The Day the Cannula Came Out

Joseph called from school earlier today and, in a slightly panicked tone, told me that his cannula was out.

Huh. Well, that's never happened before.

He then said "mom, you've got to come to school right away and change my set."

Maybe it was because I'd gotten a bit of sleep the night before, but I actually didn't internally freak out.

Instead, I said "Calm down honey. Let's check your sugar and see where you're at first. Do you have any idea how long the cannula's been out?"

"No, I just noticed when I went to the bathroom that it was sticking out."

While I waited, Joseph did a finger stick. His blood sugar was 146. "Super," I said. "I'll be there within half an hour. Just hang tight."

A quick note here before I continue. For those of you who are unfamiliar with the term "cannula," this is the very small (6 mm long), very thin, teflon tube or catheter that is inserted with a guide needle into my son's abdomen, hip, buttock or thigh-- anywhere he might have a little fat. (Click here for sample photos of infusion sites.) The needle is then removed, while the cannula stays in place just beneath the skin. The cannula is attached externally to a length of detachable tubing (in Joseph's case, 23 inches), that is in turn, connected to his insulin pump-- a device that looks like a small pager, or as Joseph prefers, an Mp3 player.

Voila! When he eats or is running high, we program a bolus amount, then insulin travels from a cartridge inside the pump, down the tubing, into the cannula, and then on into his body. Here, the insulin essentially “unlocks” the cells in his body so that the glucose in his food can be absorbed for energy and growth– as opposed to spilling into his bloodstream and urine.

Now, because Joseph's cannula was out, the concern is that his blood sugar could rise quickly-- this is because the pump only gives him pulses of short-acting insulin as his basal or "background" insulin. And without the safety net of a longer-acting insulin on board, he would be much more vulnerable to DKA (diabetic ketoacidosis).

And that is REALLY bad.

The cells in his body would be in a state of lock down– completely unable to use the glucose coming in from his food. And if this gets out of hand, his body goes elsewhere for energy–- to the fat cells. When fat cells are burned for energy they release toxins, or ketones into the body. You get enough of these buggers and you can become very, very sick. Ever hear of a diabetic coma?

Soooo, cannula out. Not good.

It took about 20 minutes to close out Evan’s game of “beauty shop.” This is one of her favorite past times. When I got the call from Joseph, she was in the process of giving me “blue and pink highlights." Ah well. Leaving in the middle of our game was not a popular decision with the 2-year old toddler. But what can you do?

So, off we went. Ten minutes later we were at the school. Walking into the nurse’s office, I spotted Joseph sitting on the short, black vinyl chaise– the one where the kids who feel sick lie down. He was quietly reading “Harry Potter and the Order of the Phoenix.” And he was all alone. Which really bothered me. But after we checked his sugar and found that he was 153, I felt better. And since school was going to let out soon, I decided to take him home right then to do the set change.

At home, Joseph took the whole cannula popping out in stride. So did I. We were scheduled to put in a new set that day anyway– this incident just moved things up by a couple of hours. And stuff like this is going to happen. Hopefully, not often though. It’s really scary when you start to think about what this might have done had it happened earlier in the day– and if Joseph didn’t notice.

But he DID notice. And he was fine.