Andrew is playing on the all-star baseball team, and his team, which started practicing together Monday, entered a tournament hosted locally this weekend. He enjoyed learning the new rules and even got to pitch the maximum 8 innings per tournament! He and his team did very well, and I am so proud of them!
Diabetes, however, did not play nice today. It's ironic because a parent asked how his blood sugars were early this morning, and I showed off the perfectly straight line on his dexcom. I know, "Pride goeth before a fall," but it was such a pretty graph! They won the first game which, considering we were the only non-travel ball team there, was fantastic! Andrew pitched the last two innings. It was 11:30 or so, and we had an hour break so we headed out for lunch and some air-conditioning. On the way, Andrew complained that his arm hurt. Not his pitching arm - his site arm. When checking on it, it pulled out. We thought it pulled out right then, but in hindsight, I wonder if it had pulled out earlier in the game. We had limited time, so I offered Andrew a choice. Would he prefer to put in a new site, or take a shot for lunch. He chose to take a shot for lunch. It's hard to get to legs or "hips" in public when in baseball pants, so it seemed like a good choice.
We ate at Subway. We've eaten there before, so I'm fairly confident of the carb counts. I used the pump to calculate the dose (8.7), so I didn't make a math error. I had to use the pump cartridge for insulin, so I fiddled forever trying to get insulin without an air bubble in my syringe. I added a little to replace the missed basal, but I didn't replace all of it since he had been active. I figured 9 units of insulin should carry him through the 12:30 game & then we could put on a new site.
Andrew was in the 200s before eating, so I wasn't that surprised when he hit 300's. I showed the pump to a friend who knows another recently diagnosed child. She asked about dex, so we checked and it read 388 going double up (up very quickly). The problem is that it had only been about an hour since the shot, so I really thought it would start to kick in. I pushed Powerade Zero and waited for the insulin to work.
First inning, Andrew pitched again and did a great job. No one scored. I think it was three up, three down. He came in, and I went to check on him. He asked to go to the bathroom. I know that's a symptom of high blood sugar, but it is unusual for him, so that was a red flag. He was still in the bathroom when he was supposed to be on deck. His coach (of one week) had to come looking for him. I was embarassed for him, but there was nothing we could do. Unfortunately, we had three outs before Andrew got to bat, but he still had to head straight to the pitcher's mound. I don't know how he still threw strikes, but he did. When he came back into the dugout, he said, "I'm so thirsty!" and chugged some more to drink. He was first up at bat, so there was no time to do anything but hand me dex. It read, "High" going double up. I wanted to cry. Thirst, frequent urination, high blood sugar... this wasn't good. When he crossed home plate, the opposing team got their third out at first, so Andrew hustled back to the pitcher's mound.
At this point, I didn't know what to do. Part of me said to pull him off the field right now & put in a new site. On the other hand, the tournament games are only an hour and twenty minutes. We had started late and no one started the time on the scoreboard, but surely there couldn't be that much time left in the game. Are minutes worth pulling him off the field? Once the first pitch was thrown, this was his last inning to pitch anyway. I was fighting tears. I lost a few, but I don't think anyone saw them. I know "Andrew can still do anything he wants to do", but I wish he could just go out and play ball like the other kids. I felt like throwing up. I could tell he was getting worse, and I just wanted the game to end so I could get the insulin going again. Andrew moved to short stop and started hanging his head between plays and just not looking right. Coach brought him in off the field, and I was so glad! I jumped off the bleachers and got him.
We immediately looked for a "private" spot in a crowded ballfield. I was so nervous that I put the site in upside down in his arm. :( You want the tubing pointing up so that it can feed through your shirt. We had to redo it. By the time we finished, the game had ended and he had even missed the shaking of hands and team talk. As soon as we had the new site, he did another blood sugar check (599) and we did a full correction. I knew now he would be okay, but it was still hard. When we got home, I had him check ketones to see how bad off he was. MODERATE ketones! How? How did 9 units for lunch allow him to get that kind of ketones? Nine units is alot of insulin, and I still can't believe it wasn't enough. I wonder if the site came out early in the first game and he was pitching without insulin. I feel like I let him down. He's fine now. It took until 6 pm to get him in range, ketone free, and steady.
Yes, the risk of ketones goes up with the pump. A lack of insulin gets serious quickly. With that level of ketones, Andrew shouldn't have been playing. On the other hand, if he had his pump on, I wouldn't be waiting for the shot to kick in. I would have been able to increase his basal rate. When it was obvious that it wasn't working, I could have given a bolus with the remote while he was putting on his helmet and batting gloves. I could have done ... something. I haven't felt that helpless in a long time.
I'm scared too for Fall. We're going to let him play football. I asked about it at our check-up on Thursday. The textbook answer to playing football on the pump is to disconnect the pump (it would be destroyed) and reconnect to replace missed basal every hour. It's probably good advice. However, imagine yourself covered in football pads. Every hour, in front of your teammates, reach down your pants, find your site and connect the tubing. The site is either on your leg or rear. Seriously? There has to be a better plan. We are considering using shots for corrections instead, which is why today's shot for lunch sounded like a good plan. No, I'm not feeling it. Scared to death. I hate diabetes.
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