High With A Chance of Ketones

I went to bed at 10pm last night.

All three kids safely within range with no active insulin.

I didn’t set any alarms for night checks, no reason to worry.

This morning I got up made coffee and packed lunches.

Middles got up and took a shower, checked BS (117) and ate breakfast. All was well.

Sugarboy got up, took a shower, checked BS (149) and ate breakfast. All was well.

No sign of Sweetstuff. I went up to get her moving guessing teenage girl ‘sleeping in’ issue. She was curled up still asleep. I nudged her and then poked her finger. As the meter counted down she mumbled “my site fell off”.

Huh? When?

She shrugged. She didn’t know when she just found it dangling.

(The infusion site that normally is stuck to her body that allows her to get a constant insulin drip was not attached.)

BS 418. Crud.

I ask her to get up and check for ketones. To check for ketones (something caused by lack of insulin – not a good thing) one must either pee on a stick or use a ketone meter to test the blood for ketones. We don’t have a ketone meter. She peed on a stick.

ketone1photo

Massive ketones. Not good. Chest hurts, feels nauseated, head hurts, pale.

To clear ketones she needs insulin, STAT. Plus time to start pushing fluids.

New infusion site, new insulin, yogurt consumed.

Moments later Sweetstuff is in the bathroom vomiting.

Call left on attendance line at school – Sweetsuff will be out today.

An hour later still large ketones. Sleepy child. Head hurts. Chest feels better. BS 271

Like me, when her head hurts she desires a hot shower, always makes head feel better.

2 hours later still large ketones. Still sleepy child. Head feels better. BS 201

3 hours later moderate ketones. Child is asleep on the couch. BS171

ketonephoto

Diabetes is stupid.

PS. Dear FDA – please hurry the heck up and approve Dexcom G4 for use with those under 17. Had she been wearing a CGM (continuous glucose monitor) this would be less likely to happen.

About Christina

Mom of 3 kids, all 3 have Type 1 diabetes - I blog to share stories. I am not a medical professional and my thoughts are my own. Please do not make changes to your medical care plan based on my stories - always consult your medical team. Hope you find something in my ramblings helpful and or amusing. You can find me on twitter @momof3T1s and on my Facebook page Stick With It Sugar. May all your dreams forever be bolus worthy.
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18 Responses to High With A Chance of Ketones

  1. katy says:

    I am so sorry she’s sick.

    I’m sure this is a naive question, but how is the FDA making it impossible for you to get Dexcoms? I thought if the endo/any doctor prescribed a Dex, it’d be covered–regardless of FDA approval.

    But I mean, obvsly—they should be FDA approved. Suckers work on anyone with interstitial fluid regardless of age.

    • Christina says:

      Katy – it is true that many kids have Dex CGMs. Most insurance companies will cover Dex with doctors orders. Our insurance has a strict NO ‘off label’ policy. Our doctors are employed by the same company that provides our insurance. I think our doctors would prescribe Dex if they could but with the super strict No off label policy it would never be approved. Not until the FDA approves for under 17. Even then I will need to fight but the fight is in vain without FDA backing. Trust me – all bets are off and my gloves on when FDA approves for under 17. Ill camp outside our doctors office the very day FDA approves. Ill call it ‘Occupy Kaiser’. I won’t be alone.

      • katy says:

        Why is it like this? I understand the insurance company’s best interest is to avoid paying for expensive items, but why doesn’t Dexcom make it…approved? What’s the issue? Stricter safety standards for children? Fear of a baby choking on the slider-piece everyone says falls off after a few months?

        • Christina says:

          I had never considered the choking hazard for babies but I have seen kids under 1 wearing them. Extra vigilance I’m sure. From my understanding most companies get approval for adults first because trials are expensive and different trials have to be done for different age groups. Im not sure the safety restrictions are stricter though. Interesting question.

