Riddle: When is a stomach bug not a stomach bug?

Answer: When your kid has Type 1 Diabetes.

We weathered our first stomach bug since diagnosis this weekend, and it has been pretty scary. Granted, I think every parent is nervous the first time your kid gets a virus that causes vomiting, but the odds that things will spin badly out of control is an ever-present possibility when you throw diabetes into the mix.

How bad can it get? Well, let's just do a little worst-case scenario comparison, shall we?

Take Jimmy, your average toddler, who has the same bug that Richard O did this weekend: no fever, no diarrhea, just vomiting. What's the worst that will generally happen to Jimmy as a result of the virus? Well, he could get dehydrated. He can drink pretty much anything he wants to combat dehydration, so long as he can keep it down. If Jimmy's dehydration gets too severe, eventually he will have to go to the ER to get rehydrated by IV fluids, but that's pretty rare.

Now, let's take a look at what happened with Richard O. Dehydration is also a worry for Type 1 kids, but the consequences are a lot more severe and immediate if Richard gets dehydrated -- and there are several other factors that you have to balance along with the hydration issue. Let's examine them one by one:

1. Blood Glucose Level -- Illness causes stress hormones to be released in the body, which cause the body to use insulin less efficiently, resulting in higher blood glucose numbers. If the blood glucose runs over 180 for a certain length of time, the body starts sending excess blood sugar to the kidneys to be flushed out of the body. The result? More rapid dehydration -- uh-oh! No good. Thus, you've got to use insulin to keep the blood sugars under control, which brings us to the second balancing factor...

2. Insulin -- Okay, so your T1 kids needs insulin, even though he's throwing up and not eating normally (food, specifically carbs, raise blood sugar levels, remember?) However, if you've just given certain amount of insulin by injection to help bring down that pesky high blood sugar, and your kid just throws up everything he ate, well, then, life gets a little crazy -- because you can't turn that insulin off, and now the food that was going to help balance out the blood sugar is GONE from the body. You're headed for a potential low blood sugar if your kid can't manage to get some kind of carbohydrate into him. And the low blood sugar could make your little guy have a seizure.

But wait! There's even more to make you crazy!

3. Ketones -- Ketones are a waste product of the body when it breaks down stored fat for energy. So, if you don't eat carbohydrate to fuel your body because you're nauseous and vomiting, you get what are known as "starvation ketones". High blood sugars will also cause ketones. Ketones will continue to build up in the blood unless there is sufficient insulin in the bloodstream to help break them down, and the person is sufficiently hydrated to flush the ketones out through the urine. If too many ketones accumulate in the body, the pH of the blood actually changes, and can send your little one into a coma. Oh, and once enough ketones accumulate, they can also cause insulin resistance, making it more difficult to get rid of them.

It is a constant balancing act to make sure that these three things are under control, and when your little peanut isn't tolerating food and drink well, it becomes even more challenging.

In our case, Richard O. had only taken his 24-hour insulin on Saturday, and we were still unable to keep up with the lows. He couldn't tolerate nursing -- it came back up. On occasion we had some luck with Kool-Aid with added corn syrup, but that also would come back up from time to time. And so we were faced with the perfect storm of low blood sugar, ketones from starvation, dehydration, and a little guy who couldn't eat or drink in order for us to elevate his blood sugar and help him flush the yuck out of his system with fluids.



Thus, we started at one ER, and wound up in another not 24 hours later. And we're still here in the hospital. And we're still fighting. It's all we can do, really.



If I had to find a bright side to all this (and I do, it's the only way I can keep my sanity), I guess it would be this: I am far, far stronger than I ever suspected. That doesn't mean that I'm strong ALL of the time (and I had a pretty nasty meltdown this evening), but when it comes to caring for my son, I can be much more assertive and downright aggressive than I was ever before. Kind of a momma bear instinct, really.



Since Richard's diagnosis, one of the phrases that I get thrown at me a lot is that "God doesn't give you more than you can handle." I don't believe that's necessarily true. I tend to think that He intentionally pushes us beyond what we can handle every now and again so we remember that we need to rely on others, and that we need to rely on Him. And hopefully, we grow a little more patient, more tolerant, more compassionate, and more loving through the experience, though that's not to say that we don't pass through periods of anger, frustration, and terrible doubt.



Well, I haven't really slept in days. And I should go to bed. But I'm glad that I stayed up to write for a while. This does my soul good, especially when life gets a little nutty like this.