Managing Your Blood Sugar: Summer Highs and Lows
It is the beginning of summer and what I am doing? Sitting on my patio typing a blog on my laptop, listening to the screaming kids in the pool next door, and the barking dog! Summer, is the time for leisure, participation in activities involving exercise (camp), travel, and perhaps volunteer work or paying jobs for teens.
Changes in activity result in alterations of daily self-care routines including blood glucose monitoring, insulin regimes, and food choices. How do you merge your school life into summer fun?
- Plan ahead: if traveling on vacation (either locally or abroad) ensure that you have all your diabetes related supplies in triplicate (redundancy).
- Check out if you will be traveling in different time zones that may affect insulin administration.
- Campers: As with school, caregivers will be required to fill out a camp form listing all medications, instructions, etc. It would be a good idea to meet with the health team (either in person or on the phone) to discuss their experience with children and diabetes. If they have had no experience, you must provide detailed instructions as well as phone numbers explaining who to call and when to do so. Make certain you cover everything. If you have a camper that cannot be responsible for self-care skills, one must ensure that there is a trained responsible adult to do so. Private camps do not have to adhere to public school guidelines and can do as they wish. Make certain they are comfortable taking care of your child/teen. Children and teens can go to overnight camp (even non-diabetes camp) if the camp is given enough information about how to assist your child with diabetes related care. Network with other families and their camping experience!
- Swimming/hikes/sports involve extreme exercise and observation for low blood sugars is essential. Depending on insulin regime, you may want to provide a small snack prior to swimming to aim for blood sugars between 150-200 mg/dl (these are Children's National recommendations, so please check with your diabetes team for specific blood glucose ranges) before jumping into the pool or ocean! Be wary of post-exercise induced hypoglycemia, as well in the immediately post-swim interval up to 24 hours (sometimes even more). Check blood sugars generously to avoid surprises. If the child or teen is involved in an exciting activity, be reminded that blood sugars can often go high immediately prior or during the activity, and then drop during or later. Checking blood sugars frequently is the key to management. Some diabetes teams recommend giving a snack prior to the activity with half the calculated bolus amount to counteract the release of adrenalin and noradrenalin.
- Sleeping in! Many teens just love to begin their day beginning at 12 noon or later. This typical behavior wreaks havoc with traditional split mixed insulin dosing (2 or 3 shots/day) that rely on timed insulin injections and meals. In addition, although in theory, waking up later in the day should have no effect with basal/bolus regimes, this is not often the case. Indeed, many children/teens on the insulin pump either become high or low when they sleep past their usual school day wake-up time. Therefore, adjustments may be required in basal rates overnight as well as in the morning and basal insulin (NPH/Lantus/Levemir) may need to be altered as well. It also is possible to have multiple patterns programmed into the insulin pump depending on the daily activity. Discuss all these issues with your diabetes team and they will provide strategies.
- Summer vacation often leads to a pump vacation. Our diabetes team has absolutely no problem with taking a pump holiday. Many of our kids want to be able to swim and hang out at the beach without worrying about their pump, etc. It is very easy to translate basal rate on the pump into a basal insulin dose. Simply add up your total basal rate (or check the total basal rate on the pump under basal rates, it is there in different places depending on your brand of pump). Total basal rate is then translated into the Lantus or Levemir dose (for example: total basal rate equals 29.7 units/day. A typical Lantus dose would be @29 or 30 units/day and a typical Levemir dose would be 15 units in the morning and 15 units in the afternoon if you use twice a day dosing!)
- Volunteer work or paying jobs have the same issues that apply during the school year. Plan ahead if possible. It is essential to check blood sugars frequently, and avoid forgetting to bolus (even with new colleagues). If you are doing strenuous activity (building new homes in Haiti for example), beware of unexpected hypoglycemia and have rapid acting carbohydrate always available. (Bring extra infusion sets to your work place as well). I also would suggest letting your supervisor and colleagues know that you have diabetes should something go amiss. You will be more embarrassed if they do not know of your situation.
- Lastly, you should be able to participate in everything as long as you plan ahead and be prepared for the unexpected.