Wednesday, March 9, 2011

"Shooting-UP" The Sugar

Taken this morning
"Please just give me the shot, Mom."

These words muttered by a pale, sleepy, I-have-been-fighting-a-low-for-over-an-hour-Joe. This was last night. This was about an hour after dinner, about an hour after a "softer" carb coverage dose of insulin was given.

Hard to believe just an hour prior Joe was sashaying around the coffee table to the beat of Vietnamese Bamboo Xylophone music with Bridget's saxophone accompaniment. He was. He has "felt" fine since the Gastro Intestinal warfare was waged on his body a couple of days ago. He has sledded. He has played chess. He has hiked through 4 foot high snow drifts. He has also needed Glucagon Mini-Dosing twice since my last post to keep his post-prandial blood sugar level up.

Apparently, his gut is in a rut. His energy level and "zest" for life recovered within a couple of hours after his last GI tract evacuation. His stomach...his intestines... are not 'open for business' yet. Every time Joe eats and I attempt to cover the carbs with insulin (1/2 doses), he bottoms out. His blood sugars stay low in spite of 15g-30g-60g's of fast acting carbs. Honey oral mucosa massages (sounds "dirty" doesn't it?) and lollipops have been given in hopes of "boosting" via the mucus membranes. The process is tedious and it hasn't proven itself in our current situation. I have programmed decreased temp basals. The decreased temp basal 'after the fact' hasn't been particularly helpful in boosting up blood glucose levels asap.

I have found Mini-Glucagon Dosing to be the only way to boost Joe's blood sugar up in this particular situation. Are you scared of Glucagon? I think many people are. Glucagon is a naturally occurring hormone made in the pancreas. It is a life-saving injectible hormone that raises blood sugar by stimulating the liver to release stored glucose. Glucagon injecting, while it should not be taken "lightly," does not carry near the administration side effects as Insulin does.

The side effects of glucagon do not include death. Thank God, we have enough of the "may cause seizures, coma, and death" doom and gloom reality with the "Insulin Side Effect" WARNINGS.

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Side effects of Glucagon that you should report to your doctor or health care professional as soon as possible:

  • chest pain or fast, irregular heartbeat
  • difficulty breathing
  • dizziness or light headedness
  • muscle cramps
  • unusual weakness

Side effects of Glucagon that usually do not require medical attention:

  • nausea, vomiting
  • rash, itching

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

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When I was reading this site on mini-dosing Glucagon I noticed that there was a whole section, labeled "Controversial United States Instructions", on Wikepdia dedicated to how fucked-up the Glucagon directions are folded up and printed. Seriously, have you guys ever looked at that wadded up piece of "life saving" instructions? NOT.EASY.TO.USE!



I thought this might be a good time to share my "Glucagon For Dummies" Cheat Sheet that I made a couple of years ago for Joe's school. Please feel free to copy from here, or you can access it under the "Docx For Ed" tab at the top right, or you can access it on Scribd. I have this instruction sheet laminated and placed in Joe's Lock Down Bag.

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GLUCAGON ADMINISTRATION – for severe low blood sugar
For Joe Maher (reviewed 8/22/2009)

GLUCAGON: What is it? A naturally occurring hormone made in the pancreas. It is a life-saving, injectable hormone that raises blood sugar by stimulating the liver to release stored glucose.

LIFE SAVING, cannot harm a student – cannot overdose….

  1. WHEN TO USE - for treatment of SEVERE LOW BLOOD SUGAR (low blood sugar with inability to swallow, unconsciousness, and/or seizure)
  2. PROCEDURE – Act immediately – get help, have another adult call 911/parents.
    a. If possible, check a blood sugar, don’t delay
    b. If in doubt, always treat
    c. Position student safely on side for comfort and protection from injury
  3. PREPARATION
    a. Flip cap off glass vial containing dry powder
    b. Remove cap from syringe
    c. Put on gloves if available
  4. MIXING SOLUTION
    a. Inject entire fluid in syringe into the bottle containing powder.
    b. Shake gently or roll to mix until all powder is dissolved and solution is clear.
  5. DOSING AND DRAWING OUT
    a. Inspect. Solution should be clear and colorless
    b. Draw entire contents of glucagon in the bottle back into the syringe.
  6. INJECTING
    a. Clean site if possible
    b. Inject at 90 degree angle into the tissue of cleansed area (may administer through clothing if necessary)
    i. Buttocks
    ii. Thigh
    iii. Arm
  7. AFTER INJECTING
    a. May take 10-20 minutes for student to regain consciousness
    b. Check blood sugar
    c. Give sips of fruit juice or regular soda, once student is awake and able to drink
    · Discard needle in container provided

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So...back to Joe...

Where we stand right now:

First off, I sent Joe to school today. He has felt fine since Monday, just hours after his last "gastric erruption". He was begging me to let him go. My plan was to bolus breakfast with half the amount of insulin that he would normally require. I was then going to have him only bolus for 1/2 of the carbs consumed at school.

Plans change...

Flexibility in dealing with "D" is always a "must"...

So...

This morning...

As I was pulling away from dropping off Bridget at her school, from the back seat... Joe chimes in, "Mom I am 84 double down."

***** (in my head)

I was pegged between 5 foot high snow drifts chucking glucose tabs back at Joe, while trying to steer the van to avoid careening into a self-righteous "Walker-To-Schooler" lady who is taking up half of the road to walk her kid to school. There are no side walks on this particular street, so she is impeding the flow of traffic. I drop several glucose tabs in my crotch. I then state an "oh.. ***" (this "oh ***" was not in my head), as I am still trying to not hit this lady and her child...even though at the moment nothing would have given me more pleasure except for a euglycemic Joe.

I digress...sorry about the "wanting to run over the lady" comment. It did make me feel better to write it down.

So,

Again, back to Joe...

We get to his school. BG was 54. Joe stated, "I guess we should do the Mini-Glucagon Mom." We did it. No big deal by now (this is the third time in three days). I had reconstituted a batch last night at 8pm (it is good for 24 hours). I drew it up in the insulin syringe. I gave 7 units of Glucagon into the back of his arm, into the subcutaneous tissue (Mini-Glucagoning technique is that of an insulin injection). I explained the "goings-ons" to his teacher. I loitered and rechecked Joe 20 minutes later. His BG was 126.

I then headed down to see the School Nurse...unsure of how she was gonna feel about my "cowgirl pancreating" ways.

My plan was/is this:

*No carbs were to be covered at snack time. Correct for BG>200 (as Joe's BGs seem to be tolerating corrections and his basal, just not insulin given for carbs).

*I instructed the School Nurse on "Mini-G-ing" (I think Kerri needs this one for the fourth edition). I doubt Joe's School Nurse would administer it without a doctor's order, but I gave her written instructions in case.

*I wanted to be called with Joe's lunch time BG.

The lunch-time call just came in. Joe was in the low 100s at 10am. He ate 23 grams uncovered. His noon BG was 97. He is going to eat 78 grams, none of which will be covered. His next check will be at 2pm.

Wish us luck.

And, again...I am not a doctor. Please consult your physician in times like these. I just emailed ours. And, please don't judge me too hard on sending Joe to school. It is three days into this. I feel he is "stable"...and I am determined to limit diabetes' affect on his day-in-the-life.

A day-in-the-life of post-stomach bug havoc.

For more on our day-in-the-life visit: http://www.betabuddies.blogspot.com/