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Re: [IP] DKA


    Sounds like you didn't do anything wrong.

    I've had a pump since I was 15 -- for almost 17 years -- and have had things like
this happen many times.  A # of times, especially as a teenager, I had DKA b/c of
infusion sets that had come out, the stomach flu, etc.  About 5 years ago, I decided I
had had enough of these traumatic episodes and started trying to figure out more
successful strategies.   Here are a few observations which might provide some help:

1).  Avoid the parametics and the emergency room unless an IV is necessary (for extreme
dehydration when it is and you should go).  They are taught to treat hyper and
hypoglycemia with extremes and do not measure what they give you, thus starting big bg
swings.  Often they won't let you (the diabetic) or the family member blood test with a
meter and will wait hours for blood test results.  Giving someone glucose for a low 3
hours before after intravenous glucagon is not terribly helpful.  National statistics
generally confirm that emergency rooms and paramedics aren't much help to diabetics in
all but extreme cases.  Once in a while this is not true but it is easiest to skip them
when you don't really need them.

2).  If you are at home and encounter DKA, give your son lots of water and insulin to
bring him down -- John Walsh gives good directions on this in his book.  Keep track of
what you do and give enough insulin to get him down.  Watch out for the low drop when
the insulin bottoms out.  Humalog is helpful here since it acts quickly.  Try to
identify and address the cause of  the DKA -- ie flu needs to be treated like the flu,
not with an infusion set change (I think the last might be a little bit obvious but
you'd be surprised what people can forget :-).

3).  I have to admit I don't test for Ketones anyway these days -- just work on keeping
my bgs under control and making sure I don't get dehydrated.   Those are the things you
can control and which tend to take care of the ketones problem.

4).  I've found that in the ER or with EMTs that for some reason they are more helpful
to my husband.  We actually discovered this when we were getting married and found that
wedding industry people were far more helpful to me than to him.  We've tried some
experiments and in hospitals, doctors and nurses tend to dismiss me and listen to his
explanation.  They also tend to react when he gets angry.  (We actually tried giving the
word for word same requests and explanations).  Interestingly enough, we've also found
that insurance company reps who are male help me more and female are very unhelpful to
me and vice versa with him.  It's very sad that that seems to be true but it really
does.   It's bizarre but true.  A good strategy is to find someone male who can help you
deal with those kinds of hospital situations.

Don't feel bad!  You aren't crazy!  For years the assumption was that uncontrolled
diabetics (even if they had lost control for a very good reason or b/cof illness etc)
were "bad".  At the same time, I remember being told as a teenager that it is impossible
to control teenage diabetics.  In other words that I had to be bad b/c I was a teenager
and diabetic.  I'm sure that attitude extended to parents too.  It's very sad.  Many
health professionals are beginning to understand that it is more productive to assume
that most people want to do the right thing and just need the right kind of help.
Hopefully that will continue to change.

Hang in there!  Hope Nate stays better and you will feel better too.


> Ladies and Gentlemen:
> I think I just need to know that not all medical professionals are like what we
> had to deal with last weekend!
> My son, pumping for 7 weeks, developed the 'flu.  OK, I know I didn't handle it
> right, but this was our first sick day in 17 months.  He hadn't had any vomiting
> for several years, so I am lucky in that respect.
> To try to shorten this story, I took him to the hospital at 1:30 a.m. on Friday, a
> small-town hospital, and had some trouble (they called me a fruitcake, because
> i told them Nate would jump up into the 4 or 500's during high stress, and since
> he had the Kussal (sp?) breathing, he was obviously in a high stress situation.
> I finally called nate's nurse practitioner, which is the only thing that probably
> saved nate's life!!  They had not done a blood gas test, which she said should
> have been done immediately.  He was finally transferred to a well-known
> children's hospital, in the Pediatric ICU unit for about 40 hours, and I was made
> to feel like it was all my fault, you're a bad mom, etc.  I also had lots of
> problems because I did not want to continue their program, staying in another 3
> days to continue education their way, (which included the exchange list, etc.),
> when we are already counting carbs.  I don't know what I would have done if it
> hadn't been for the nurse that has been with us since day 1!!!!  She did tell me
> it wasn't my fault, that DKA happens, etc., but I was still under the impession
> that most of the MDs thought I hadn't done something right.  Do you guys ever
> have these episodes, or is it really my fault.  I will say that he had the flu, felt
> better, took a shower ate supper, and then several hours later, vomited again.
> All of this happened in less that 12 hours!  (My child responds quickly to
> anything, including DKA!)  So, if it is my fault, please tell me.  Our educator is
> giving us a prescription for vomiting and/or diarhea (sp), and we are going over
> sick days in GREAT detail, which we were lax on because of not having any,
> and also, we now test for ketones after anything over 200.  This was our very,
> very first hospital visit, we didn't have to go in for education nor pump training,
> we went to the CDE's house (same nurse).  So, please be honest, have you
> guys with lots more experience had this happen, and what is the best way to
> handle it?
> Thanks for your help,
> Fruitcake
> Deb (Nate's mom)
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