Wednesday, December 21, 2011

Oh Glucagon, Oh Glucagon, How I do Love Thee

Title is cute, right?

Last night was anything but cute.

Youngest daughter came home from school feeling tired and asked to go into my room to watch TV and snuggle under the covers.  This is not normal behavior for a small child who loves to cook dinner, play with her sister or perform a singing/dancing number to entertain us all.

Sometime after dinner, she came back downstairs and was visibly shaking.  With a meter check, her BG was 53.  I quickly gave her a mini 14 carb juice box and had her drink it.  Immediately, she started to complain of her stomach hurting. 

Let me pause and explain that at this moment my instincts kicked in.  Although a blood glucose of 53 isn't low enough to warrant glucagon, it is actually what I immediately went for.   I knew a storm was brewing and could just tell that she was headed for the inevitible sunami of belly pains.

But my mind went blank on how many units to dose.  And this is where having friends in the DOC is most important.  My husband was still at work and I had no one except our oldest daughter to bounce ideas off of - which would have just scared her at the mere mention of glucagon.  I picked up my cell phone and immediately called a mom who has done mini-glucagon injections for her own child.

While on the phone, I mixed the glucagon and drew up 5 units ( apx. 3 less than the recommended one for every year of age due to the juice box) using one of our own 30 unit syringes.  I injected it and after saying our good-byes over the phone, my dear friend offered me support for the entire night.  That simple and kind gesture restored my calm and I knew that I had a friend 'in it with me'.

A bit later, we re-checked youngest daughters blood glucose.  The peak was around 100 but random testing everying 10-15 minutes showed that she was going back down.  She was wearing her CGM too but the lag time made it impossible to keep up with real time numbers, so all we could do is look at the trend arrows.   After seeing a second set of double arrows pointing down, I knew it was time for a second glucagon.  Again, drawing up a second dose and cutting it back to avoid inducing vomitting, I injected her with another 5 units.  I also decided to reduce her basal rate by 50% for four hours.

Throughout all of this, her face was as white and translucent as it has ever been.  Her hands were uncontrollably shaking and she was very cold.  After injecting the glucagon, slowly (it felt like hours but was just a few minutes), her color returned and she became more expressive telling us that her green room had looked purple.   And these are the symptoms from a blood glucose never below 50.

My husband came home right about this time and witnessed the second injection.  I could tell that he was scared to see me do it but he trusted that I knew the right thing to do.  After seeing her color return, he looked relieved and gave me a small squeeze of reassurance.  We tucked her into bed and continued to check her actual blood glucose every hour.  It stayed stable at around 125 - 135. 

Then, before midnight, our daughter started vomitting. 

We held her and wiped away the tears and soothed her worries.  Before long she was talking and saying how much better she felt.

At this point her blood glucose was in the high 180s.  I knew that she was going to be ok.  The glucagon had already raised her blood glucose to a comfortable level and we weren't fighting any bolus insulin.

We put her back into bed and made plans to continue to check throughout the rest of the night.  Around 5:00 a.m., she peaked at 254 blood glucose, so we gave her a tiny bit of a bolus at .20.  Just enough to take the number down a little bit.  As I write this, I am letting her hover around 200 blood glucose to ensure we are still safe.  With a stomach virus, 24 hours in the norm for recovery which makes me want to proceed cautiously.

And I feel safe knowing that we have more glucagon should we need it. And most importantly, dear friends in the DOC supporting us.

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