  2. Sara says:

    We just had a similar experience last week. All normal going to bed (170) after a pump site change, wake up with a BG of 450 and stomach ache. Bolused for it, checked later and was 470, started vomiting and couldn\’t stop. Changed the pump site, rechecked, still in the 400s; checked ketones – high. She was still vomiting and keeping nothing down…we were in the hospital for 3 days with our first DKA.

    • Christina says:

      UGH. That sound awful Sara. It is true that things can go south quickly. I’ve learned (the hard way) that ‘unexplained’ highs after a site change often mean the site is bad. Since you changed the site I’m guessing it was actual illness that may have caused the high numbers and ketones. I hope you keep zofran handy now. Sweetstuff was ill two weeks ago with a virus that caused vomiting and ketones. Zofran stopped the vomiting and then we were able to push fluids and foods to clear the ketones. Never fun.

  3. kerri says:

    Diabetes IS stupid. Poor kiddo.
    I cannot understand
    a) why the G4 isn’t approved for kids [OF ALL POPULATIONS!!!] and
    b) why on EARTH Dexcom is not available in Canada. CGMers in Canada only have the option of the MiniMed pumps (and of course, those aren’t often covered by insurance either, though more provinces are getting pump programs).
    Stupid realities. I hope she is back to her bouncy Sweetstuff self very soon. <3 Give her a hug for me!

    • Christina says:

      SHUT THE FRONT DOOR – how did I not know this? So PWD in Canada can only use MM pumps and not everyone can get a pump? That’s ludicrous. Im sad now.

      • Brandy says:

        New to your blog but love it!! I am in the process of reading back posts. I wanted to comment on the PWD/pumpers in Canada….
        Pumpers in Canada have the option of the Animas Ping, The MiniMed or the Omnipod….that’s it πŸ™ As far as availability of pumps, Most (but not all) of the provinces have publically funded pump programs (but not all patients qualify) & not all insurance companies will cover the pump & supplies.
        The ONLY CGM in Canada is the one that comes with the MM. Although the rumor has it the FDA has approved Dexcom for adult usage. Hopefully will be available by the new year. & hopefully it will be approved for kids soon after!!

        • Christina says:

          Im sad for canadians with diabetes right now. I mean I love the animas pumps so Im glad that is an option but I don’t like it when anyone is restricted. Wish you could get the Dexcom G4 too – it is an amazing device. The MM my daughter is wearing as part of a trial isn’t too shabby so maybe yall will have access to it after its FDA approved.

          Thanks for stopping by and leaving a comment. sorry it took so long to acknowledge it.

          Hope to see you again.

  4. Colleen says:

    Hope tomorrow is a much better day.

    • Christina says:

      Thanks Colleen. The next day was a much better day. Sadly she missed important class info in her math class that her teacher did not think to give her so her next few homework assignments were graded poorly because she did not show her work in the way he had told the class they needed to the day she was out. all fixed now.

  5. Joanne says:

    So sad that she had to go through this. Even more sad about your insurance. Hope she’s feeling better.

    And no blood ketone meter? What the what? Please don’t tell me your insurance gives you a hassle about those too…

    • Christina says:

      No blood ketone meters approved by insurance either. Only the pee sticks. We had a blood ketone meter we got at the conference but it only came with a few strips – all used up. Sweetstuff was up and back to her snotty – oops – wonderful teenage self within a day.

  6. katy says:

    i just read this (old) piece of news saying Dex for for kids 2+ will be FDA-decided by the 2nd half of 2013! i bet you know this already.

    http://diatribe.us/issues/53/new-now-next/3

  7. Scott E says:

    To be honest, three hours to 171 is pretty good. (Three long, grueling hours I’m sure, but still… the recovery seems quick in hindsight). That aside, I’m glad she’s coming back — or, hopefully IS back by the time you read this.

    Reading those last two paragraphs over, I’m not too sure which is more stupid: diabetes or the FDA.

    • Christina says:

      3 hours to 171 really is quite good – thankfully not a super stubborn high. The ketones are what always worry me but luckily went away fairly quickly too.
      Diabetes is stupid the FDA just needs to work faster. πŸ˜‰

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