Who let it be March already? Woah.
Sorry to my readers for the lack of posting, I'd like to come up with a bunch of excuses but truly it's just out of sight - out of mind with a pinch of laziness that brings me to my first post in 60+ days. Nevertheless, off we go...
We took a trip to Phoenix in January to visit the grandparents. We ended up in the Emergency room the 2nd night we were there with Cadence vomiting profusely and her sugar plummeting despite our best efforts. Ambulances, Sheriffs, flying down the highway to the nearest hospital was not the way we intended to begin our vacation obviously. We were treated well and by the next morning, Cadence was doing much better with some IV fluid in her system. I had to use glucagon for the first time since her diagnosis as well. Glucagon is an emergency measure for diabetics. It's an injectable substance that will cause the patient's liver to dump emergency sugar storages into the blood stream. It's designed to be used in a non-responsive diabetic.
We got home at 7am, fell asleep, woke up about 9 am and we were all tired and hungry. Cadence had a normal breakfast for her, we bolused her the same as we would for any other day....food and carbs in a diabetic usually means they need insulin. As we were heading out to get some errands run, I looked over at Cadence and she didn't look right, checked her blood sugar and she was in the 2's. After a juice, fruit bar, banana, and 2 more glucagon shots she was still sitting at 3.2mmol/L and lethargic. We were scared and out of glucagon. We raced over to Wal-Mart to get some more of the glucagon.
Cadence was slumped over in Nic's arms, her sugar falling again. We ran into Wal-Mart right to the pharmacy. I announced to the pharmacist, "my 2 year old daughter is a type 1 diabetic and his having an insulin reaction, I need glucagon for her to bring her out of it." The pharmacist looked panicked and went over to her the manager of the pharmacy to find out where it was. He shook his head and walked away (no I'm not kidding) and the pharmacist came back to us and said, sorry we can't do that for you without a prescription. I showed her the diabetic letters that we travel with, the almost empty container of glucagon, and Cadence's pump. Meanwhile Cadence is slumped over in Nic's arms drooling on her shoulder, sugar sitting just below 4.
I said to her and loud enough that the manager would hear, "would you take a prescription over the phone from her endocrinologist, we need this for her!" He said yes, so I phoned the Children's hospital on my cell and got a hold of Cadence's endo. After a minute or two on the phone, he hands it back to me and says (no I'm not kidding) "I can't take this from a Canadian doctor, good luck." And walks away with my 2 year old slumped over on Nic's shoulder.
So...what would you do in his position? Would you leave a 2 year old little girl to the mercy of her disease in order to follow your protocols or do you make what seems an obvious choice to help her? What if you thought your job might be in jeopardy? Could you justify to an employer that the patient was in obvious distress, proven to have the condition stated, and needed help? Does a good samaritan action override a "policy" designed to cover your own ass? It's not an easy question. I told him what I thought of his decision, as did his staff but in retrospect...it had to be hard for him, at least I hope it was. If it were me, I'd break the rule to help a child in need but I come at that answer with a significant amount of bias. At very least I'd offer options "I can call you an ambulance" would have been a nice gesture vs. "good luck".
Now the question needs to be answered, why were we not on our way to the hospital in the first place? Ah, another ethical question that I have asked myself. The issue was that our travel insurance would not cover us for a second visit for the same diagnosis. Meaning that if we showed up at the Emergency room again for a diabetic insulin reaction, we would be uninsured. I don't have 10,000 or so to cover an ER visit in the US. So my judgement call was that if we can keep her sugar above 3.0 and she's not vomiting up the carbs we give her, she's would not be in immediate danger. What would you do? Did i make a decision that possibly put Cadence in jeapordy even though we were monitoring her extremely closely? Does our background as medical professionals help us in reaching this decison?
We went to the ER to get a prescription from the attending doctor for glucagon, while Cadence slept in her car seat in the parking lot, Nic checking her blood sugar every 20 minutes to make sure she stayed above 3.0mmol/L. If we bring her in to the ER, they admit her. I tore myself up deciding if I was making the responsible decision. I filled the glucagon prescription at the pharmacy and never had to use it. It still sits in the fridge or the diaper bag just in case. So, I was vindicated, I made the call that saved us money and didn't jeopardize Cadence...or did I?
These are examples of no-win situations, thankfully the decisions we made produced a favorable result. Fodder for discussion though and we chat about it often.
As a side note for parents of and diabetics travelling in the states. Make sure that you have a plan for an emergency. We have standing prescription for Cadence in Phoenix now for glucagon, so if we are ever down there and need a backup, we can get it. If you're in Mexico or something like that? Make sure you have enough emergency supplies to see you through it.
B.
