So, after getting Emma's BG down yesterday morning and her ketones back to trace, we had a relatively normal afternoon. She ran a bit high but I just corrected and she was fine through dinner.
But, then she didn't come down much after her dinner dose and hit 400 again and stayed there. So we gave her a correction and waited a couple of hours. After she didn't budge, we ended up doing a site change and another correction in the new site. Her ketones were up to 2.4 already. She stayed awake for a little while that time (after not going to sleep until after 10pm).
She woke up in range this morning - but barely - she was 84. But, she still had ketones in the high moderate range. Treating ketones with low blood sugar is tough - because the way you treat ketones is with insulin. And the way you treat a low is sugar WITHOUT insulin. So, I had to get a lot of carbs in her, to get her up above her target range, so I could then correct her and give her enough insulin to clear the ketones.
I got her back down in range for lunch with no ketones thankfully. She's upstairs now taking a nap with an increased basal of 20% (which is typical - I just hope its enough).
And all of this because she has a low-grade fever - and no other symptoms.
Showing posts with label Ketones. Show all posts
Showing posts with label Ketones. Show all posts
Thursday, October 25, 2007
Wednesday, October 24, 2007
Rough morning
So we were a little surprised when Emma woke up today in the high 300s. Especially since she was 50 at 2:30am and we have gotten her juice at night DOWN so that she ends up in the 100s - sometimes the high 100s but the 100s no less.
So, when I saw the 397 on the meter, I took it again to make sure. The second reading was 409. Within the margin of error.
When you have a pumper with an unexplained high, you check for ketones (which is usually a good sign of whether your pump site is actually working or not). A trace amount of ketones is a measurement of 0.2. The last time she had a bad site, she had ketones of 1.6. I kinda expected some ketones in that range and I was fully prepared to treat those.
I was not prepared to treat ketones of 4.4!! I can't find a smilie that demonstrates the shock at that number. I took it again in the event it was just off - it wasn't. So, we quickly gave Emma a correction dose of insulin at 150% of the calculated correction dose - because the only way to reduce ketones is with insulin. I then paged the nurse to see what else I should be doing. Emma felt hot so we took her temperature and it registered just over 100. So, a low grade fever which COULD have triggered that enormous spike in her ketones.
Celia's response was just to keep testing and slowly correcting, feeding the extra insulin that we needed for the ketones to prevent a low.
Within 1 hour, her ketones were down to 2.2 - a shocking figure if I didn't know they were going DOWN. Within 2 hours, her ketones were down to .3.
Within 3 hours and 15 minutes of her first dose, she was back in range for her blood glucose.
That was a pretty uncomfortable 3 hours - I was actually WILLING time to move faster so that I could see that she was adjusting. And I think I tested ketones about 3 more times throughout the day because she has continued to complain about her stomach hurting despite the fact she is in range and has no ketones.
She still has the low grade fever, so she is probably fighting something. That means another night of extra checking so we can stop this from happening again tonight.
Boy, its situations like this that I wish we had a Continuous Glucose Monitor. For all the challenges and struggles you hear about these new machines, there are definite benefits - such as getting an alarm when that type of high reading comes out of nowhere.
So, when I saw the 397 on the meter, I took it again to make sure. The second reading was 409. Within the margin of error.
When you have a pumper with an unexplained high, you check for ketones (which is usually a good sign of whether your pump site is actually working or not). A trace amount of ketones is a measurement of 0.2. The last time she had a bad site, she had ketones of 1.6. I kinda expected some ketones in that range and I was fully prepared to treat those.
I was not prepared to treat ketones of 4.4!! I can't find a smilie that demonstrates the shock at that number. I took it again in the event it was just off - it wasn't. So, we quickly gave Emma a correction dose of insulin at 150% of the calculated correction dose - because the only way to reduce ketones is with insulin. I then paged the nurse to see what else I should be doing. Emma felt hot so we took her temperature and it registered just over 100. So, a low grade fever which COULD have triggered that enormous spike in her ketones.
Celia's response was just to keep testing and slowly correcting, feeding the extra insulin that we needed for the ketones to prevent a low.
Within 1 hour, her ketones were down to 2.2 - a shocking figure if I didn't know they were going DOWN. Within 2 hours, her ketones were down to .3.
Within 3 hours and 15 minutes of her first dose, she was back in range for her blood glucose.
That was a pretty uncomfortable 3 hours - I was actually WILLING time to move faster so that I could see that she was adjusting. And I think I tested ketones about 3 more times throughout the day because she has continued to complain about her stomach hurting despite the fact she is in range and has no ketones.
She still has the low grade fever, so she is probably fighting something. That means another night of extra checking so we can stop this from happening again tonight.
Boy, its situations like this that I wish we had a Continuous Glucose Monitor. For all the challenges and struggles you hear about these new machines, there are definite benefits - such as getting an alarm when that type of high reading comes out of nowhere.
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