Showing posts with label sick. Show all posts
Showing posts with label sick. Show all posts
Flu
Neither of us felt great on Tuesday a week and a half ago. By mid-day Wednesday we were camped out on the couch coughing, feverish and watching the Olympics.
We visited our respective primary care providers on Thursday. Both were out of diagnostic swabs but our symptoms of fever, aches, cough and utter exhaustion led both to diagnose us the old-school way.
Despite getting flu shots and obsessive hand washing and hand sanitizing, we ended up with the flu.
Because of the afore-mentioned flu shots, the experience was allegedly less awful than it could have been. Nevertheless we spent Wednesday through Monday pretty much immobilized in front of the television.
Diabetes, needless to say, did not like the flu. The night before it hit was a multi-juice box night, which is consistent with my daughter's pattern when she's coming down with a virus. Despite no medical information to back me up, I've always assumed these pre-symptom lows were caused by her body waging a last-minute battle against whatever germs have invaded.
Then the blood sugars headed up. And stayed there. Days would usually start out okay- higher than usual but nothing crazy. Then, despite temp basals, corrections, and a diet consisting mostly of chicken soup, she'd crest 300 by mid-afternoon.
By bedtime (which was before 9 several nights- when sitting on the couch became too exhausting) she was sliding back into an acceptable-for-being-sick range. My saintly husband took overnight duty a few nights in a row, each of which required at least one correction bolus.
By Sunday afternoon and Monday the highs weren't SO high and the correction boluses began to actually work a little. She was on the mend.
We've done diabetes + colds, stomach viruses, strep, pneumonia, chicken pox, dental surgery, ear infections and more, but never flu. There was quite a bit of transferrable information from our experiences with other ailments. We knew about the necessity of frequent glances at the CGM, setting increased temporary basal rates on the pump, and aggressive correction boluses for highs. We knew that with patience and perseverance blood sugar would return to normal as the illness passed.
The primary novelty of the flu compared to our countless other illness + diabetes experiences was the duration of being really sick. With the illness lingering, in a serious way, for nearly a week it was a long wait for blood sugars to look more like they usually do. The silver lining was that both of us were too sick to expend any energy worrying about it. It took everything we had just to keep our tea mugs full.
Antibiotics
The sniffles and cough started last weekend. "I feel fine, just stuffy," was the report. We started the allergy medicine, assuming the start of spring was to blame. On Wednesday she woke with a disconcerting fever of 102.5. The pediatrician did an exam and a strep test, and diagnosed a virus. "Keep giving her Motrin and plenty of fluids." I wasn't convinced, but we took that route for a couple of days. When she still had a cough and a fever of 102 on Saturday morning, I took her back to the doctor's office. To add insult to injury, her blood sugar had been hovering around the 250 mark for 3 days despite aggressive corrections and temp basals.
The practice's other doctor had pulled the Saturday shift. I elaborated on the recorded chain of events, and emphasized my concern that nothing about her condition had changed in the past three days. My stubborn skepticism about the virus idea led to a more careful look. "Looks like she has a little ear infection. I'll put her on an antibiotic." She thought for a while. "I'm going to give her one that works on ear infections but which we also give for upper respiratory infections and mild pneumonia. Her throat is very red and her lungs don't sound great either. This medicine should take care of anything that's going on."
Observing Saturday's Dexcom graph below, you'll see an ugly pattern in the first 18 hours. This is indicative of the previous 3 days' patterns as well. No tactic we attempted proved to be a match for the havoc this illness was wreaking on her blood sugar. Her first dose of antibiotic was at noon. We did nothing different that afternoon, diabetes-wise.
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| Exhibit A |
She spent Sunday primarily below the (admittedly inflated because we couldn't stand the constant alarming) line. Everything was not awesome all day long, but comparing the two is like looking at two different people's dexcom receivers.
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| Exhibit B |
The fever was gone by mid-day Sunday and so was the lethargy of illness.
