Tuesday, May 8, 2012

Insulin Overload --- what could have been a fatal mistake


in·su·lin/ˈinsələn/

Noun:
  1. A hormone produced in the pancreas by the islets of Langerhans that regulates the amount of glucose in the blood. The lack of insulin...
  2. An animal-derived or synthetic form of this substance used to treat diabetes.




Insulin . . . such an important part of my life today.  The small vial of insulin that I pick up at my local CVS pharmacy each month literally keeps my son, Nate alive each day.  Without his insulin pump, the OmniPod infusing insulin into his body 24 hours a day/7 days a week Nate would not be able to live.

I've said it many times the scariest part of Nate's T1 is that the very same insulin that keeps him alive and healthy can actually cause extreme hypoglycemia which could lead to a coma, brain damage or death.  It's a very, very fine line.

The insulin isn't magic and Nate's pump isn't magic . . .  although that would be really nice.   Jim and I have to calculate each dose of insulin that Nate receives through his pump. It is a non-stop, never-ending, always-changing job that keeps us on our toes at all times.

Mistakes are not an option when it comes to insulin.

That being said . . . Saturday the 5th of May, 2012 a monumental mistake was made and it could have been fatal.  I'm not saying this to be dramatic ---- it is a fact! If we had not realized what we had done --- the mistake that was made ---- it would have been fatal.

Most of my readers know that Jim and I are going through a divorce, he works out of state most of the time and I handle most of Nate's diabetes care.  Jim can do everything that I can do --- he's just not here most of the time so the every day ins and outs of D care are mine.  Nate has been pumping with the OmniPod for over 2 years now and I can probably count on one hand the number of insulin injections I've had to give Nate from a syringe.  In that same time Jim has not had to give Nate any injections via syringe.

So, Saturday was a rare day for us.  Jim was in town, it was his weekend with the littles but he had a ton of work to do so I volunteered to hang around and help out so he could get it all done.  Yea . . . pretty much I had nothing else to do all weekend so you know --- I was nice.  :)

I decided to take the kids hiking Saturday afternoon and at the last minute Jim decided to take a break from work and tag along.  I was actually happy he decided to go.  As much as I love hiking with the littles --- it can be a bit challenging solo.

As we were hiking Nate's pod fell off and being the stellar D Mama that I am I didn't have another one with me (I always have an extra or 2 with me EXCEPT for when I actually need one).  I wasn't worried at all during the hike because he stays in range with the help of a lot of carbo boosting along the way.  After our very long, hot and dirty hike we decided to grab a bite to eat and instead of doing a pod change we decided to just give Nate an injection to bolus for dinner.  No. Big. Deal.  Except it turned out to be a VERY. BIG. DEAL.

We SWAGGED dinner and decided that Nate needed about 1.25 units of insulin.  Jim drew up the insulin and was handling giving Nate the injection while I took the girls to the restroom.  As I was leaving the table I could tell that Nate wasn't too thrilled about a shot so I decided to grab the syringe and give the shot in Nate's arm really fast while Jim was distracting him.  I never even looked at the syringe just picked it up, stuck it in, and pushed down on the plunger.  As soon as I did I knew something was very, very wrong.  I asked Jim how much insulin he put in the syringe and he very confidently answered 1.25 units.  I asked him to show me on the syringe because I knew . . . I knew by the feel that I had never given that much insulin before.  When he showed me on the syringe he pointed somewhere between the 10 unit line and the 15 unit line and my knees went weak.  He thought the 10 was 1.0 and the 15 was 1.5.



I actually felt the blood drain from my face and I saw the look of absolute fear in Jim's eyes when I told him what we had done.

We gave Nate 12 units of FAST ACTING APIDRA.

To date Nate's largest bolus has been 4 units and that made him bottom out.  His current total daily insulin intake is around 11 units per day.  12 units of fast acting insulin in my 3 year old son was a fatal dose and we kind of freaked the F out.

The part that scared us both the most is that if I had not decided to turn around and help with the shot Jim would have never known that he gave Nate 12 units of fast acting insulin.  The what ifs and the what could have beens were pretty overwhelming.

 I usually handle all things diabetes pretty calmly --- I avoid the hospital like the plague when it comes to Nate and diabetes.  I'm pretty cocky . . . always thinking ---- I got this.  This time I was ready to go straight to the ER --- I was pretty scared.  I stayed calm and Jim and I very calmly and quietly discussed our options.  We were soon overwhelmed when we realized Nate's dinner time insulin to carb ration (I:C) is 1:30.  That means he only gets 1 unit of insulin for 30g of carbs eaten.  That meant we need to feed Nate 360 grams of carbs to keep him safe. CRAP!  I did call the on call endo at Children's but she said 'just give him some ice cream' . . . ummmmmmm ok!

Jim and I decided we could handle it and it would be more traumatic for Nate if we took him to ER for glucose drip.  So, we began the carbo overload right there at Uncle Julios!  We started with regular Coke --- 2 glasses, ordered sopapillas with extra honey & ice cream.  When we left the restaurant we stopped and picked up a few treats . . .



Jim kept up with carbs on paper and I kept up with my iPhone calculator.


