A family living well with type 1 diabetes.

Posts tagged ‘close calls’

The Last Resort.

Jenna seemed fine at bedtime.

The usual routine was playing out — bath, hair wash, a little family TV time before teeth are brushed, hands washed and stories are read. Then the final step before goodnight kisses are exchanged — the blood sugar check: 4.2 with a truck load of insulin still on board from supper.

A couple of carb tabs and another story later, a second check revealed a 2.8. This was NOT what I was expecting. Jenna has seldom had a stubborn low requiring multiple treatments. It has happened, but it’s rare, thankfully. So I gave her three more carb tabs, suspended her pump and stayed with her for snuggles and soft words of reassurance. But there was no hiding my concern from Jenna who is as smart as a whip with intuitive abilities to boot. She knew there was reason for concern. She tried to be silly to downplay the situation. I wasn’t in the mood to be silly back even though I knew she was just trying to cope the best way she knows how. She wanted me to join in this silliness like I often do. Anything to give her the sign that she was okay–that she would be okay.

I checked again and as I awaited the result I closed one eye while keeping the other firmly fixed on the meter (something I do when I’m afraid of what the number might be) and repeated out loud in a quiet chant, “Please be a good number. Please be a good number. Please be a good number…” BEEP. 2.4.

This is when mild concern rounds the corner on two wheels to desperate panic. That’s the wrong way, damn it! WRONG WAY!! If the carb tabs are not working, what the hell else is there?!

Glucagon. My final weapon against this most terrifying of D-demons. But before I proceeded, I posted on facebook for some much needed reassurance from my D-peeps. (I love you guys.)

Melissa, a person with diabetes and a mom, was the first person to give me a virtual pat on the back and encourage me: “You can do this, Sherry. Do whatever you have to.”

It was precisely what I needed to hear, even though the moment I read it I had to leave the room so Jenna wouldn’t see me bust into a full blown cry.

I went straight into my bedroom closet to where I keep the glucagon along with all of the diabetes supplies. I retrieved the kit from the travel case that accompanies us on all overnight trips away from home while flashbacks of the last time I had to employ this lifesaving intervention pelted my conscious mind like hail stones falling from a slate black cloud.

Blinking away the tears so that I could see what my hands had to do, I pulled out the contents of the kit on my bed and began reconstituting the white powder in the glass vile with the pre-filled intramuscular needle that comes with the kit. I remember thinking that at least I wouldn’t have to use that needle to inject Jenna since mini-glucagon dosing is done with a subcutaneous insulin syringe instead. That would be little consolation to Jenna, however.

I drew up the six units of glucagon (one unit per year of age) and with the needle hidden behind my back I entered Jenna’s bedroom once more. Jenna was upset now and kept telling her Daddy that she was tired and just wanted to go to sleep. She knew I had something in my hand and she knew what it was.

“No mommy! No mommy! Please NOOO!!”

I did what had to be done and left the room again to stomp the shit out of my bathroom floor while letting the tears come.

It wasn’t the fact that I had to give Jenna a needle. I don’t have a problem with that. It was giving her something I had never given her before that really upset me. Glucagon is a last resort. It is harsh. It gets the job done but it can really kick the shit out of the person receiving it. Vomiting post glucagon is not uncommon. How would she react to it? What will the rest of this night bring?

Jenna was craving toast. Before I gave her the glucagon she kept saying she smelled toast and how good it smelled to her. So as a way to wrap up this upsetting end to an otherwise great day, I invited her and her sister back downstairs for a late night, post bedtime toast snack.

Later as I was settling Jenna back in bed with a post glucagon blood sugar of 9.9, I told her she was okay and it was safe for her to go to sleep now. Jenna became emotional. She hugged me and told me how thankful she is to have a nurse for a mom who “…know[s] how to make it all better.” I told her how lucky I am to have her for a daughter and how amazing I think she is.

“I think you’re amazing too, Momma.”

We hugged more and then Jenna told me with her chin quivering and her eyes flooded with tears that when she grows up she wants to marry a man with type 1 diabetes so that they can take care of each other. This glimpse into Jenna’s thoughts made me realize just how much she gets the seriousness of her diabetes and how alone she feels at times facing the challenges diabetes presents.

