Last night was surprising. Tab was high. 400 city. All night we were:
MIDNIGHT: yarrrrgh he’s 400, what should I do?/we’re supposed to wait to see if he goes down. 1AM: are you sure he took his Lantus?/yeah, he took it with dinner and he bolused then too. 2AM: he’s still in the high 300’s; should I give him a unit?/no, it seems like he’s starting to go down now. 3AM: should I give him a something? he’s not going down anymore/no, the doctor said not to give corrections, and I don’t even know how to guess how much to give him. 4AM: should we give him something?/forget it, it’s almost time to wake up anyway.
And then he was high all day today. Late this afternoon, I paged the on-call endo. It took me that long to realize he’s really not going down. When she called back, I didn’t go into our whole story, for once. Instead I said, “I’m calling about my son and he’s high, and I don’t know how much background information you need.” She said she’d need to know the patient’s diagnosis (T1d), did he have ketones (no), age, and weight. She said based on that info, the correction would usually be 1:60, but as a precaution, we should use 1:75. Okay!
Of course, my next act was to admire myself for not telling her all about his diagnosis, his little brother, his high activity level, TrialNet, teplizumab, and why I imagined his endo recommended against corrections (my belief that she believes he might be more insulin sensitive than the imaginary person used in the correction formula, or that his pancreas might kick into action at any moment).
By the time I had the formula in hand, Tab was 300+ and going up, 4+ hours after lunch, and having spent the afternoon running around and shooting lacrosse balls.
Three hours post-correction, he’s down to 260. Reader, I am unimpressed by the efficacy of this treatment. I am assuming we should wait at least four? Five? Hours before attempting another correction. Because stacking.
He feels kind of sick. His head hurts. He’s lying under a fuzzy blanket, watching Homeland. He feels like I’m not hungry, but I just feel like I need to eat something because my body feels deprived of nutrients. It’s the behavior of a person who gets diagnosed with Type 1 diabetes a few weeks in the future, and you look back and say, “Remember how you were lying under that blanket and you had a headache and you didn’t feel like eating but you felt deprived of nutrients? I bet you had high blood sugar back then but golly, we just didn’t know.” BUT WE KNOW.
We know, we know, we know. But we don’t know how to make it go away.