Part 2 of 2
For about a week I saw Caleb’s blood sugars plummet multiple times after each episode of vomiting. I took advantage of the relief he felt post-throw up to get some concentrated carbs in him to help elevate his blood sugar.
But when my other kids have a stomach bug, the course of action is to ingest as little as possible to avoid more throwing up.
We don’t have that luxury with Caleb. We often have to do the exact opposite. Illness makes his blood sugars drop. We reduce his insulin dosing to avoid low blood sugars. Less insulin and/or dehydration causes ketones. The way to counteract low blood sugars and ketones is to ingest liquids and carbs -the last thing you want to do when you have a stomach virus.
But to avoid a trip to the ER, that’s exactly what we must do. Force carbs. It makes an unpleasant situation exponentially more unpleasant.
So here is what I want for people living with diabetes who experience a stomach virus:
A glucagon filled, one time use, basal-delivering patch pump.
I seriously considered whether I had enough glucagon in the house to fill a Pod and slap it on Caleb, activating it with our backup OmiPod PDM. Why can’t something like this be made available via a quick trip to the pharmacy as opposed to an ordeal at the ER? I’ve heard women tell me they used a similar device when they were pregnant to infuse labor inhibiting drugs. Why not one for glucose?
With the benefit of a home glucose drip, Caleb’s recovery would have been much more comfortable than what it was and what it would have been in the ER. With a steady flow of glucose, his bgs could be maintained safely without having to eat or drink. Insulin dosing could be increased to offset the glucose flow and reduce the risk of ketones.
Am I crazy? Does this at all appeal to you as a preferred option to going to the ER for a glucose drip?
On top of that, I want the ability to infuse saline into my son. Yes – I want that at home. I am given the responsibility of infusing insulin – something that could easily kill him if not properly managed – with barely any training. I don’t think it’s too much to ask for a way to deliver saline to him from the comfort of his home. Does the ER really have to be the only option?
So I want a third pump – maybe another patch pump with a preset basal delivery rate that connects to a saline bag so that enough can be delivered. This one may be more of a stretch, but still not completely unrealistic, right?
People living with diabetes go through enough each and every day and a stomach bug shouldn’t be such an urgent, deathly situation. I think it’s within the realm of reality that it doesn’t have to be.
Thanks to Linda for trouble shooting my hair-brained idea with me and suggesting that even saline might be a possibility with an attachment of some sort.
This is Caleb... 
I think the glucagon patch is a great idea. Especially going through the begining of this pregnancy not being able to eat much of anything. It would be great for those times I prebolus, then when it comes time to eat and I can’t hold it down, to be able to use one. Even if it weren’t glucagon – just straight glucose somehow. Not sure how it would work, but I seriously think you’ve got a great idea on your hands.
Yes.. a glucagon patch! My son is currently home w/ a MILD…so far.. Stomach bug. Yesterday he took a nap and woke up 47 though…..and last night when I checked him at 3am he was at 70…I gave him 1 cup of milk and he woke up 140. I know he has to eat but am also worried about lows from giving him insulin. I can’t back off on his BASAL cuz they made him go of the pump for a while and he is on Lantus 37U So…. I have to keep checking and keep carbing if needed. He seems to keep everything down…he just doesn’t want to eat or drink. What if he was a way at college right now? He is 16…that is not too far down the road……..scary.
Of course – the difference between pumping and injections – you can’t turn the basal down! I hope he’s feeling better soon.
Um, yes! I would love either of these. The saline appeals to me as I am on pretty much a every 6 month ER trip for rehydration. I’m sick of health insurance companies and drug companies making decisions for what I need and can use as a diabetic. i’m the one that lives with it every day! I’m jumping on your bandwagon Lorraine! Awesome ideas!
I think it would be great to have a two, potentionally three-hormonal pump available. the filling would be a matter of choice, for example insulin+glucagon+saline or insulin+glucagon+symlin. wouldn’t that be awesome? you could program basal rates, switch hormones on and off, combined with a continuous glucose monitor of course. that would be like being our own fully functioning beta-cells 🙂
“Am I crazy? Does this at all appeal to you as a preferred option to going to the ER for a glucose drip?”
If you are crazy then I am your little friend, insane. YES this appeals to me. Why wouldn’t us D-rents be able to handle this and saline to administer when we are expected to inject and administer insulin?
You are one to something here, Lorraine. Who can we write or call to get this fabulous idea rolling?
I think that glucose patch it a WONDERFUL idea. I was home all weekend with a tooth infection and could not get to a dentist until Monday morning…. in the mean time they prescribed me some Vicodin for the pain and because I couldn’t eat on the sore teeth, my stomach was empty, thus causing a horrible reaction to the pain meds. It was all around just hellish to try and stay hydrated, balance blood sugars and a glucose patch would have been wonderful.