I think this is one of the most heartbreaking aspects of being the mother of a child with diabetes: to watch her gradually lose her innocence and awaken to the reality of life with a disease that never sleeps and can turn on you without warning. She is thinking about her future with diabetes. And not just tomorrow, but 20 years down the road! A six year old little girl who still loves to play dress up, play with dolls, skip, ride bikes, blow bubbles and play in the mud should not have to worry about such things. And yet, a part of me is relieved that she is aware and gets it, as much as it hurts my heart.

I’ll be up several more times tonight — Jenna’s blood sugar is lunar bound and I just heard her awaken and take a big long drink from her water bottle. Last check was 16 mmol/l. This roller coaster ride is far from over.

*Nothing here should be construed as medical advice. Please consult your healthcare team of professionals if you have any concerns about your or your child’s diabetes.*

Hot Zone

It’s been lurking around the school since the start of the new year, picking kids off one by one. It started in Jenna’s classroom when one of her classmates let fly with a sudden barf-blitz that left one girl’s backpack covered, rendering it trash, and forced the rest of the class to the complete opposite side of the classroom to avoid the infectious, noxious nastiness.

I was bracing myself for Jenna’s first bout of a full-on case of gastroenteritis in all it’s abhorred glory after that day. I can honestly say I felt fear. The idea of my wee, insulin-dependent kindergartener throwing up for two or three days straight, unable to retain even the smallest amounts of solid, carbohydrate-providing food is enough to send me into a near panic state. This is mostly because I realize that a virus like that could easily land Jenna in hospital.

But days passed since the unfortunate “classroom yak-attack”, then weeks. Other kids came down with symptoms in the school here and there, but I started to feel comforted by the likelihood that Jenna had escaped the dreaded bug.

And then it happened again.

This time it was my older daughter’s classroom which is right across the hall from Jenna’s kinder class. I felt the all too familiar cold chill of fear when another Mom told me “Did you hear? So-and-so threw up in class today.”

“Oh NO! REALLY?!!” I’m certain my response seemed an over-reaction to this mom who appeared slightly taken aback by my concern, no doubt oblivious to the implications a stomach flu could have in my household.

I felt thrust back into the hot zone once more. I frequently detected the faint smell of emesis for days after, every time I entered the school. Perhaps it was my imagination … I don’t know. I wanted to keep my girls home until the danger had passed. But I didn’t. I wanted to follow the custodian around to ensure he was doing a good job of cleaning and disinfecting every bathroom stall, tap and door knob. But I didn’t do that either. Instead, I did what all parents do; I sent my kids to school per usual with extra reminders to wash their hands. What else can a parent do?

Then Jazmine vomited this past Friday afternoon after school. Game on.

I spent this weekend wrangling my daughter’s waist long hair out of the line of fire while she proceeded to involuntarily evacuate her stomach of all solid food taken, over and over and over again. For 36 straight hours she was unable to hold any sustenance down. Luckily, she was able to retain enough fluids to stay adequately hydrated.

But the real challenge was keeping the pathogen confined and away from Jenna. Luckily, we had no “misses”; Jaz hit the toilet or the bucket every time. But even still, it’s a messy ordeal that is not easily contained.

So, on Saturday Jenna spent the day with her daddy having lunch out at a restaurant then a movie and a trip to the book store, while Jazmine enjoyed a Gravol-induced nap and I cleaned house like a sleep deprived woman on a mission. Each bathroom was scrubbed and disinfected with a bleach solution, each counter top sanitized, each floor surface mopped. I even had time to run the vacuum and do some hot water loads of sheets and towels with a splash of bleach for good measure.

Jaz was finally able to retain food again mid-morning on Sunday. She is back to her usual, sweet self. Have we once more dodged a bullet and staved off what is no doubt, at some point, the inevitable? I don’t know. I’m almost afraid of getting too cocky at this point. Don’t want to tempt the fates. Jenna could still succumb to this vile bug, in spite of all our efforts.

But in the meantime, I’ve armed myself by boning up on my diabetes sick day management skills. I printed off the procedures for sick day management* and mini-glucagon dosing* from the BC Children’s Hospital website*. Even though I’ve read through these procedures several times in the past, a little refresher course never hurts. And now I feel better prepared to take on the dreaded barf bug while juggling diabetes if it is, in fact, in the cards for us to do so. Knowledge is power. And as lacking as our healthcare system can be at times, it is comforting to know it’s there for us should we need it.

Stay healthy, and if you can’t — stay knowledgeable. It just might save you a trip to acute care.

