Hello Ketones

She was awake early with stomach cramps, nausea and a low grade fever. She felt miserable. On the bright side her blood sugar was quite reasonable.  I relegated her to the 'sick corner' of the sofa with the remote and a cup of peppermint tea.  

I proceeded to make the requisite phone calls, and coffee.  Then, ironically, I had to go to the school anyway to drop off dessert for lunch with a visiting author. On the way home I stopped at the convenience store to pick up a low-carb sports drink.  

Arriving home, I had my daughter check her blood sugar again.  Then it occurred to me (belatedly, I know) to check for ketones too.  I dug the blood ketone meter out of the diabetes box.  A quick drop of blood and the result read out.  '1.2.'

"That seems pretty high," I said vaguely. We check ketones during illnesses, but it's been years since she's had any.  I did some quick research. 'Moderate' was the official term I was looking for.  We needed to take action quickly or things would go from bad to worse.  Meanwhile, her blood sugar was down to 120. She needed insulin to help clear the ketones, and therefore she'd need to take in some carbohydrates to balance it out. 

I calculated a generous insulin dose and she managed to get down 15 carbs of ginger ale.  I then provided her with a cheerful travel cup full of the diet sports drink. She sipped as best she could to start washing those ketones out of her system. The combination of insulin and hydration began to work their magic. We were soon out of the woods.

What struck me about this incident was how unprepared I felt for it.  My instinct, when I didn't know what that ketone reading meant, was to time travel back 11 years and dig out the booklet our children's hospital gave us when she was diagnosed. The chart was right where I pictured it, accompanied by lots of helpful advice which helped me deal with the problem.  Yet questions remain.

Should I be relying on 11 year old information or are there newer protocols?  Would it be worthwhile to review sick day plans at our next endo appointment?  Should plans for various emergencies be reviewed every couple of years as a rule?

Hopefully it will be another few years before I need this information again, but I don't plan to wait that long to refresh my memory.

The Tummy Mystery

Faithful readers may recall that my daughter missed the first day of school because she threw up.  Neatly summed up in one quick post, it may have seemed that was the end of the story.  Unfortunately, the story continued through the fall and winter and is still a part of our lives. 

She made it back to school for day two, but continued to complain of stomach aches and nausea.  In retrospect, her appetite had been decreasing for a few weeks, and it continued to worsen.  Her blood sugars seemed erratic, though whether from the unpredictable diet or its cause it was hard to tell. A doctor's visit showed she'd lost 2 pounds in the past year, not normal for a 9 year old.  The pediatrician thought it might be gastric reflux, from which she'd suffered badly as an infant.  He also tossed around the idea of food intolerances, strange infections, and diabetes' frequent partner in crime, celiac disease. 

A little acid reduction medicine took the edge off the discomfort while we scheduled an appointment with the gastroenterologist.  (Who my daughter, 8 months later, still calls the 'gastroencrinologist').  The doctor agreed it could be any of the things we'd discussed with the pediatrician.  She also spent some time talking with us about anxiety, and about something called 'functional belly pain,' which, as I understand it, involves chronic stomach aches with no identifiable cause. A full blood panel was ordered, as well as an increase in the acid reducer medicine and the addition of a medicine whose side effect was to increase appetite.  We reached the point where my daughter felt pretty good some days, though there were still others when dinner went half-eaten. 

The whole thing continued to be a diabetes nightmare.  We resorted to bolusing only when she was finished because she could not predict how much she would eat before her stomach began to hurt.  Even then, blood sugars continued to be unpredictable.

In early November, the bloodwork came back normal.  No celiac, no strange infections. Her blood sugar was an embarassing 3-oh-something, but par for the course for her when being stuck with a needle. At this point, my child was feeling somewhat better, though not perfect  She'd gained a couple of pounds.  We agreed with the gastroenterologist to wait it out through the end of the year to see how things went.  I remained fairly convinced that this had a definite, physiological cause.  It was increasingly disconcerting that we weren't learning what it was.

In the beginning of January, the symptoms began to worsen again.  A second opinion gave us no additional insight, and deciding we preferred the first doctor, we scheduled another appointment. The end result was the ordering of an endoscopy.  Through this, the doctor would see whether there was physical evidence of gastric reflux, or any other visible problem.  She would also take biopsies for lurking infections, celiac disease, and lactase enzymes. 

Five months after first realizing there was a problem, we hoped for answers. Tune in Thursday to find out what we learned.