I am pretty tired tonight so this won’t be a long post... yea right, I always say that! The morning began with Ian’s Glucose Tolerance Test. He was given just shy of 2 ounces of the sugary sweet drink through his G tube... the same drink used during the same test in pregnancy. Ten minutes later, after lots of coughing and gagging, Ian promptly threw it up :(
Not long after, the Attending Doctor, Dr. Palladino and his Fellows trailed to say we were going to run the test again. I told them he was going to throw it up again and asked why. Apparently, Ian’s higher blood sugar of 154 , up from 84, was not enough to trigger the nausea. He said it was probably just the drink itself because it is so sicken-ly sweet. This time, we infused the 2 ounces over 20 minutes through his pump. This time, although a little coughing, Ian kept it down. Ian’s sugars were perfect through the test and showed no signs of dumping syndrome, go figure. Lactate, Insulin Series, and C.peptide were also drawn. These results are not back yet.
Baseline Glucose: 84
45 minutes after: 102
60 minutes after: 119
90 minutes after: 101
120 minutes after: 87
180 minutes after: 92
Not too long after the completion of this test, Ian did another Glucose Tolerance Test with his formula recipe, only without the corn starch to help him buffer his sugars. Once again, Ian passed with flying colors and had not trouble with dumping.
Baseline Glucose: 92
30 minutes after: 110
60 minutes after: 83
90 minutes after: 80
120 minutes after: 85
180 minutes after: 89 (ketones 0.7)
The completion on this test essentially began the fasting test..... the final 180 minute blood draw marks the initial testing of the fasting test. Ian then was able to have a regular 6:00pm meal, withholding the corn starch again. Corn starch is meant to help sugars and could skew the results of the testing. It took 4 hours for a Fellow to come and explain that to me. A little annoyed, but glad to finally understand some decisions, even though the Formula Glucose Tolerance Test was already over.
So far, Ian ate at 6:00pm...... once he was done, sugars begin testing every 3 hours. His 9:00pm test showed excellent values of glucose level 97 and ketones 0.7. His 12:00am test showed values of glucose at 83 and ketones at 0.8. The ketones should continue to rise as glucose falls. Once ketones reach 2.5, two glucose stick tests in a row, the test is over because Ian’s sugars are doing what they should. My previous post talks about ketones, and their importance in the test and in the body.
Dr. Palladino explained a few outcomes of the Fasting Test.
- Ian’s glucose falls, but his body increases ketone bodies form fat metabolism for the brain energy and the test continues for long enough, about 16 hours or so and everything is deemed “normal.”
- Ian’s glucose falls, but his body once again increases ketone bodies from fat metabolism for the brain energy....... however, this happens quickly and Ian’s body is unable to fast for extended, “normal,” periods of time. This is called and Immature Fasting System and happens frequently with tube fed children. Their bodies simply are not used to having to fast because they are continually being fed and keeping sugar levels even.
- Ian’s glucose falls, but ketone bodies are NOT created because fat is NOT being metabolized...... a dose of Glucagon is given to breakdown liver glycogen into glucose for energy, but nothing happens. this once again shows signs of an Immature Fasting System.
- Ian’s glucose falls, and again, ketone bodies are NOT created because fat is not being metabolized....... a dose of Glucagon is given to breakdown liver glycogen into glucose for energy, and Ian releases a large dose of glucose. This signals that there is too much insulin and there is a problem.
Option 1 is the ideal scenario. Options 2 and 3 create a mild issue that can be resolved over time and growth. Option 4 signals a medical problem that then needs further attention. There are other possible outcomes that can signal other medical reasons for Hypoglycemia. I am not sure what these are, but if those arise, I will keep everyone updated....... Come on OPTION 1!!!
Another sticky subject is the difference between GI, Endocrine, and Dr. Blinman’s Reflux Clinic when it comes to theories and treatment options. Dr. Blinman tends to think outside the box and is often criticized for his treatments and opinions. I can tell by speaking GI and Endocrine about dumping and reflux and other concerns with Ian’s history that there is tension there. They do NOT all agree on how to best treat things.
Bottom line, we have been very happy with the treatment from Dr. Blinman.... and although not initially tested, we believe his diagnosis of Late Dumping Syndrome to be accurate. The Endocrine Fellows believe Ian does not, and did not have LAte DUmping Syndrome. While we have always been told by Dr. Blinman that children can outgrow and move on from this, Endocrine doctors are telling us Late Dumping Syndrome is permanent and really never goes away.
I know the food recipe, corn starch included, can also help with reflux, and vomiting, but I firmly believe its has helped Ian with his blood sugars....... even if today’s tests did not show it. We will see what Dr. Blinman has to say next week when we take all the information to him for review and decision making. Robin, ian’s dietitian was in today to review some of the things with us. I could tell she did not agree with some of the reasons for Endo’s tests, but hoping that the information will prove useful next week. As the Fasting Test continues overnight, we are G tubing Ian some special Sodium Chloride solution here and there overnight to keep him hydrated. I will let everyone know tomorrow how he is doing.
He was s brave today since he needed a big Iv for blood draws every 30 minutes for the Glucose Tolerance Tests. This kept him from being stuck to draw blood every time. Since Ian’s veins are small, they had a hard time drawing blood. There was lots of pouty kips and crying....... hoping the Fasting Test glucose sticks will be better for him. He doesn’t even flinch now when they stick him for a glucose test.
On a funny note, Ian has learned where the buttons for the bed are. He now raises and lowers the head and food of the bed and thinks it is hysterical when mommy goes up and down!! He always knows how to keep us smiling! he has been lifted from “room arrest” by infection control and is busy running up and down the halls flirting with nursing students and getting a whole new set of girlfriends in Philadelphia. He’s such a ladies’ man! That cute smile, dimples, and blue eyes go a looooooooooooog way!