Yesterday we had quite a day here. It was one of those days when you truly don't see the tsunami coming until you're already ankle deep in poo.
The day started like any other day, other than that I failed to notice I sent Grace to school with only 5 units of insulin in her pump. NORMALLY, this wouldn't be a problem. She never needs more than 2 units to cover lunch, and her daytime basal rate is only set at 0.2 units per hour, so 5 units SHOULD get her though the school day.
While at the nurse for her bg check before morning snack, her pump alarm went off.
"Why?" you ask.
Because for some reason, her pump said it needed to be primed. For those non pumpers out there, 'priming' is the act of sending the insulin through the 23 inch (centimeter? I never measured... I just know it's 23 something) tubing that connects the pump to the infusion site (the part attached to your child's body). You know it's fully primed when a couple drops of insulin come out the other end. Usually you should only need to prime your pump when inserting a freshly filled cartridge full of insulin. We have occasionally had to re-prime her pump, mostly after it's been suspended for a while such as during swimming. It doesn't happened often, but often enough that Grace knew what to do.
See, she knew what buttons to push to prime the pump, but forgot one crucial step... disconnecting herself from the pump.
she primed the pump, without disconnecting the tubing from her infusion site, which pushed an unknown amount of the existing insulin already in the tubing, in to my daughter.
It was at this point that I got my FIRST call from the nurse. She didn't yet realize anything was amiss, but was just calling to let me know what was going on.
HELLO! BIG PROBLEM HERE!
How much insulin did she give herself? How low will she go, and when? The good was that she had some insulin left in her pump, so she didn't dump the entire amount into herself. I told the nurse to check her every 30 minutes until she seemed out of the woods.
30 minutes - 114
60 minutes - 59
It's now lunchtime, so the nurse corrects her low with a juice, and feeds her lunch in her office (with all the checking Grace missed lunch). She chose to bolus her after lunch instead of before like normal, due to the potential that she was still falling (kudos to that idea!).
After lunch blood sugar - 214
Can you say REBOUND! It's common for lows to be followed by highs, as a diabetics body is trying to compensate for the low by releasing stores of glucose.
So a bg of 214 + 52 carbs for lunch = 1.5 units of insulin needed.
But by this point, Grace's pump doesn't have that much insulin left.
Here's where I got my SECOND call from the nurse. Or I would have, if I had my phone with me. (Stupid D momma moment - leaving my phone when I know my daughter might need me.) I left it on my desk so I didn't know she was trying to reach me. Until a coworker came running across the courtyard to tell me that Grace's school nurse had called the school where I work, and all of the sudden the entire school was trying to find me.
Picture me, sprinting down the hallway, trying not to knock over innocent schoolchildren on my way.
Long story, I know, but we're getting there... still with me?...
So, I talk to the nurse, and we decide to give Grace all she has left, .95 units. This leaves her with a beeping, angry-that-it's-empty pump, and not enough insulin on board to cover lunch and bring down her high number. I tell the nurse to disconnect Grace and keep the pump in her office, and that I'll be there soon to change her site.
Here's another stupid D momma moment... Grace's school nurse has an insulin pen for emergencies, but NO NEEDLES! Our CDE forgot to call in the needle prescription, and I haven't called to take care of it. Never once did this happen last year, but Murphy's Law...
So, I leave my job, rush home to get the vial of insulin (I always carry supplies for a set change, but not insulin, in my purse), go to Grace's school, and do a full site change. Now she's 220, so I bolus her .5 units to cover what she missed at lunch, and hoped for the best. Then go back to work, to finish the day.
2:30 - 194
Coming down, crisis solved, stressed out D momma!
The apache wars by paul hutton
21 hours ago