I know the medical community is increasingly wary of prescribing antibiotics, recognizing that their overuse can cause problems on both individual and global levels. These are important concerns. But sometimes there's an actual infection and an antibiotic is needed. Had an antibiotic been started on Wednesday, we wouldn't have spent 3 days beating our heads against the wall fighting unfightable high blood sugars. And she wouldn't have spent so much time on the couch instead of at school, or out in the spring air.
But I suppose she wouldn't have been introduced to Gilligan's Island.
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.
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.
Sick Day Project
to help us with a very important project:
We put together our cards for the World Diabetes Day postcard exchange.
The germs should die off in plenty of time to mail them. Now if the glue would just dry in time too...
Bits and Pieces 4
It's been a busy week with a busy upcoming weekend. My thoughts are scattered and it feels impossible to create an entire post about one topic. So here are a few bits and pieces of what's on my mind:
My daughter had her standardized testing this week, which went better than it has other years, diabetes-wise. She's tired of peanut butter whole wheat toast every morning, but there was no repeat of the infamous 3rd grade nurse's office workout. I think we have a test-day breakfast winner.
A new favorite product is Gatorade's G2. We bought it to aid in recovery from a stomach bug, but it's become a must for softball games too. With something like seven carbs per 12 ounces, it's just the thing for both a sick, dehydrated kid and a budding athlete.
Last but certainly not least, 'who's your diabetes co-star' would be a great question for Diabetes Blog Week next year. For now, there are great prompts for all seven days next week plus two wildcards to choose from. I'll be participating and can't wait to read the thoughts of my fellow bloggers. Stay tuned!
Alone
My daughter was home sick from school at the beginning of last week. She spent most of two days on the sofa watching t.v. and blowing her nose.
By the morning of day two we faced an emergency. We were down to five tissues. I had to go out.
At eleven years old many of her friends get left home alone. Some are alone for an hour or two daily before their parents get home from work. Others are left while siblings are taken to practices, games or appointments. We are fortunate to live in a relatively safe community. The word 'responsible' has been used to describe my daughter at every parent teacher conference since she was four. Despite all of this, my daughter had never been left home alone for more than about 10 minutes.
It's not my daughter I'm afraid to leave home alone. It's her diabetes. Would she remember to bolus for a snack? What if she were low? Would she notice? If she did notice, would she have the wherewithal to treat it? What if the low caused her to be too confused to react? What would she do if the pump alarmed?
Yet the idea of resorting to blowing our noses on napkins or paper towels seemed unappealing. So did scrounging around the freezer for ossified leftovers for dinner. We had finished the box of peppermint tea. A snowstorm was predicted to begin the next day. I had to go, and I couldn't drag a child with snot pouring down her face around the grocery store. Had it been necessary, I probably could have found somebody to come stay with her, but I really didn't want to expose anyone to this illness.
So around 10 a.m. when she wanted a snack, she tested her blood sugar. It was 200-ish (not bad for sitting on the sofa all morning) and she bolused for the number and some dry cereal. I put the meter, a juice box, and the phone on the table in front of her.
"Please check if you feel at all funny. Call me if you need me." And then, in an attempt to elicit a smile, "Don't do anything crazy."
It was a combination smile and eye roll. "I'm just going to sit her and watch 'Good Luck Charlie.' Don't forget to get me a diet ginger ale."
So I left.
You know how the story ends. When I got home she was sitting on the sofa watching 'Good Luck Charlie' and blowing her nose in the next to last tissue.
At this age, I can still avoid leaving her alone in most circumstances. She prefers a visit from grandpa or going to a friend's house to being home alone anyway. Yet the day will come when she can legitimately be home alone for a few hours. I'm sure she'll be responsible and careful. I'm also sure I will be nervous. While I can't arrange playdates when she's sixteen, I'll always be happier when she has a buddy around in case she needs a little help.
