What Happens at the Hospital?
Besides the acute medical intervention your child needs, his hospital stay will also be an immersion class in diabetes care. As stressful and exhausting as an inpatient stay can be, some families prefer them since it gives them medical support to care for their child as they learn how to give shots, how to count carbs, and how to begin to estimate doses.
Stabilizing Your Child
Your hospital medical team will work first and foremost to get your child's blood sugar into an acceptable range and to clear all the ketones from his system. This will mean, at first, insulin and fluids by IV and no food by mouth. Usually, most children (not in an ICU) only need this overnight or for a half day or so. Once the medical team believes your child is within a target range, they will work to get your child off the IV, on to shots, and eating real food again.
Expect your child to be ravenous at that first meal after diagnosis. Her body has not been metabolizing food for a good long while, and truly eating a meal will be a treat. No need to worry though, your child's appetite will stabilize soon.
Once the team sees your child eating, holding food down, and staying within what will at first be a wide range of target blood glucose readings, your education will begin and so will the transition from the medical team's caring for your child to your doing that on your own. Lean on the team at this time and ask them to help you gain confidence in your skills.
Once your child has moved from the emergency room to his inpatient room, a pediatric endocrinologist will begin the process of educating you. Sometimes, particularly if you are in a large city hospital, the endocrinologist is a fellow (a physician who has already completed medical school and preliminary training and is eligible for board certification). Do not let that worry you. If you feel a positive connection, stick with him or her. Fellows are just as dedicated as long-timers and always have the support and oversight of a senior endocrinologist. Many families have stuck with residents for the long haul, celebrating with them when they become attending physicians.
The endocrinologist will describe each member of the team and what the team goals will be for your child (see Chapter 4 for details on who is on your team and how you'll work with them).
The amount of information can be overwhelming. It is important to take notes and keep files right from the start. Ask your spouse or a loved one to get a good organizer (like a loose-leaf notebook with folders that your children use for school) that you can use to keep track of all the new information you'll be given.
Be ready for the first big question your child is going to ask you: “Will I need another shot?” It's inevitable, and you can ask your Certified Diabetes Educator, endocrinologist, or social worker to help you answer that question in a way that is age appropriate for your child.
The first major moment—and one you'll never forget—will be giving your child a shot for the first time. Most hospitals have fake “flabby butts” to practice on; others have you use an orange. It's a good idea to get the feel of a needle's penetration before trying it on your child. Be assured, everyone—even nurses and doctors who give strangers shots all the time—is petrified the first time she gives her own child a shot. It truly is a matter of just doing it. Once you've moved past that first time, you should adapt quickly.
Some older children prefer to give themselves shots from the start. Even so, it's still a good idea for you and your spouse to give a shot or two while at the hospital. You'll need to feel comfortable with the procedure in case your child ever needs help.
Finger pricks, too, are a learned process. You'll want to learn how to choose the best spot on your child's finger and why rotating is important. Again, even if your child chooses to do it alone, insist on doing it a few times yourself while you have educational support there.
Forget the bandages on the fingertips. You simply cannot consider finger sticks a boo-boo; like it or not, they will be a part of life. Try to picture your child with a bandage on each of six or more finger pricks a day. It's just not practical.
You'll quickly learn, too, that diabetes does not mean the end of all sugar in your child's diet. Ask your nutritionist to help you create a diet plan that's as close as possible to any child's lifestyle. You may even want to let your child have a treat like a cupcake or candy in the hospital, so she (and you) can see that it can, indeed, be done.