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near miss

We spent the evening at our local fair, a hot air balloon festival complete with midway, games and fair food. Excitement pumped through Madeline as she rode ride after spinning, flying ride. We took a break for a while, to indulge in some fair food. I tested her BG and found it to be, surprisingly, in target range. I’ve heard tale of how adrenaline can raise glucose levels, but this did not seem to be happening for her.

We hunted around for a vendor that could give her most favored, most savored, most anticipated treat of the entire year. Fried dough. With powdered sugar and cinnamon. You see, I allow Madeline to have this treat only once a year, at this fair. Its carb content is so difficult to SWAG, and it lingers in her digestive system for hours. These things are a recipe for BG disaster… but luckily, I remembered that last year, we SWAGged 75 carbs with reasonable results. So, while she carefully ate this rare delectable, I bolused her for 75 carbs.

She rode several more rides after eating, but then complained of feeling low. We stopped to test her BG, and I found a beautiful 104 staring back at me. That’s a prized achievement under normal circumstances, except in this case she was still metabolizing nearly 5 units of insulin from the fried dough bolus. Ain’t no juice box going to take care of that much insulin on board. It’s your lucky night, I told her, because you can get an extra treat. She chose a soft serve ice cream cone, and based on my calculations, I figured that its carbs would be gobbled up by the IOB. All would be well in BG land.

We headed home later, and tucked into bed around 10:45 p.m. I tested her as she settled in for sleep, and her BG/IOB balance seemed safe to me. Still, I set my phone alarm to test her each hour for the next three hours, just to be sure.

About 20 minutes later, Madeline’s sister came to me and said that Madeline sounded like she was scared. I went into their bedroom, and found her drenched in sweat and breathing rapidly. I asked her what was wrong, and she burst into tears that she felt low. She seemed disoriented to me, like she did  not know what to do. I chalked this up to the effects of disturbed sleep. I tested her, and the reading took my breath away.

35.

I immediately started to reassure her as I scrambled for big juice boxes and Smarties. She sucked down the juice and I fed her Smarties, quickly getting about 50 carbs into her little body. I also suspended the basal insulin program on her pump. As she lay there waiting for the sugar to hit her system, the full impact of this low began to register with me. She was sweating profusely. Crying that she was hot. Crying that she could not move. Although she had awareness that she was in the middle of a terrible low, it was very clear to me that she was incapable of helping herself.

Her glucose level rose rapidly, 79…116…149. And then she vomited. By this point, she had very little insulin on board from that fried dough bolus, and it was clear in the readings that her body had absorbed quite a bit of the emergency carbs before she got sick, so I did not expect that her BG would begin to tank again. And yet, that is exactly what happened. Over the next hour, her BG steadily eroded:  124, 109, 92.

As I sat with her waiting in between BG checks, I started to google something I’ve heard about in the Diabetes Online Community, called a “mini glucagon” bolus. In more than three years of living with T1D, Madeline has never had a low this severe, and has never needed emergency glucagon. This situation, though, seemed to a little something more than simple carbs, especially since Madeline had vomited and was now refusing even the smallest little Smartie. I checked three different sources on how to administer a mini-dose of glucagon and decided that if her BG was still dropping at the next check, I would give her a dose.

When an 80 glowed on the meter screen, I proceeded with the gluc dose. It worked, and fast too; within 30 minutes her BG had jumped to 185. Under typical circumstances, this is too high, but I spared it from treatment. I turned on the basal program again, and tried to sleep for an hour before testing again.

Madeline’s BG hovered in the 170s for the remainder of the night, thankfully. All told, it took over two hours, 11 BG tests, and 10 units of glucagon to help her recover from this terrible low.

All day, I’ve been struggling through the Monday-morning quarterbacking that invariably occurs after an event like this. Why did her BG deteriorate so quickly and drastically? What if her sister had not awakened and come to me to tell me Madeline was crying in bed? What would have happened if I had waited even 10 minutes longer before getting up to test her (which was my plan, until Sophia intervened)? What if she had been sleeping alone in her room?

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Over the past three years, I have worked very hard to control my anxiety and fear related to diabetes. We’ve become accustomed to its unpredictability even as we’ve learned how to manage it with as much mastery as possible. Fear is no longer palpable in my throat every moment of every day. I’ve tried to teach myself–and Madeline–that while T1D is a condition that always requires vigilance and due consideration, it does not require one to live in a constant state of fear.

Yet, the reality of this low is terrifying. The truth is that she likely would have gone into a diabetic coma and even died in this situation, had she been sleeping alone, had her sister not heard her crying and come to get me, had I not been aware of what was happening and had waited to test her BG. She was not able to help herself, even though she was conscious of what was happening to her. She would have died.

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About Heather Garcia Queen

I am… a mother of 3 spectacular children. A wife of an architect extraordinaire. An MSW. A psychologist in an elementary school. A (wishful) writer. A protector of family and spirit. A worshipper of the natural world. A seeker of knowledge. A lover of the arts. An introvert. A silver-lining kind of girl.

Discussion

6 thoughts on “near miss

  1. So scary.

    I like miniglucagon. It makes me feel like a bionic pancreas.

    Posted by katy | 07/18/2014, 5:20 pm
    • We have never been told about mini glucagon dosing by our endo team. That puzzles me. Especially for the fact that we live 1 hour 10 minutes from the nearest ER equipped to handle pediatric T1D. It seems like such a valuable tool. Once again, thank goodness for people sharing knowledge in the DOC.

      Posted by Heather Garcia Queen | 07/18/2014, 10:15 pm
  2. I knew about it from the DOC too; our endo never mentioned it, but I called her before I did it to ask how she would do it. I feel like I’m pretty good at knowing whose “this is not medical advice” CAN BE used as medical advice, but that red box is so scary! I admire you!

    Posted by Katy | 07/20/2014, 11:36 pm
  3. In 9 years, we’ve used glucagon once…for a scenario much like the heart pounding one you just described. I’m so sorry…in the aftermath, it’s hard not to get lost in the sea of “what ifs”. Thank goodness her sister was there and thank goodness you were able to maintain sound judgement in the face of such a wicked, horrible, terrible situation.

    Posted by Wendy | 07/22/2014, 9:48 pm
  4. Thank you for your brave sharing. The last sentence in your post takes my breath away.

    Posted by lesleykimball | 07/25/2014, 9:35 pm

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