Then you forget to re-connect the pump when you get into your pajamas….
A few hours later – the NUMBERS HAVE GONE MAD ! You too…..
He went to bed with a perfect BG for the night - 7.2.
I woke up around 5 am and thought to my self, “might as well check him since I am awake” 21.8…. what ! Then, without checking the pump (clearly I was not thinking clearly – I was half a sleep after all), I just corrected it. Bzzzzz the pump squirted the insulin. Guess where ?
An hour later, I check again: 23.1 ! Aaaaaaa something is really wrong – and that is when I discovered it. The delivery line just hanging in the pajama and a wet spot from insulin.
Immediately I deliver the correction bolus and knowing that his body was starved of insulin for the past 8 hours, I increased the basal for a few hours, using the temporary basal function. It has helped in the past.
Mr T wakes up, feeling terrible. Straight to the toilet to wee and vomit. I know it is ketones making him sick so I test immediately and ketones = 0.9. I remember our diabetes educator saying that you must get rid of ketones as soon as possible, get them under 0.6 .
Although I knew Mr T was not sick, as in ill, the lack of insulin was making him feel sick and I had to correct that and bring back the balance.
It is a tricky situation and I have the doctors and the hospital numbers handy in case his BG stays high, vomiting persists and I can not get some fluids in him, but I get on with the sick day routine for now.
Insulin…hydration…..frequent Blood Glucose checking…..check ketones……
Luckily this time, vomiting was mild. His stomach was empty so vomiting was minimal and just once.
I knew, his body needed more insulin to lower the BG and to stop producing ketones but he cannot eat anything – too sick for that. I naturally fear giving him too much insulin in case he goes too low and I cannot offset the given insulin with food.
I realized that at the same time his body is trying its’ best to get rid of the excess glucose by urinating more, so I knew I needed to load him with liquids to prevent dehydration.
But too much liquid in one go could make him vomit again, so I dosed that too.
I still use the 10ml syringe to deliver water to his mouth. It is small amounts that he can easily swallow, I can do it frequently without nagging him to sip and I can measure how much liquid he has had.
The Blood Glucose was going down by the hour: ….23.1…..16.3……..9.8…….7.4……
Every two hours I check ketones in blood: …..0.9……….0.6……..0.1….
Four hours later, by morning tea he was his old self, BG and ketones back in range, except he was one very, very hungry boy.
This whole episode was just a reminder to us that it takes only few hours without insulin to throw Mr. T’s body out of balance and make him very, very sick.
Ahhh, Insulin – that magic potion !
Note: A person on the pump receives basal insulin in small amounts every few minutes during 24h/day. In this case, Mr.T was without any basal insulin for about 6-8 hours. This would be equivalent to a person using long acting insulin once or twice a day, skipping their evening does. The result, in the morning, would be similar.
In similar situations, please follow the instructions by your doctor.