*Please note that these are Canadian procedures where we measure blood sugar in mmol/L, instead of the American measure of mg/dL. Also, this should in no way be considered medical advice. If you or your child is ill or experiencing flu symptoms you should consult your healthcare provider or diabetes medical team for assistance.

This Day.

This day a meeting was scheduled to take place at noon — an IEP meeting to assess how the school is doing at addressing Jenna’s needs in school. Both my husband and I were present along with Jenna’s teacher and the student support teacher. The meeting went well. I was able to voice my concerns about the fact that no one in the school has been trained to give life saving glucagon to Jenna in the event of a severe hypoglycemic episode. We were informed by the public health nurse before the start of the school year that the school is not permitted to give insulin or glucagon. For reasons that are all too obvious, I have grave concerns about this policy.

The support worker understood my point – that it is imperative that someone at the school is trained to administer glucagon. He too questioned why this is the policy. In an effort to demonstrate the steps involved in giving glucagon I reached into my backpack that contains, at any given moment, my laptop, a few books and a large makeup bag with an extensive array of back up diabetes supplies inside (no makeup, whatsoever). This includes, but by no means is limited to, a glucagon kit. I always have it with me. I keep it in an old rigid eye glasses case that used to house my glasses, before my laser eye surgery. I haven’t opened the case to gaze upon the prefilled syringe and accompanying ampule of glucagon powder in months. But today I did.

This day was all about the worst-case scenario. I went into detail about what can happen during a low and when it is the appropriate time to give glucagon. I noted out loud that our glucagon was expiring soon and J and I both agreed we would have to pick another one up at the pharmacy. I then carefully placed the glass syringe and ampule back into the case, closed it and returned it to the makeup bag, grateful for another year that we didn’t have to use it.

Fast forward to this evening:

It was around 7:00pm. The girls had just had baths and were enjoying a hot chocolate before bedtime. I was working at the computer desk and J was snuggled up with the girls in the living room. We live in a new, rural townhouse development with quiet roads that are only used by locals.

It was Jenna who first noticed the black SUV sitting right in front of our town home unit.

“Why are there cars sitting outside?” We all turned to look out the living room window at the black SUV sitting, engine running and brake lights on. Another car was trying to maneuver around the SUV in an attempt to get by. It was a little strange to see a car running yet stationary in the middle of the road with the driver at the wheel, making no attempt to park or continue driving. Just sitting.

We kept our eye on the vehicle for another four or five minutes.

“What the hell is this guy doing?!” J finally said.

“Go out and ask him if he’s okay” I replied. I wasn’t thinking this guy was in any need of medical help. In all honesty, I thought maybe he just needed some directions. But then J said he could see his hand on the steering wheel was moving up and down repeatedly.

“Okay. That’s a little strange” I said. Now it starts to cross my mind that this person may need medical assistance of some kind.

J got up from the couch, headed out the door and walked around to the driver’s side of the vehicle. Another woman, a neighbour, was also there. She had been out for a walk and was compelled to check on this individual who was stopped in the middle of the road, conscious but not responding to questions.

J knocked on the driver door and started talking to the guy.

“Hey, man. You okay?”

The man startled when J knocked on the door and made a feeble attempt at eye contact.

“You okay, bud?” J repeats the question.

Nothing.

I opened the deck door and J looked up at me.

“911” was all he said.

I headed right back inside and grabbed J’s cell phone from the coffee table and made the call. J came and took the phone from me to talk to the 911 attendant while I tried to help the man and keep my girls on lock down at the same time. The neighbour woman who was there told us she was going to get her husband to help and she would be back. I was attempting to get the girls to stay inside the house while neighbour woman’s husband (who we later found out is a medical doctor) arrived, turned off the engine to the vehicle and did a quick assessment.

“He’s sweaty.”

“Maybe he is diabetic” I said. “I’ll get my daughter’s meter.” I ran inside and grabbed Jenna’s OneTouch. Back out I went and performed the check.

Three….two….one….BEEP. 1.4 mmol/l.

“SHIT!” My suspicions confirmed, my heart suddenly broke into a gallop and my legs quickly followed suit as I ran inside to grab sugar. I raced around the house trying to find glucose tabs.

“JUICE!” J shouted from outside.

Juice! Of course! The poor guy can’t hold his head up, let alone chew, for shit sake!

I ran to the fridge but J beat me there. There were three boxes of grape juice sealed together in plastic. He grabbed them and started fiddling with the plastic. I had a feeling we would need more than one box since this was a grown person we were dealing with — not a five year old little girl.

