Ketones

 The longer we are in this journey called "Diabetes", I realize there will probably never be a time where I know everything there is to know about the disease - never a time when I'm not hit with something new.  Today, after 2 yrs, we were given a new experience called "high ketones".  What are "ketones", you ask?  I have no idea.  If I understand it correctly, it is something in the blood that, if left untreated, can lead to diabetic comas and death and at a minimum cause flu-like symptoms.  I remember on our 3rd visit to Peoria - about 3 weeks into Noah's diagnosis - we had the DKA talk.  It was a scary, scary talk.  DKA stands for diabetic ketoacidosis.  They had diagrams, notes, etc... all about this part of diabetes.  We have little test strips that Noah can pee on to test to see what his keotone levels are.  He can get them with high blood sugars or sickness.  Even a scrape on his knee can cause his levels to fluctuate and cause ketones.  As scary as ketones sound, I've never been nervous enough to test him regularly for them.  If he's exceptionally high, he'll test.  If he's sick, he'll test.  But, he's always been negative.  Guess you get pretty comfortable after a while and don't worry about it as much. This morning, about 2am, he came in our room and felt really sick to his stomach.  He ended up puking several times throughout the rest of the night, finally just dry-heaving during his last 2 sessions at 5 and 7am.  We tested his blood sugars, which were steadily rising into the 300s as the night wore on and ended up giving him a correction dose around 7:30 to help combat that, but we didn't think to test for keotones.  I had to go to church and then decided to go to the grocery, because I wanted to get some food before I ended up being home with (what I assume would be) flu-ridden kids all week.  While I was at the store, Pete called and said he tested Noah's ketones and it was high.  High?!  I immediately started freaking out.  High meant a hospital visit.  High meant coma.  I know that's not completely rational, but it's where your mind immediately goes as you remember that DKA talk back in February of 2011.  

I finished up my shopping and quickly headed home.  Pete had gotten out our notebook from the hospital that we got that first day in Peoria.  He read up about ketones, because we honestly had no idea what to do, and he started administering his first ketone insulin supplimental dose.  When I got home, I saw things laying out all over the table that Pete had been researching and managing.  We called his doctor, per the notebook that said to call immediately if he registered as "high".  She quickly reassured us that 95% of the time, high ketones are caught early enough to be treated at home that he probably wouldn't need to go to the hospital.  I was breathing a little easier.  She told us Pete did the right thing by giving him a correction dose AND a supplemental dose.  Now our job was to monitor him and check his blood sugar and ketone level every 2 hours.  Usually the levels come down after a couple supplemental doses.  Again, I was breathing a little easier.  He was still feeling really miserable, but at least we had a plan!  After his second supplemental dose, he perked up quite quickly.

You can see from the chart above that his level, that 4 hours earlier was a dark brown, was down in the moderate range in the dark peach range.  So, now we're wondering if he had the stomach flu at all.  DKA symptoms are nausea, vomiting, headache, stomach cramps/ache - all of which he had.  His numbers have been on the high side the past few days, but nothing that really raised the alarm.  Or, it all could be a coincidence that he had the stomach flu and the DKA reaction.  Only time will tell.  For now, we're quickly learning about the scary side of diabetes and feel like we acted in the right amount of time.  Even when he was diagnosed, he wasn't sick like this.  We caught it before that happened, thankfully.  So, looks like Noah is on the upswing, which is great news, though he has the rest of the day to continue with the 2-hr blood sugar checks and insulin doses to bring him down to a normal level, as well as continued urine tests and watching out for any lows that may develop, because of the extra insulin.  But, glad to say we've made it through the first 12 hours of his very first DKA with pretty good results.  It's definitely scary and, sadly, a lot of extra pokes into Noah when he's really feeling his worst, but it just reminds you how blessed we are that technology has come such a long way in the fight against this disease.  We were able to act quickly, because of that technology and it's saved him from a trip to the hospital this time and for that, I am so thankful.