Wednesday, July 13, 2011

I expected more from you Glucagon...

June 29th I was awoken at 2:30am by Alivia climbing into my bed. I didn't think much of it, she ends up in our bed about once a week. Next thing I knew I heard something that sounded like someone pouring something, still half asleep I wondered if she spilled a cup of water...then I noticed my back felt wet a warm, I rolled to see her throwing up again and again and again. I woke up my husband and he changed the bedding and started the laundry while Liv and I took a quick shower. I set her up on the couch and did a quick sugar and ketone check, 96 and trace ketones. Hubby make a quick trip for some 7up and she was able to keep it all down, I thought for sure it was something she ate.

A few hours later she requested breakfast, still a little worried about her tummy but knowing she needed insulin for the ketones I gave her some toast and a banana and only after she kept it down for a while and her blood sugar started rising I bolused her for it. She said she felt good and was up playing and acting normal. Lunch time rolled around and she wanted to eat what everyone else was eating and she did, bolused her for all of it after she was done eating and she was off and running.

An hour and a half later she climbed into my bed and fell asleep...this was very odd for her, she stopped taking naps years ago. Quick sugar check showed her at 57 with over 2 units active insulin still working to bring her sugar down even more, 4oz of 7up sipped slowly, tummy ache and she wanted to lay on the couch and watch iCarly. On her way down the hallway she started throwing up again, I ran to the kitchen to get her "bucket" and she continued to walk down the hallway and into the living room all while still throwing up, leaving a trail behind her. PANIC was starting to set in, I called my husband who just left for work asking for him to return home. I was alone with 6 kids, puke all over my floors which Addy kept trying to get! And a child whose sugar was dropping QUICKLY!!! I hung up with him (he came, cleaned up the mess and left again) and called our endo clinic, I LOVE our team but I HATE the way they take their calls. You call the main number and before you hear any options you have to listen to this message that takes forever! (Or so it feels while you're panicking!!!) "Blah blah blah, we follow the Portland schools, if they are closed so are we, if they have 2 hour late start we will open at 10am, blah blah blah, our fax number is blah blah blah, for scheduling press one, diabetes management press two", I press 2," if your child is newly dx or sick press one", I press 1, "you have reached the priority line please leave your name, number, childs date of birth and 1-3 days of blood sugar number" I try my best to hold back the tears as I leave the details requested and letting them know it is urgent! While on the phone I was collecting the little red box and a few insulin syringes.

A few minutes pass since I left the message, I mix up the Glucagon, I draw up 5 units, my phone rings and she tells me to do exactly what I had just done and to remove her pump, I gave the shot while she's still on the phone. She tells he that it takes a little longer to take effect and to recheck in 20 minutes, if she's not above 80 repeat, if she's still not above 80 come straight to the emergency room.

20 minutes pass and I recheck...59! Crap!!! Why aren't you working Glucagon!!! Another 5 units given, timer set for another 20 minutes.

Recheck after only 15 minutes showed 115, thank you Glucagon! Glad you could make it!!

Timer went off 5 minutes later, recheck showed she'd dropped to 81. By this time she had no IOB and no reason to drop any more. I thought for sure Glucagon was still working and she'd start heading up soon!

Called the clinic again to give them an update and to request a new Rx for zofran, the pharmacy we use is 30 minutes away and does not have a drive through, I wanted it sent to our local pharmacy just down the street that does have a drive though but does not accept our insurance. $75 is a small price to pay to get it now and not have to drag all 6 kids (1 very sick and weak) through Target. The Rx is sent and she advises me to call before I load everyone up.

I call and am told they do not have it in stock but can order it, ummm I need it NOW! She tells me she will call around to the other Walgreen's and see who has it in stock. She calls back letting me know that the closest place is in the same town as the pharmacy we normally use 30 minutes away! Ugh, if i have to drive all the way out there i might as well save my $75 and run into Target, I tell them to never mind. I call Target and ask them to fill the Rx already on hand, I ask if they keep it in stock and told YES! Do they double check? NO! They tell me to give them 45 minutes and it will be ready.

I'm supposed to have the extra kids overnight so I swing by their house to grab their bag on the way to Target. Alivia has been in and out of it on the short ride to their house so I check her...55! Seriously Glucagon you could of stayed a bit longer!!! I grabbed a 20oz Sprite out of their fridge and passed it to her and placed the "bucket" on her lap, hopeful that even if she did throw up some of the sugar would be absorbed. I called the extra kids Mom on the way to the hospital and had her to meet me along my path to get her kids from me.

