Wednesday, May 8, 2013

D-Talk: DKA, 2nd time around.

I knew that a hospital stay was bound to happen again at some point in our lives.  I just didn't expect it to happen again so soon.
As many of you know, Jameson spent this past week transitioning to an insulin pump.  You can see here that it was a bit of a rough start.
Needless to say, things didn't get much better after I wrote that post.  Daycare called me multiple times last week, concerned because Jameson's blood sugar was over 500.  I called the endocrinologist office on Friday morning.  The diabetic educator and the other RN in the office were out of town for a conference, but a diabetic RN that normally deals with adult patients was covering.  After speaking to her and emailing her Jameson's records, she called back and decided to tweak his insulin-to-carb ratio from 1:80 to 1:70.  This means that he would get 1 unit of insulin for every 70 grams of carbs he ate, rather than the previous 80 grams. 
She thought that would take care of things, and I was hopeful, so with that, we charged into the weekend.  All weekend long, Jameson's blood sugar was in the 500's and 600's.  I tried getting the on-call nurse's phone number from the answering service, but they weren't able to provide it to me, which was frustrating.  We were testing ketones (which were present in trace-to-small amounts all weekend), checking sugar every couple hours, encouraging drinking water, and went to the park in hopes to burn off some of those large glucose numbers! 
Unfortunately though, nothing seemed to work, and he was still sky-high all weekend, and by Monday morning, ketone amounts had gone from small to moderate.
The first thing I did once I got to work Monday morning was call the endo when they opened.  After voicing my frustration to LeAnne - the diabetic educator - she recommended that we bring Jamers in that afternoon, they would download the numbers off of his pump, and evaluate from there.
I went to daycare on lunch to give insulin, so Matt took him to the endo at 3 pm.  They noticed his ear was draining so they did some labs to see if he had an ear infection, which he did.  LeAnne looked at his numbers, and tweaked the pump settings even more so the dosages were better suited to his body and blood sugar trends.  Then they tested him to see if he was ketotic.  That test came back positive, and I got the call from Matt around 4:40 pm that they were going to admit him to the hospital. 
I grabbed my things and headed to daycare to pick up Hendrix.  We met Matt and Jameson at the endo's office, just as they were finishing things up, and LeAnne was going over the sick day insulin scale with Matt.  I could see in Jameson's eyes the second I walked in the door that he was a sick boy.  It sounds terrible, but he looked drunk.  Glassy eyes, empty stares.  He was conscious and talking, but you could definitely tell he wasn't well.  We wrapped up there and drove to the hospital, where we were a direct admit.
This is Jamers as we were speaking with the admissions clerk.

I could have been imagining it because of my state of concern and worry, but it seemed to me that Jameson's condition deteriorated in the time between when we left the doctor's office and when they finally got his IV started.  His breathing was getting heavier, and the lethargy kicked in a bit more.  The picture below was shortly before the IV was started.

Matt took Hendrix to McDonald's to get some dinner, then they ran home to pack an overnight back for Jamers and I. 
The IV experience was in no way pleasant, as it took them 4 sticks to get one in.  He screamed, I held back tears.  (Way too soon to be doing this again, dangit!)  After the first two pokes, they gave him a break, and we snuggled.  Matt and Hendrix came back during the IV break, and I took Hendrix downstairs to the cafeteria with me and got him some ice cream while I had a stale ham & cheese sandwich and some fries.  The boy puts up with a lot of Jameson-focused-attention, and I hate that sometimes. 
When we got back upstairs, they had given up on the 3rd unsuccessful poke, and were just getting ready to start the fourth.  Hendrix wasn't a fan of listening to his brother scream while the nurses poked him, but the fourth attempt was successful - thank God - and he finally was hooked up to the fluids he needed.  Hendrix and I both relaxed a bit.
I hugged Matt and Hendrix and they headed home, while Jamers and I settled in for a long night.  They brought Jameson a tray of food, which he didn't touch.

Actually, after staring at the tray for a while, he said, "Night night," grabbed BlueBear, and laid down to go to sleep!  Poor pumpkin was pooped!

Staff was in and out of the room all night, taking vitals, blood sugars, and ketone checks.  You can see below - from one of my own ketone checks - that his ketones had become very large.

I didn't get a full two hours of sleep Monday night, I don't think.  Tuesday morning, Jameson was doing better, but still having sickly moments, so there was a lot of snuggle time involved.

It seemed like he kept bouncing from very sick boy to somewhat normal Jameson.  You can see that if you compare the picture above to the pictures below.

Above - happy go lucky.
Below - momma's worried sick.

The doctors were concerned that he might have walking pneumonia, so they tested him for that, and our room was kind of "quarantined."  That test ended up being negative, though. 

Long story short, we got both his blood sugar and ketones under control, and we were sent home Tuesday afternoon around 1 pm.  Matt went to work for the rest of the afternoon while Jameson and I crashed and took some serious naps.

In the 24 hours that we've been home, his ketones have remained small, and his sugars have been awesome.  We had 139 at dinner last night, 120 at breakfast this morning, and 119 at lunch today!  Yay!
I am very hopeful right now that the pump and his dosages are all set-up correctly, and we can really start living a normal life without having to constantly worry (not that that will ever go away completely, of course) about his condition.  In fact, we are planning a fun little day trip this weekend.
Thank you to everyone who was thinking about and/or praying for us this week.  It means so much to all four of us!  Little Mr. Piggy is a fighter, and he's not going to let a little T1D get him down!!
Have a fantastic week, friends. 

1 comment:

  1. I can't even imagine dealing with that.... uhhhgggg.... So glad things are better now and I hope they stay that way!