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[IP] DKA experience (and humility)

Hi all--

After 33 years of living with diabetes, and 15 years as the mom of a child
with diabetes--I've just had my first experience with DKA.  I learned some
hard lessons that I'd like to share.

Josh (my 17 year old pumper who was diagnosed when he was 2) got a flu bug
and started vomiting Sunday morning.  He'd spent the night at a friend's
home--woke up ill and came home around 6 a.m.  I wasn't up yet, but he
talked to his dad and was asleep when I got up.  I let him sleep most of
the day, with periodic wake-up calls to check his bg.  Late that afternoon
his blood sugar was 145, and I told my sister (via ICQ) how pleased I was
that the pump was helping us manage this sickness so easily. 

Josh got up and ate a little bit of dinner--still pretty puny, but kept it
down.  He seemed to be feeling a little better, but went back to bed around
7:00.  School started up again Monday, and after the long break I was happy
that he was getting caught up on his rest.  I'm fighting a cold, so I took
a decongestent and went to bed early, too.  Later in the night, as we all
slept, Josh started vomiting again.  He was thirsty, so he kept trying to
drink large amounts of liquids, but they weren't staying down at all.  He
woke me up at 2 a.m. (thank goodness!) and told me what had been happening.
 His blood sugar was over 300 and he was spilling ketones--but he told me
he'd been chugging koolaid (ugh!).  I had him start sipping flat diet 7-up,
figuring that slow steady fluid intake and corrective bolusing would get
him back on track.  

Two hours later he'd managed to drink about 16 ounces of fluid--we'd
bolused with a dual wave, trying to correct to 200 without making him
crash.  Then he started vomiting again.  His blood sugar was still over
300, and his ketones were high.  So I fought back all of my reservations
about calling docs at 4 am (why does this kind of thing ALWAYS happen in
the early morning hours and/or on the weekend?) and all of my reservations
about hospitals and emergency rooms (all the stories I'd heard about
ignorance regarding pumps) and took him into the ER.  

He was in serious DKA.  The ER personnel were very knowledgeable about
diabetes and DKA (and fairly knowledgeable about pumping, too).  After 24
hours of treatment, he is well on the road to recovery.  I am getting ready
to go back to the hospital with a greater understanding of my own
limitations and a heightened appreciation for doctors and nurses and
emergency personnel. I had over-estimated my own knowledge and experience
and ability to cope with the curves that diabetes can throw at us.
(Diabetes sucks, as my son would say!)  

I'm not beating myself up--every medical person I've talked to throughout
this ordeal has been gracious and non-judgemental and impressed with the 15
years that my child has NOT been into the ER.  I am, however, feeling very
humble and going back this morning to learn from this experience.  

So far I've learned two MAJOR lessons (and I hope some of you can learn
from this email):

1.  DKA can develop--and become life-threatening--VERY QUICKLY with
vomiting and dehydration.  I thought DKA developed over the course of days
and weeks--not mere hours.  I was wrong, wrong, wrong!

2.  I need to remember my own limitations, no matter how many years I've
dealt with diabetes and how much experience I have dealing with it one a
day to day basis.  Doctors and nurses and emergency personnel have
limitations and we do need to monitor the care we (and/or our loved ones)
receive, but they have resources and knowledge that I don't have.  They
probably saved my son's life yesterday, and I am extremely grateful.

Thanks for the opportunity to get this all out of my head and to share it
with others who will understand.

:-)  Doreen in Wyoming

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