As far as the saline goes though…. doesn’t that have to be delivered via an I.V? Not just in the blood stream like insulin and glucose? I think a lot of people would end up getting hurt if it wasn’t properly attached (air bubbles, etc)
I’m sure you are right Windy. Thanks for bringing that up. I’m sure I’m not the first person to wish we could do this from the comfort of our home and all these questions have been asked before. But a girl can dream, right? 🙂 It just seems so extreme to have to go to the ER for hydration, though people do it all the time – D and nonD alike. It’s just more of a reality for the D folk. I wish it could be easier/more convenient.
I think the glucagon patch is potentially a great idea. However, glucagon is highly a unstable molecule (see http://goo.gl/1nMPi for more background on that_ which is why it has to be reconstituted immediately before use. Several companies, including Biodel, Inc. and Marcadia, Inc. are working on this at present, but it’s unclear how soon these glucagon (or glucagon analogues) might come to market. Presently, I see of one way you could do something like this. First, the pump. There is a product from Patton Medical Devices called the I-PORT(R) which is already being sold and is FDA approved. This is basically a low-tech pump that saves the patient and/or caregiver from having to do injections. It is kind of a disposable pump that is approved for insulin usage. As for the glucagon, given that isn’t feasible yet, I don’t know if dextrose might be feasible instead. Ordinarilly, that would be given intravenously, and you’d have to check with a doctor to see if it could be given subcutaneously (and if so, how how it would take to be absorbed into the bloodstream). But I like the idea, and you might want to think about asking his endo about the I-PORT for this purpose. Although it cannot do basal delivery, it can do periodic boluses in response to test results, for example. If dextrose could be used, it’s then a matter of understanding dosage ratios.
Thanks Scott! I appreciate you adding some reality to my “pie-in-the-sky” dream of an idea. 🙂 I remember seeing the I-Port when Caleb was first diagnosed. It might make bolus’ of glucagon seem a little less intense in this kind of situation.
I hope the more stable glucagon takes shape soon and maybe it could springboard into some kind of home remedy in these cases.
Along the same thought process…and, yes, I’m referring to a sick pet I had once…the vet clinic injected a bolus of about 100cc of fluid subcutaneously to the back of my cat’s neck once…it was a funny looking bubble that absorbed over time.
If not glucagon, then why couldn’t we fill a pump with a highly concentrated dextrose solution to infuse SQ temporarily?
That may manage blood sugars, but there’s still it issue of rehydration using IV therapy. Though…if PWD’s/T1 parents were given prescriptions for anti-nausea meds (a routine prescription, like strips), then it’s possible we could get those in the system right away, thereby increasing the likelihood that we could keep them hydrated at home.
Loving your thought process 🙂
It’s turning into a brain-storming session! We may come up with something viable and not so crazy after all when we put all our heads together!
Wendy, I thought the same thing reading this… the vet injecting my dog with a ton of saline under her skin! I’ve thought about it with Camden, wondered if I could just inject saline like insulin and have it absorb. Of course, those tiny syringes would force an awful lot of injections to help…
Yes, it would be great to have an at-home remedy for these things! Not such a crazy idea!
Thanks for the vote of confidence Emily
You are totally onto something Lorraine! I think that your idea is so brilliant that I actually thought that it was currently being studied when I saw your blog post on FB. This to me makes sense. HUGE sense. I think that the saline IV may be denied b/c of IV training blah.blah.blah. But the subcutaneous glucagon via pump is a huge FAT winner!
Take it to the higher ups! You could be rich AND, more importantly (in my eyes) FAMOUS. We will all be happier and safer. Simply, the flu season will not scare the bejeezus out of us all trying to pancreate for our kiddos.
Love to you friend…and thanks for your kind words earlier today.
Thanks Reyna – your opinion means a lot – really. You know your stuff girl. 🙂
I knew the saline idea was less than perfect, but I can’t help thinking there’s gotta be something…
Ok this is brilliant! The Pod actually sounded like it could work! I think youre really onto something here..
While glucagon is not stable isnt the glucose drips they use stored for a while? Why not allow those to fill up said patches.
This is great Lo!
I read it was actually good for up to a month once mixed. That was refrigerated though. Nevertheless, it’s got to be better than nothing, no?
Lorraine, you are brilliant! I love both these ideas! Hope Caleb is on the mend and feeling much better. Thanks for blogging about your experiences… I love learning from other D-moms!
Thanks Joanne. He’s make to normal, thank goodness.
oh my goodness I just got done reading part 1 and 2 and phewww…what an exhausting 8 days you guys had to go through! I’ve only had the flu once in my life but, I remember thinking that I wished I could take little shots of glucose for when I was throwing up, so I LOVE your idea for a pump patch! It’s something that would really be helpful. Even for pregnant women who may throw up from nausea or in my case on time, nausea + a stomach virus.
I definitely agree with the others that you’re on to something!
Thanks Sysy. Sarah was saying the same thing about pregnancies!
crazy AWESOME idea!
Hi Sarah! Thanks.
Hi Lorraine,
What a great idea, it is just brilliant! Hope Caleb feels better soon.
