From previous entry: “We all know that when you make such ambitious plans, Murphy's Law steps in to laugh in your face and kick you after you fall down.”
So, we had possibly 20 vials of frozen insulin, that was the start of the day. The kids still had school. That may be the worst thing to happen…… but wait, it’s not.
When we arrived at the school that morning, our lovely diabetes caregiver, Mrs. Linda the Librarian said “Daniel!!! We’ve been doing this whole diabetes thing for over two years here at Hiawatha, and we’ve never had to use the Glucagon!” Now, I’m not a superstitious type of person, but I maybe should have knocked on wood. Can you guess what happened on his final day at school? For those that don’t know, Glucagon is an emergency injection that is compared to Epinephrine. It’s for Diabetic low blood sugar emergencies.
I got a call right after I ordered lunch at a restaurant that Brad and Jacob and I went to after cleaning the house and before loading the van. Mrs. Linda said, “Daniel has already had his lunch insulin, he’s complaining of a headache and nausea and can’t eat his food.” Honestly, I don’t remember exactly what was said (or if it was even Linda who said it), but it was along those lines.
I abandoned Brad and Jacob at the restaurant and went to the school to better help decide what to do.
Brad and Jacob stayed at the restaurant with no car (Brad’s Jeep was in Oregon) and I went to the school, where Daniel was curled up in the library not doing well.
I assessed the situation with Mrs. Linda. His blood sugar was about 120 if I remember correctly, but dropping slowly. He had enough insulin to cover a 60 gram carbohydrate lunch, and ate tiny bites of it before suddenly having a headache and stomach pains and feeling like he was going to throw up. First thing to do, verify blood sugar and check for ketones (a result of Diabetic Ketoacidosis [DKA]). No ketones, so the headache and stomach pains (both symptoms of DKA) are from something else. Blood sugar confirmed the accuracy of the Continuous Glucose Monitor, so we can trust those numbers and don’t need to prick his finger anymore (or at least until he vomits). Next, we urge him to drink juice slowly, and eat fruit snacks. The goal, get the carbs into him to prevent the insulin from dropping him into dangerous blood sugar territories.
His stomach was too upset for him to take in much carbs. We didn’t want to risk his vomiting, because that will bring about a scary spiral of low blood sugars with ketones and we want to avoid DKA and hospitalization. After trying to help him remain calm, we decide he needs intervention before that fear becomes a reality. I decide I’m going to use a glucagon, but not the full dose. When a T1D kiddo is sick and vomits after being given insulin for food, or if they cannot get their low blood sugar up after a while to trying, or for other similar situations, a pediatric endocrinologist will prescribe what they call Mini-Glucagon. If you are part of the T1D community and have questions about this process, ask your endo. It has limitations you need to be aware of before using on your own.
In order to use the mini-Glucagon, you need a regular Glucagon set and an insulin syringe. I went to grab the diabetes supply bag for the syringe and realized I didn’t have the bag! I didn’t take it to the restaurant because Daniel wasn’t with me and I forgot to stop by the house for it. I didn’t have any syringes at the school, either. I have since added a few to the big school box. Not wanting to leave Daniel’s side per his frightened state of well being, I called a neighbor who I hoped was home. “Please, walk into my house. BTW, the dog is loose and will try to love on you. I will unlock the door with my phone’s security system app.” I explained where the bag was and she brought it to me.
Daniel’s blood sugar was in the 70’s and dropping very fast by this time. Remember, below 70 requires sugar intervention. Below 60 is concerning, below 40 and the CGM won’t read, and unconsciousness can happen anywhere below 65. With enough insulin for a big lunch and almost no food ingested, it was only a matter of time before his original blood sugar of 120 became dangerously low. So, I made Mrs. Linda prepare the glucagon solution and I drew it up and injected it. Just a little bit of a “you did this, Linda” was joked around for easing tension.
10 minutes later, he was back in the 80’s. 15 minutes later he crossed 100 and his headache and nausea were dissipating, though still not gone and we all began trying to figure out what caused it and if they’d return. After all, the risks of a stomach virus at the beginning of an un-reschedulable road trip…. Plus the added risk of hospitalization for Daniel. Yeah, we don’t want that! After over an hour of my getting to the school, Daniel was willing to let me go for a bit and I was able to go get Brad and Jacob from the store next to the restaurant (cause they got bored waiting). I picked them up and they returned me to the school, taking the van so they could pack it.
Brad and Jacob returned to the house to pack the van and wait for the driver to come pick up the loaded moving truck--necessary before we could leave. Those plans didn’t even work out right. When Brad returned to the house, the new owners had arrived for an unexpected inspection, the driver had come by when Brad was stuck at the restaurant and didn’t return before school was out and he had to pick me and the kids up. I wanted SO badly to get a good farewell in (not realizing we weren’t leaving Michigan for another couple hours). And, to top it off… I left my purse in the library at the school. Thank goodness, my friend followed me home for extra hugs before we left and was able to take me back to the school. Double thank goodness they were doing parent teacher conferences and the school building was still open. Triple thank goodness, the teachers were having a pot luck in the library and let me eat a little (I skipped breakfast and due to what happened at lunch, I didn’t get that, either). I still wish I could have had a better goodbye with the school staff that had become family to us.