Thursday, October 14, 2010

The not so super substitute...

I think Bekah is out of the honeymoon phase and her pancreas has now kicked the bucket.  Since school started we were battling lows.  Not low lows, I'm talking a lot of 77s.  (we treat anything under 80 as a low)  Then suddenly we had a beautiful week of  105-135.  No joke.  I couldn't even bring myself to blog about it because it was such a thing of beauty and I didn't want to jinx it.  Suddenly last week we started having a random 3somethings, but still most of her numbers began with a 1 and life was good for the most part.  BAM!  Out of the blue last night when I did her midnight check before heading to bed myself,  the meter read 415!  I'm not sure where it came from.  I washed her hands with a baby wipe to make sure we were getting an accurate reading.  395!  Bolus for the HBG and check for ketones ( we just got a blood ketone meter and I LOVE it) 0.0.  Whew, no need to change the site just yet.  Of course I didn't get much sleep.  My hubby checked her at 3:00, BG = 330 and ketone check said 0.0 again.  I breathed a sigh of relief because as much as I was hating those numbers I did not want to do a site change in the middle of the night.  Last time I tried, Bekah woke up just after I placed the new site and yanked it out, and then was a CRAB for the rest of the day.

First thing this morning we did site change.  Her fasting BG this morning was 158.  It had come down quite a bit.  Her teacher had told me the day before that her class would have a sub as she got called last minute to attend a class.  I had an appt over in Portland with Megan to see a GI specialist for some liver issues that she has been having so I would be quite a ways from school if there was a problem.  I was exhausted from the night before and a nervous wreck about how the school day would go.  I wanted to keep Bekah with me but decided that she needs to know that I trust her and that I trust that she is going to be ok.  I don't want to create a relationship with her where she is unhealthily dependent on me all of the time. So, I sent her to school.

When she got off of the bus, I asked how her day went and immediately took out her daily BG log that I use to communicate with her teacher.  ( I pretty much copied Reyna's)  It was not filled out except for the lunch part that the secretary does.  I asked if she had just had a snack and Bekah said no.  Did you have one before recess?  no After? no.  I start to panic thinking she is on the verge of a low and we have 1/4 mile to walk back home.  (a very long walk when you have a low BG)  As we walk she mentions that her last BG reading was 4 something.  I stopped in my tracks and took out her meter then raced through the button pushes to get to her last BG.  Yes, indeed it was 453!  I asked if they checked for ketones? Bekah informed me that she just went out to play.  I have written a very detailed 504 that outlines all of this.  See:


5.1    Bekah may feel thirsty, sluggish, hungry, have a headache, blurred vision, and/or need to urinate often when her blood glucose is high.  See Bekah’s Diabetic Information and Care Plan document for specific information on treating high blood sugars.

5.2    Hyperglycemia (high blood sugar) should be monitored closely.  Whenever Bekah's blood glucose is over 300, the nurse should also check for ketones using the urine ketone strips.

5.3    Lack of insulin supply, which can occur with a pump malfunction or an occlusion in the tubing or infusion site, may lead to diabetic ketoacidosis (DKA) within a few hours.    Diabetic ketoacidosis is an emergency medical condition that can be life-threatening if not treated promptly.

There is another section that talks about when to call mom and a BG reading of over 300 is one reason, ketones present is another.  I wrote a letter to the principal, nurse and her teacher to let them know this happened.  Once home, I rechecked her BG and checked for ketones.  BG= 348 and ketones 0.2 (I'm still getting used to the blood meter readings but I assume this is trace)  I was still infuriated that they allowed her to go play when she had ketones present.  I know this was not much and she was not in danger but she could have been.  What ifs flooded my mind.  I'm so thankful that this turned out ok.

Add to my day Megan's appt.  It was not horrible.  The GI doc was extremely encouraging the first time we saw her.  Megan has been working hard and our scale at home reflects about a 20 lb weigh loss.  She was weighed last week at the nutritionist office and that showed only a 10 lb weight loss.  The doc's scale reflected only a 3 lb weigh loss. The doc didn't even mention it.  Even 3lbs for a 12 year old is amazing!  The doc was a bit more critical and didn't want to recheck Meg's liver numbers because she didn't think that much had been done.  I left a little disillusioned.  I guess I was hoping for some kudos because I feel like we have done and are doing a great job!  Maybe I was just overtired and sensitive because of the lack of sleep.  

I'm tired.  I'm frustrated.  I'm done.


  1. Speechless. I am a sub RN for our school district here. This would never happen. Well, obviously not when I am subbing being a D mama and all...but they do a great job of orienting all subs. I just want to hug you guys right now Heidi. This stinks. Makes you feel all alone, doesn't it? SIGH. :(

  2. You and Megan ARE doing great job!! Keep up the good work and you will get there :)

    Maybe make a letter to give to subs whe the teacher is out. I copied mine from D-tales.
    The school really liked it.