The closest hospital is 20 minutes from us but they know NOTHING about children with diabetes, we went there at Dx and they had her transferred to a children's hospital. I chose to skip the middle man and go straight for the children's hospital 45 minutes away, our endo team was there and I felt she would be best cared for there. The drive was stressful, she kept falling asleep and I was worried she might not wake up when we got there and yet I didn't want to pull over... I just wanted to get there. As we pull up to the ER parking I notice that Alivia didn't have shoes!!! How was i supposed to carry Addison and my 60 pound 4 year old?!?! One of the lot attendants came to my rescue and carried Addison for me so I could carry Liv :) We checked in just as the hubby showed up from work and they put us in a room right away. Blood sugar was up to 180 (thank you 20oz soda!) but she still had ketones. Our endo wanted her pump back on but no correction. They loaded her up on the Zofran I hadn't been able to get my hands on all day. The nurse brought her a drink and some jello, if she kept it down she could avoid the IV, if not they'd start one. The snack stayed down and a few hours later she reached the 300's! Tiny correction ordered and they sent us on our way with actual Zofran, not just a slip of paper that said we could have it if anyone ever chose to keep it in stock!! On our way home we stopped by the Target pharmacy to pick up the original Rx that had been waiting for us only to find out they couldn't find the Rx and they didn't have it in stock anyways!!!!!!

They next few days were vomit free but she still had ketones for days and was completely unable to get any insulin other than her basal with out going low for almost a week! But all is back to normal, thank goodness!!!

I'm thankful that we made it this long with out this happening but at the same time I think I had the wrong idea about Glucagon this entire time, I always thought the mini dose was as magical as the half dose she would get in a emergency. But as I learned I shouldn't rely on it in cases like this, I shouldn't expect for it to work quickly and keep her stable... and zofran will always remain in my diabetes cabinet not as a Rx sitting at the pharmacy waiting for me to need it!


Joanne said...

Wow... so glad she is doing okay. How scary. I would have expected to glucagon to work like magic too. And I like the idea of having zofran on hand in case. I wonder how quickly it expires?

Denise aka Mom of Bean said...

So glad everything turned out OK.
How utterly frustrating about the Rx. I hate places that don't have drive thrus...when is it ever convenient to lug a sick kiddo through a store to get meds?!?
Interesting about the Glucagon. We've never had to use it (regular or mini dose) thankfully, but it's great to hear others' experiences to tuck away!

AjsMommy82 said...

Joanne the liquid I finally picked up from the pharmacy lasts for 1 year, however the tablets the hospital sent home don't expire for 2 years!

Unknown said...

Holy COW! Joe had a bad vomit bug...BAD lows for a whole week after the bug... took me a few times of feeding/bolusing to realize his body would NOT tolerate any bolused insulin what-so-ever. The mini-gluc worked like a charm for sorry that you did not experience the same. Thanks for sharing about the Zofran.


Valerie said...

That is so scary! I felt panicky just reading your post. I have glucagon as a backup but haven't had to use it...I always thought of it as magic also. I've never heard of Zofran before though. I'm glad everything worked out ok and she is doing better now!

LaLa said...

WOW! I thought it would be magical too. Good to know that it doesn't work the same on everyone.

I hate tummy bugs and T1 --- we had our 1st one just weeks after dx and ended up back in the hospital. Boo!!
We've had a couple since but still haven't had to use the glucagon.

I'm glad she is all better now!

Lora said...

And somehow she still has the best smile on her face. These kids amaze me :)

Tracy1918 said...

Oh wow! That is so scary! My heart was racing just by reading your post.

Glad she is doing okay!

You are an awesome mom!

Unknown said...

Ummm.....I'm just seeing this and....HOLY MAC!!!! SO SO SO glad to hear things are back on track. WHEW! Me no likey!

Kari Seekins said...

I know exactly what you mean about the answering system!!!! So frustrating when crisis mode sets in.
We go to the same office in Portland!

I am glad everything turned out OK.
Great info on the Zofran~ I have never heard of it but will definitely be asking about it today at Allie's appointment.

Jen said...

Wow, so happy that everything turned out ok, sounds like it was pretty scary there for a while!

We have had problems with glucagon as well - it usually works right away, but my son's bg goes up slowly at first after a glucagon shot, then jumps way up for a bit, but drops quickly once it wears off. And he usually can't hold down food or drink after, so it's always a roller coaster for about 6-8 hrs post-glucagon. As a result, I don't even bother with the mini-shots anymore, I just give the full dose and correct once his bg levels stablize.

I'd love to compare with other parents and see how they deal with the gluco-coaster...

Melissa said...

I am so glad that it worked out but that would have been so stressful.
Glucagon only works by releases the stores of glucose in the liver. So it relies on there being actual stores there.

Anonymous said...

We have used glucagon for our 4year old in a similar situation, but were told to double the dose if no rise in 20 minutes. We ended up giving around 20 Units to get a significant BG change. I don't know if was because of dropping bg, But I certainly felt the 1 unit per year of age was conservative!

Kristin said...

Wow - I also thought mini-gluc worked like a charm (always has for us - knock on wood). What an ordeal - glad all turned out well!!!