Managing Diabetes on Vacation: A First Hand Look
Diabetes Camp is coming! You may remember my angst in preparation for our first annual Children's National Medical Center sponsored Diabetes Camp last year. In anticipation of another 4 day, 3 night stay in the wilds of Virginia in mid-August, I decided to take a real (relaxing) vacation with a colleague in Narragansett, Rhode Island. We had a week of relaxation, sun, a swimming pool, and reading novels (not diabetes-related books or journals). My colleague has type 1 diabetes and brought all the necessary supplies in triplicate (in case I messed up changing any of her infusion sets or if there were any problems, etc.) We stayed in a beautiful house that faced the Atlantic Ocean -inviting us to take walks along the beach or relax listening to the waves. I was able to observe my colleague's blood sugars (and blood pressure) very closely depending on the activity.... We learned a great deal of information from our 7 days together.
- Stress is an upper (of blood sugars)! Within hours of our arrival (after a 9-hour drive from Washington, DC, to Narragansett), we noted that our tension dissipated. This was confirmed by outstandingly normal blood pressures (we took a professional blood pressure cuff with us). My colleague was even able to omit her blood pressure medication during our stay. In addition, she noted that her blood sugars were well controlled and barely fluctuated on her insulin pump.
- Exercise is a major downer (of blood sugars)! My colleague walked up and down the beach and exercised daily. (I must confess that I cannot claim to be as virtuous, but I did get to read a great Larsson novel!) As a result of her swimming laps in the pool, while I floated and leisurely swam sidestroke, she was able to disconnect the pump and required little basal rate for many hours after the activity. Blood pressure remained within normal range.
- We made an attempt to sample the delights of Narragansett: fish, fish, fish, ice cream, and krazy burgers! My colleague's blood sugars remained extremely stable despite the delicious homemade ice cream.
- An excursion to see the new Harry Potter film in 3D, despite the incredible action and emotional upheavals did little to upset blood sugars!
- A shopping expedition at BED, BATH and BEYOND including heavy lifting, packing, and removing heavy objects did not budge her blood sugars downward. No lows!
We asked the question foremost on our minds: can diabetes actually go into remission? Even if one eats real ice cream? The answer, of course, is no.
CONCLUSION: Diabetes can be very well managed in the absence of stressors, presence of exercise, and general overall well being!
We also asked the question, how does the sun affect blood sugars?
Thus far, my colleague and I had taken great precautions using sun block, avoiding swimming at peak hours, etc., and had no problems (she did get a bit redder and I developed more and more freckles). However, on the last day of our visit, we truly learned how the sun could cause major problems.
Around 5 pm, my colleague informed me that she had very high blood sugars (for her). She did change her pump site earlier in the day. I performed my usual queries:
1. Is the pump site an issue? No, apparently she did bolus and the blood sugar came down a bit... but not enough. We agreed that in several hours we would use an injection if the blood sugar did not go down appreciably.
2. Did the insulin go bad? No, she changed vials.
3. Is she becoming ill? I checked her out and she was quite sunburned on her face and back. She also developed chills, but did not have fever. Despite adequate hydration, there was some associated nausea. No ketones.
She went to bed, prescribed Advil by her "personal physician" and instructed to drink non-glucose containing fluids. A repeat blood sugar was improved (after an injection) and by 9 pm the same evening she felt well enough to eat a bit. Blood glucose was checked in the middle of the night and was actually low, prompting treatment with rapid acting carbohydrate..
CONCLUSION: Sun poisoning will increase blood sugars. Multiple factors are implicit in this scenario: probable release of those pesky stress hormones, dehydration to a certain extent, and perhaps decreased absorption of insulin. I still cannot rule out that the insulin in the pump was less functional due to the sun while she was walking about.
The very next day we had to leave paradise and return to the 102 degree weather in Washington, DC.
Back to normal!