By the morning of day two we faced an emergency. We were down to five tissues. I had to go out.
At eleven years old many of her friends get left home alone. Some are alone for an hour or two daily before their parents get home from work. Others are left while siblings are taken to practices, games or appointments. We are fortunate to live in a relatively safe community. The word 'responsible' has been used to describe my daughter at every parent teacher conference since she was four. Despite all of this, my daughter had never been left home alone for more than about 10 minutes.
It's not my daughter I'm afraid to leave home alone. It's her diabetes. Would she remember to bolus for a snack? What if she were low? Would she notice? If she did notice, would she have the wherewithal to treat it? What if the low caused her to be too confused to react? What would she do if the pump alarmed?
Yet the idea of resorting to blowing our noses on napkins or paper towels seemed unappealing. So did scrounging around the freezer for ossified leftovers for dinner. We had finished the box of peppermint tea. A snowstorm was predicted to begin the next day. I had to go, and I couldn't drag a child with snot pouring down her face around the grocery store. Had it been necessary, I probably could have found somebody to come stay with her, but I really didn't want to expose anyone to this illness.
So around 10 a.m. when she wanted a snack, she tested her blood sugar. It was 200-ish (not bad for sitting on the sofa all morning) and she bolused for the number and some dry cereal. I put the meter, a juice box, and the phone on the table in front of her.
"Please check if you feel at all funny. Call me if you need me." And then, in an attempt to elicit a smile, "Don't do anything crazy."
It was a combination smile and eye roll. "I'm just going to sit her and watch 'Good Luck Charlie.' Don't forget to get me a diet ginger ale."
So I left.
You know how the story ends. When I got home she was sitting on the sofa watching 'Good Luck Charlie' and blowing her nose in the next to last tissue.
At this age, I can still avoid leaving her alone in most circumstances. She prefers a visit from grandpa or going to a friend's house to being home alone anyway. Yet the day will come when she can legitimately be home alone for a few hours. I'm sure she'll be responsible and careful. I'm also sure I will be nervous. While I can't arrange playdates when she's sixteen, I'll always be happier when she has a buddy around in case she needs a little help.
How Low Is Too Low?
An hour or so after tucking her in, I checked my daughter's blood sugar.
85.
What a great number. Unless it's 9:30 at night.
At 10:15, she was still 85.
At 12? 85.
Bizarrely consistent. Maddeningly sleep depriving.
I set a temporary basal rate and set the alarm for 1:30.
150.
Good enough to set the alarm for morning.
Breakfast number? 89.
On the one hand, seeing 85 for every blood sugar check would be excellent. It would, of course, require a cure, but a girl can dream. At 9:30 at night, sans cure, it's frustrating. It's not really low. During the day, I'd certainly let it go and have her check again in a little while, or if she started to feel it.
Yet when she's sleeping, it's a tough call. Ten points lower, and I'd be reaching for a juice box, but 85 is no reason to wake her from much-needed sleep. Even a smidge of juice would probably raise her into the high 100's, less desirable than 85. Yet 85 is not comfortable. It's a quick drop from there to significant hypoglycemia: a dangerous proposition in the middle of the night. I should have set the temp basal earlier on in this scenario, if for no other reason than for my own peace of mind. But otherwise, I don't know what else would have helped.
The worst part is that the reason for hours of straight 80-somethings was not some fabulous basal rate tweak or the discovery of a perfect dinner menu.
It was the cold she woke up with this morning.
85.
What a great number. Unless it's 9:30 at night.
At 10:15, she was still 85.
At 12? 85.
Bizarrely consistent. Maddeningly sleep depriving.
I set a temporary basal rate and set the alarm for 1:30.
150.
Good enough to set the alarm for morning.
Breakfast number? 89.
On the one hand, seeing 85 for every blood sugar check would be excellent. It would, of course, require a cure, but a girl can dream. At 9:30 at night, sans cure, it's frustrating. It's not really low. During the day, I'd certainly let it go and have her check again in a little while, or if she started to feel it.