“Just take all of them.”

Back out the door to the black SUV where a man was experiencing the very thing I have been terrified of happening to my daughter for the last three and a half years — the very thing I have been losing countless hours of sleep in an effort to prevent — the very thing that haunts me and compels me to advocate for her with a passion.

And all the while my little girl with type 1 diabetes is looking on — taking in the urgency and seriousness of the situation.

We started feeding the man juice box after juice box. He was able to suck the juice up through the straw. Seven minutes later, he was still very diaphoretic and still unresponsive, his head hanging down with his chin touching his chest. Neighbour-Doctor-Man (Doc, from here on) was attempting to palpate a pulse while holding his head up so he could continue taking in juice.

“Time for another check?” I asked with a voice I didn’t recognize. My words tumbled out of my mouth all at once. The adrenaline was flowing full chisel.

“Good call” said Doc.

Doc readied a finger for me and I cued up the strip and fresh lancet.

Three…two…one….BEEP. LOW.

“He needs glucagon” I said.

“You’re right. I will take responsibility for that” Doc states, reading my mind about the legal ramifications of this intervention.

I ran back inside and got the very kit I had pulled out just hours before to demonstrate to school staff the steps involved in reconstituting and administering glucagon. I then went back out to our deck, sat down on the cold concrete and proceeded to do just that — nursing skills kicking like an old friend, there for me when I need it.

I brought Doc the syringe loaded with a full dose of reconstituted glucagon, still inserted in the vial to avoid anyone getting an accidental stick and to show Doc what he was about to administer. He revealed the man’s forearm, unable to roll his shirtsleeve up past his elbow, and gave the injection.

At one point I looked up toward my deck to see Jazmine standing with Jenna, holding her in a full embrace while Jenna cried. My heart broke knowing my smart girl was getting a harsh lesson in what could happen to her. But I was also somewhat grateful for this. Jenna has never had a bad low. Not like this. And as I mentioned recently in another post, Jenna is stoic and prefers not to invite attention on herself, especially where her diabetes is concerned. She has insisted many times in the past that she is fine when a check reveals a blood sugar between 2 and 3. I worry that Jenna could opt not to speak up when she feels symptoms and therefore risk having a bad low.

Five more minutes passed and Fire and Rescue showed up followed by the paramedics. Finally. From the time we called 911 to the time the help actually arrived was a good 20 minutes, at least. By this time the man had received the proper help from his neighbours — who just happened to be a former nurse with a type 1 diabetic child and a medical doctor — and was now conscious and responding, insisting that he was fine. His girlfriend arrived on the scene at some point and asked him why he had driven so far down the road, passing his parking spot entirely. I quietly wondered if she was ’new’. He told her, in a manner laced with slight annoyance that she would even ask that question, that he had driven too far and missed his parking spot. Clearly, he had been confused and plummeting before he finally, somehow, fortunately made the decision to put on the brakes right in front of our house. We told him he couldn’t have picked a better place to have a bad low.

I apologized for the crazy high he would no doubt suffer after all the sugar we poured into his system.

“It’s cool” he replied through chattering teeth as he shivered in his sweat drenched shirt in the cool night air.

A few more words of relief and gratitude were exchanged and we decided to give the guy some privacy and retreat back into our home to deal with the emotional fallout our girls were, no doubt, experiencing. It was a little past their bedtime but I knew we had to let them express their feelings about what they had just witnessed, especially Jenna. I was interested to know what was going on inside her head.

Once we were back inside and closed the door, Jenna wrapped herself around me and we sat together for a while. She cried some more. I asked her if that was scary for her to see what could happen if a low was really bad. She nodded. She sobbed. I assured her that we do everything possible to make sure she is safe and that we would never stop doing that. I also told her how important it is for her to tell us or her support worker at school if she is feeling low so that she never has to go through that. She hugged me tighter.

This day has been a strange culmination of a series of events that I am going to be pondering for some time to come. I do believe, now more than ever, that there are no coincidences; things don’t just happen. I have seen too many “coincidences” that are just too uncanny to be such. This day was a gift on many levels. This day has strengthened my resolve to advocate for better care in schools for our children with diabetes. This day has left me dumb-founded.

This day has also left me without glucagon and with the sobering realization that we live in an area where timely emergency medical assistance can’t always be counted on. I’ll be making a trip to the pharmacy tomorrow and picking up a real-estate magazine while I’m there.

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