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. HIGH BLOOD SUGAR (HYPERGLYCEMIA)
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.