Yet when she's sleeping, it's a tough call. Ten points lower, and I'd be reaching for a juice box, but 85 is no reason to wake her from much-needed sleep. Even a smidge of juice would probably raise her into the high 100's, less desirable than 85. Yet 85 is not comfortable. It's a quick drop from there to significant hypoglycemia: a dangerous proposition in the middle of the night. I should have set the temp basal earlier on in this scenario, if for no other reason than for my own peace of mind. But otherwise, I don't know what else would have helped.
The worst part is that the reason for hours of straight 80-somethings was not some fabulous basal rate tweak or the discovery of a perfect dinner menu.
It was the cold she woke up with this morning.
No Big Deal
Nearly a year after she was diagnosed with diabetes, my daughter was due for her annual physical with the pediatrician. He looked through the chart and observed that he'd only seen us for one sick visit all year.
"Other than the diabetes, she's been pretty healthy then?"
"Well, you know, a cold here or there, but nothing worth coming in for," I said.
"Oddly," he said, "I think my patients with diabetes come in less than the ones without." Usually, he continued, if I child with diabetes showed up in his office sick, he could be fairly sure it was something significant.
This pattern has continued to be true for us. My daughter is rarely at the pediatrician, and if she is, there's no arguing about whether she needs to be there.
Is it because we're tired of being in doctors' offices? With each illness, we carefully weigh whether the visit is worthy of waiting room time, excess germ exposure and a co-pay.
Is it because we're more germ-averse? Hand washing, hand sanitizer, and avoiding germy surfaces have been a large part of my daughter's life since she was little. Any illness provides a blood sugar roller coaster in addition to its standard symptoms, so we avoid all we can.
Is it because we're more attuned to symptoms? The constant vigilance of diabetes means being more physically aware. Perhaps this makes it easier to differentiate a serious illness from a passing cold. Additionally, the clues of blood sugar fluctuations and ketones can often alert us to the severity of the problem right here at home.
None of this is to say that she's never been to the doctor to be sent home with 'just a virus.' If it includes a high fever, a weird rash, or if it won't go away, I take her in. It's simply that I thoroughly assess the situation first.
Those of us who care for diabetes become increasingly confident in our medical expertise. Perhaps, therefore, we become more confident in differentiating between an illness which is doctor-worthy and one which is no big deal.
"Other than the diabetes, she's been pretty healthy then?"
"Well, you know, a cold here or there, but nothing worth coming in for," I said.
"Oddly," he said, "I think my patients with diabetes come in less than the ones without." Usually, he continued, if I child with diabetes showed up in his office sick, he could be fairly sure it was something significant.
This pattern has continued to be true for us. My daughter is rarely at the pediatrician, and if she is, there's no arguing about whether she needs to be there.
Is it because we're tired of being in doctors' offices? With each illness, we carefully weigh whether the visit is worthy of waiting room time, excess germ exposure and a co-pay.
Is it because we're more germ-averse? Hand washing, hand sanitizer, and avoiding germy surfaces have been a large part of my daughter's life since she was little. Any illness provides a blood sugar roller coaster in addition to its standard symptoms, so we avoid all we can.
Is it because we're more attuned to symptoms? The constant vigilance of diabetes means being more physically aware. Perhaps this makes it easier to differentiate a serious illness from a passing cold. Additionally, the clues of blood sugar fluctuations and ketones can often alert us to the severity of the problem right here at home.
None of this is to say that she's never been to the doctor to be sent home with 'just a virus.' If it includes a high fever, a weird rash, or if it won't go away, I take her in. It's simply that I thoroughly assess the situation first.
Those of us who care for diabetes become increasingly confident in our medical expertise. Perhaps, therefore, we become more confident in differentiating between an illness which is doctor-worthy and one which is no big deal.
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