I kept adding to my calculator each time we convinced Nate to eat something else.  I like this picture because if you look closely at the top you can see a message from Lexi was coming in to check on me.  I absolutely loved the way the D moms and dads, family and friends rallied around us Saturday night. Every text message, phone call and FB message seriously kept us going and kept us encouraged enough to know that we would be able to get through one of the scariest nights of our lives.


And no . . . Nate didn't eat GaGa . . . she brought cookies and treat over for him to eat so I guess instead of writing all of those things down he just wrote GaGa. :)

Nate's blood sugar hovered between 90 and 159 all evening.  It would drop, we would feed, drop and feed, drop and feed.  We ended up finally giving 270g of carbs and 2 mini glucagon (4 units each) and he never dropped below 90 not even when the Apidra peaked.



When we finally saw his bg rising later that night we put a pod on and started his basal again.  He ended up pretty high after the pod change but after the long night that we had . . . I was so ok with it!

Oh yea - - - did I mention that 270g of carbs had Nate bouncing off the walls?  He was CrAzY!

As per usual all pics were taken with my iPhone so please excuse the terrible color and all that blah blah blah!


Nate was in carb heaven . . . he and the girls never knew the severity of the situation or really that there was a situation at all.  They just enjoyed munching on candy, coke and ice cream all night.

We kept calm and carbed on!

19 comments:

Penny said...

I stand in awe of you Laura - you did an amazing job and stayed calm throughout it. You can do anything. Love to you and Nate - rock on!

Stephanie said...

Can I just tell you how impressed I am??? You guys handled that so well. Despite mentally freaking the F out. :) I am not even sure what I would have done....probably raced to the ER, but now I know that it is possible to handle a situation like that at home! ((Hugs)) to you, mama!

Jen said...

whew.....my heart was racing when I saw your posting on FB. As always, I admire your courage Laura. You did an AMAZING job keeping Nate safe. You are one super D mama! Much love to you!!!!

Nikki of Our Diabetic Warrior said...

Laura, Praise God that He protected Nate! I understand how scary that is because I did the same thing when Andrew was first diagnosed. I actually mixed up the long/short acting insulins.

You did an amazing job thinking fast on your feet!

Sending HUGS!!!!!!!

Kelly said...

Thank god! How totally and completely FRIGHTeNING!!! I probably would have doubted myself and went to the ER, awesome job Momma Pancreas!

Meri said...

Today I am thankful that you gave nate that shot. If YOU hadn't...I can't even think about it. I am thankful you are his mother. I am thankful for the DOC who no doubt introduced us to mini gluc shots. I am thankful for you and your ability to keep a clear mind in a swampy situation.

You take Keep Calm and Warrior on to a whole 'nother level! <3

Alexis Nicole said...

Truth moment? I was scared shitless during our texts, and I knew how scared you were and that was what kept me levelheaded. But I never ever doubted that you would handle it like a pro and you did.

Ditto everythhing Meri said.

Love u too moon. And back!

Denise said...

So thankful you realized what happened and all was well in the end. You are amazing and handled this so it will be remembered by Nate as a great candy fest and not a scary near-death situation (though I am sure you probably got a few grey hairs from it...I did, just reading about it!) Hugs to you and your family. <3

FeltFinland said...

Phew, big sigh of relief at the end ! This will encourage me to double check in the future. Well done to you both for managing a really tough situation.
Amanda

InfamousQBert said...

this was linked on FB by a T1 friend of mine. my child is not diabetic (knock on wood), so i can't even imagine having to deal with all of this, but my heart goes out to you. i'm tearing up just reading about it.

thisiscaleb said...

Haha. Great new saying. Way to go mama!

Jess said...

oh my goodness! how scary! i am in awe of the calm and grace with which you handled this. so glad the little man is ok!

Sarah said...

oh my...what a team you were figuring all that out. We did something similar when Isaac was first dx and somehow my husband who at the point was used to filling a syringe just for himself accidentally injected Isaac with his insulin for breakfast and himself with Isaac's. We did the same power packing of carbs, I never felt so loony in my life trying to force my child to eat skittles, honey sticks, smarties...etc.
I am glad all went okay. I am thankful you guys didn't freak out and just did what you knew to do. You rock.
And I absolutely love that pic of nate! Perfect :)

Amy said...

I was thinking about and praying for you guys after I saw your facebook update. Sooooooooo happy to hear of the ER-free outcome. Nice job, DMama!

Denise aka Mom of Bean said...

WOW!
Amazing D-mama work, Laura! Amazing!!

lukesdday said...

Wow - glad I read this after the fact! Talk about keeping calm and carrying on - you rock! So glad all turned out OK!

Misty said...

I may have been absent on the commenting lately, but I was totally praying with you guys that scary night. You are amazing and should be so so proud of yourself for handling the situation the way you did.

Sara said...

Look at Nate's face! I can pretty much guarantee you he will not remember anything scary about that night and THAT is the most important part!

mydiabeticjourney said...

Wow, I am always amazed at how strong parents of diabetic kids are. When I got diagnosed as an adult, one of my first thoughts was "I can't imagine how challenging it would be to have a diabetic child." My hats off to you.