday morning she had sausage with no coverage. Fats and proteins drove up her sugars, I noticed that. Her waking sugar was 321.

ARN · Nov 25, 2019

so many reasons for her blood sugar to suddenly be whacky but no matter what the reason mom should have followed a flow sheet on how to handle high blood sugars and been in contact with endo to give additional insulin and not trying to wait until she got home. ugh. that makes me so mad for that kiddo.

period? insulin is bad? forgetting to give basal? not giving enough basal? kid sneaking food? carb ratio's need changed? insulin not absorbing, scar tissue? forgot to count carbs? guessing at carbs and not counting correctly? kid coming down with an illness or infection? is she on a pump? pump site bad? high fat and protein in prior meals affecting blood sugar later? correction factor needs adjusted?

hopefully they get her back under control and mom learns a lesson on how to handle when things get out of control next time.

ARN · Nov 25, 2019

Just now, MrNurse(x2) said:
She is seven, not hormonal, yet. Friday morning she had sausage with no coverage. Fats and proteins drove up her sugars, I noticed that. Her waking sugar was 321.

ugh starting her day at 321 is the first issue of course. she probably ran high all night long too. its just a domino affect from there. The sausage could have had high fructose corn syrup in it. a lot of processed meats do.

how long has she been dx type 1. my kid doesn't really get any "free" carbs anymore. even a string cheese will raise his blood sugar two to three hours after he eats it and I have to be ready to give him some insulin. thank goodness for his cgm keeping me in the know on how every little thing affects him. and thank goodness for his pump allowing me to be able to give him smaller doses as needed to knock down protein rises.

MrNurse(x2), ADN · Nov 25, 2019

She is on pump with CGM, diagnosed 3 years ago. She normally drops with infection and she never sneaks food. Our teaching with her is constant. Mom doesn't seem keen on her independence. Scar tissue could be an issue. I have reached out to her endo at Hopkins with little help, not the experience I got from their peds hospital with my son.

ARN · Nov 25, 2019

we have omnipod so the first thing I look at with higher than usual numbers is maybe the pod went bad. we have instructions to try an injection vs the pump to see if it helps get the numbers down. if it does you know its the pump site. if it doesn't it's either the insulin is bad (maybe got exposed to high temps) or the dosing needs adjusted. Once my son spiked at school and the nurse realized he had a fever so in that case it was an illness that spiked him into the 200's unexpectedly (he was ok in the morning or i wouldn't have sent him ?)

ruby_jane, BSN, RN · Dec 6, 2019

@ARN I really appreciate your wisdoms! Thank you for sharing your lived experience with us. It's amazing what a sick day looks like for a diabetic, even a well-controlled one.