Huge Mistake!

What was supposed to be our first night of proper sleep, only waking once at 3am to check on Joe and Tom’s levels, became a bit of a nightmare last night. Olly was doing the 3am check. At 3.15am he came into the room and said ‘Ive done something really stupid!’ He explained that he had found Joe was on 15.3mmol and so had corrected him. He had taken 15.3 and divided it by 4 (Joe’s sensitivity factor or his correction factor, meaning that 1 unit of insulin will drop his blood sugars by 4mmol) giving him 3.8 units for a correction. He had duly programmed this into Joe’s pump and then gotten on with Tom’s BM. Tom was on 13.4mmol.

Whilst trying to work out whether or not to give Tom a correction, and if so how much it would be, he heard Joe’s pump beep to show it had finished giving the bolus. It was at this point that he thought about the number he had just put into the pump. It occurred to his sluggish brain that this was quite a large amount of insulin. And then it dawned on him.

He had just given Joe a correction of insulin that would take his blood sugars down to 0mmol! Down to nought, nothing, zero!

What normally happens with the maths is you take the BM you are on, in this case 15.3, and you minus from it the target blood glucose, for us at the moment 10mmol. 15.3-10= 5.3 You then divide the number left with the correction factor 5.3/4=1.3 which is the amount of insulin Joe should have been given. So he was given 3.8 units when he should have had 1.3 units.

 Thank God for carb counting! Joe had had an over-dose of 3.8-1.3=2.5 units. We know that Joe needs 1 unit of insulin to cover 18grams of carbohydrate most of the day. So for this over-dose he would need to have 2.5×18=45 grams of carbohydrate.

So at 3.30am this morning you would have found Joe sitting up in our bed eating a bowl of honey-nut shredded wheat with cold semi-skimmed milk, me sitting next to him checking and rechecking the numbers and Olly beside him on the bed reading the opening chapter of War of the Worlds, whilst feeling like someone had slid a knife into his stomach. Joe came down to 14.3mmol an hour later, and then stayed about the same though going up slightly by morning to wake on 16mmol. I was happy with 16mmol given that he could have not woken up at all had Olly not realised his mistake.

And that’s what you forget at your peril. Insulin is not a cure for type 1 diabetes. It is a medication, and its a scary and imprecise medication at that. We families who take home children who the night before were ‘normal’ but feeling unwell and have now become the prey to a life-threatening, life-long condition walk this fine line every day. I know we aren’t the only ones doing this. I know lots of kids and adults have difficult lives, whether from disease or hunger or the risks of war. But that doesn’t take away the horror of doing something wrong to your child by your own hand and seeing how close to the edge that line can be.

Olly has looked grey all morning. He is so angry with himself and worried that he cannot look after his sons’ properly. This one moment is sharp and stinging, whilst the thousands of nights of testing and days of adjustments and trying your best to keep everything balanced are blurred and silken. They slip out of your hands. I suppose that is the lot of the parent, and perhaps the mechanism which will never let this happen again.

At least we have been able to explain to the boys that making mistakes is going to happen. We are not perfect. If they make a mistake no one will be cross. Instead we will know the maths to set it right. That is a valuable lesson for them. They will have far more chance of getting it wrong in the coming years, but hopefully we will be able to teach them how to put it right.