Hi Pearlsa, and thank you. Caleb is all better. 😉
I’m in. I would like to invest in the start up. I don’t have much left after stocking up on pump supplies times 3, but I know a good thing when I see one. My plea to the inventors of the world? “Make it work!”
I have learned so much from all of you bloggers- and I love it! This is such an intriguing idea Lorraine! We haven’t had a reason to consider using mini-glucagon….yet. I know our time is coming. When I asked our endo about it- his view was that Glucagon will deplete the liver of it’s stored glucose effectively raising the blood sugar-yet potentially causing severe lows later. Has this ever been the case for any of you?What do your endos say? When our time comes I will have to decide whether to obey him or….not. I was wondering as I read this why glucose itself couldn’t be administered sublingually or via an oral spray or patch of some sort thereby raising the blood sugar yet retaining the body’s stores for emergency use. Would that potentailly work? Again, this is newish for me but I love the thought of a product to ease the stomach virus fears and realities. Can’t wait to see where you go with your idea.
This is exactly what I was thinking as I read through the post and responses. Our daughter (4 yr old) had a stomach virus a couple weeks ago. She had BG 35 and was too upset to drink/eat anything so we injected glucagon. It barely did anything (got her up to 50) because her stores were all used up from being sick for so long. Thank goodness it was just enough for her to calm down and take some honey so we didn’t have to rush her to the ER.
Amen. I am all for the glucagon patch/pump. The saline is a little more difficult as you would have to find a vein and insert the IV. I am willing to learn, but this would be the biggest drawback. There has to be a better way than dragging a sick, small child, into an E.R. filled with children who can have any kind of illness, exposing your already sick child to even more kinds of sickness. Not crazy at all!
That is BRILLIANT! I dread having to take Jenna to the emerg department. I love your idea. Nothing crazy about it. Clever you!
You are a genius!! I think a glucagon pump is a wonderful idea!!!!! And I agree with the saline too. When we had our old cat he got really sick and dehydrated. And the vet set me up with everything I needed to infuse him with saline twice a day. If we can do it for a pet, we should certainly be able to do it for a human!
I think you are brilliant – what a great idea.
I would do anything to stay out of the hospital. We’ve had 2 tummy bugs since dx –
the 1st one was just weeks after dx – I was panicked and ended up back in the hospital. The 2nd one was after pumping and a wee bit more manageable. I think this idea is really great – Have pods – Will fill! 🙂
Later Lo – aka Genius!
I love the Idea! I would go for it in a heart beat! I seem to go low in sickness instead of high so glucogon is my best friend! I am just glad to hear he is up and back to his old self!
This is a fabulous idea! I think you are really on to something with this. It makes perfect sense.
I am totally on board with this idea.
And just think how much it would save insurance companies. (I’m saying that because they want to save money, don’t they?)
Our recent flu-induced ER cost $12,000 (before insurance coverage) and will be a huge chunk out of our pockets. All we needed was anti-nauseau medication to make the vomiting stop, a dextrose drip to keep her blood sugar up, and saline to get her hydrated.
I would much have preferred a glucose pump rather than taking her to the ER at 1:30 am!
I think you are on to something. (Next Diabetes Mine design challenge?!)
I’m surprised to read that anti-nausea meds are not standard for everyone. We keep it on hand just in case. Our doctor just wrote us a prescription with no trouble.
I REALLY wish we could have a saline and glucose infusion of some kind!!! Clara has only been sick 2 times since dx T1 3 months ago and it’s just awful wondering if we’ll all be packing up to go to the ER any minute. I completely agree that we should be given these tools along with the insulin. Heck, I’d even give her an IV if I had too. She hates them, of course, but at least she could be at home.
A glucose pump would be fesable but the saline would be harder. The maintence fluid needed for a 20 kilo kid is about 60cc/hour. That is not correcting for dehydration from vomiting or diarrhea. For 5% dehydration you would need an additional 40cc/hour. 100cc per hour is way too much for a subcutaneous infusion. Also, in the peds ER where I work we give different types of fluid depending on the kids electrolytes. Usually if a kid can’t eat we give diluted glucose IV.
If a kid really needs rehydration but can’t drink, IV is the way to go. It is safe, fast and pretty easy.
Thanks Ecp. I appreciate your comment. You are the voice of reason for my desperate, emotional thinking on the tails of that crazy 8 day ordeal. 🙂
No problem.
Next time you see Caleb’s doctor ask for some Zofran ODT. They dissolve under the tounge and are the rockstars of antiemetics. Phenegran also works well but many docs won’t perscribe it to kids because it can be sedating.
That should keep vomiting to a minimum and help prevent wacky sick day sugars.
Thanks for the tip. We did discuss anti naseau meds and he recommended a different OTC drug. I’ll mention the above the next time we are there. Anything with the categorization “rockstar” peaks my interest. 😉
Love your blog. We actually used Glucagon in an insulin syringe several times when we had this problem and our endo gave us formula to use per year of age when she was vomiting and unable to keep her number up. The patch is a GREAT idea! My daughter is now a teenager (dx at age 2) and its not an issue anymore…but I remember it well!