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RE: [IP] DKA



 This is what I do as well, with my daughter Shannon (who is on the cusp of
being sweet 16). I don't mess around and tend to be very aggressive when the
meter greets us with 'hi' w/large ketones and nausea/vomiting (usually only
1-2x). We don't always know her ketone status right away...if the meter says
'hi' and she is nauseous and/or vomiting, I just assume there are ketones, start
treatment right away, and check at the first available moment. I check bgs and
ketones about every 1-2hrs or so until things resolve.
  In her case, this type of situation usually happens because something has gone
wrong during the night with the pump/set/site or once, when she forgot to put
her pump back on (ooooops!) The first thing I do is correct with a syringe
(giving about 10% of the TDD), start the carb-free fluids if she hasn't already,
check ketones at this point if we haven't already, and then try to figure out if
there is some problem with the pump/set/site. Once I deem the pump etc is
working properly, I reattach it and keep it running on the normal settings, but
continue to correct with injections until the situation resolves (which has
always taken 4-6hrs to completely turn around). It is amazing how much insulin
can be required to make a dent in the bgs, even for a child!
 I have yet to see her drop too low even with this aggressive treatment. Once
she hits around 200, I keep a closer eye on things, just to be safe, and adjust
things accordingly. And of course, I always give the dr a heads up in the
beginning, in case we have to head for the ER, but *thankfully* that hasn't
happened yet. This may be too aggressive for some, but timely and aggressive
action has worked very well for us, going on 10yrs now.
 
 Take care, Kerri - proud mom of 8 in western OR :)
http://www.myspace.com/txgrits1965
 "Work hard, live simply, give liberally, save wisely." - John Coblentz,
Christian Family Living
 
Bob said:
You have to be careful,
because you don't know
when the problem is going away, and you have to not over-respond. A mixture of
aggressiveness and
patience is required!

And with agressiveness, you have to add caution and frequent testing, to
prevent serious
hypoglycemia. 
.
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