Wednesday, July 10, 2013

Swimming With Type 1 Diabetes

Photo: Spending the day at beach!
Our fourth of July lake view

A mom of a newly diagnosed daughter with type 1 diabetes reached out to discuss the effects of swimming while trying to stay in good blood sugar range.  First, I just wanted to give her a big, huge hug and then, I wanted to do my best to help.  That first year is full of new challenges and if I can do anything, it is to share what I have learned.

Immediately, I thought back to my own early days and remembered how summer vacation, while easier in many ways, is also much harder.

Especially when it comes to swimming.

While I do not profess to have all of the answers (we learn something new every single day!!!), I do have a few tricks that our family uses.  A lot of it revolves around food.  For us, it seems to be the number one way to stay in range while swimming.

A loose schedule during pool or lake time for our family is something like this:

12:00 p.m..         Test blood sugar, eat a light lunch (lunch meat or peanut butter sandwich and water), dose full amount of the bolus for food.  Disconnect insulin pump and kids allowed into the water.

1:30 - 2:00 p.m.. Reconnect insulin pump.  Test blood sugar.  Eat a small snack (cheese, small piece of fruit or crackers plus more water) and dose 1/2 of the amount for bolus for food.  Disconnect pump and swim.

4:00 p.m.            Reconnect insulin pump.  Test blood sugar.  Eat a small snack like above or drink a chocolate milk,  dose full amount of the bolus for food.

6:00 p.m.            Dinner as usual.  Blood glucose check, dose insulin as needed and more water.

8:00 p.m.            Bedtime blood glucose check, snack, dose insulin as needed.

2:00 - 3:00 a.m.  Check in the middle of the night just to make sure blood sugar is in range after a day at the beach or pool.  I do this anyway, but especially when the kids have spent a day in the water.  Swimming works every single muscle and makes it really tricky hours later.

The food doesn't have to be a lot of food, just smaller amounts and a good mix of carb to protein (weighing slightly heavier on the protein). 

The bigger two issues that we tackle are frequent blood sugar checks and encouraging tons of water consumption.  First, our kids typically prefer to swim on hot days where the chance of dehydration is greater and the risk of ketones is always a possibility.  Like my oldest daughter says, "Ketones STINK" and we like to avoid them at all cost!!!

If you use an insulin pump and have troubles with adhesive sticking, I can share what works well for us (although this may or may not work for you as everyone has different skin types - some oily, some dry, some in-between).

The Naturally Sweet Sisters Method of Placing Infusion Sets: 

1.)  Wipe the site area with an alcohol based IV-PREP pad.

2.)  Wait about 1 minute for the area to dry and become tacky/sticky.

3.)  Insert infusion set as normal.  Press down adhesive tapes.

4.)  Layer on top of the infusion site a IV3000 for Infusion Sets (hole is already cut for tubing to go through).  Press down on all sides.

5.)  You're ready to go!!!!!

Placement of the infusion site is wherever you feel most comfortable.  As my daughters have grown, they do have strong opinions about how 'open' they want to be while wearing a bikini.  I respect their thoughts and have allowed them to be a voice in the decision during that process.  The only over-riding rule is that if they chose a site prior to our swim adventure, they have to pick a new place.  Meaning, that they can't choose their bottoms every single time.  That would ultimately lead to scar tissue and to lose the chance to use that area ever again.  That means we rotate everywhere but with an idea of where we are going or what we will be doing.  So far, it seems to be working.

Even with a perfectly placed infusion set, we still have to carefully monitor the girls' infusion site area.  One year, on a beach in Florida, we actually had a small grain of sand work its way into the plastic connector.  That small grain of sand clogged the tubing and made it impossible for insulin to get into our child's body.  Lesson learned: visually check the infusion sets often to make sure that the adhesive is sticking, the tubing is still in or even to ensure the site is infection free; no redness or irritation. 

With all of that in mind, be sure to pack extra sets of everything:  tubing, cannula, batteries, cartridge, needles, etc..  Packing insulin falls under your mileage may vary (YMMV).  Often since we are using pumps, we choose to leave this at home to avoid the risk of spoilage in the sun or opened cooler.  If you do bring the insulin or are using injections in either syringes or pens, consider purchasing a Frio bag which allows the insulin to be protected and stay fresh. 

Here is a list of swim-friendly snack foods that we often tote along:

  • Water, water, water
  • Propel or Gatorade - in case dehydration sneaks up on you
  • Cheese sticks or cheese cubes
  • Frozen Go-gurts or tubed yogurt
  • Individual sized Chocolate Milk.  To risk spoilage, we buy ours at Costco where the Kirkland brand is sold as shelf - stable.
  • Sliced turkey, ham, bologna, chicken.
  • Crackers or bread without condiments to avoid the yucky mush
  • Fresh fruit - sliced or ready to eat for little fingers

Don't forget your fast acting glucose too.  Just in case your adventure at the beach or pool includes a low blood sugar (it happens to all of us!) be sure to add in either glucose tabs, juice or fruit snacks.  Bringing the Glucagon is another YMMV but always check with your endocrinologist to make a safety plan before deciding either way. 

Finally, in all of our years of going to the beach, there is one final area that we still watch carefully... that is our basic first-aid and safety.  My kids tend to be active swimmers and over the years have had many a bump or a bruise.  I have a love affair with keeping Neosporin, aloe vera, Tylenol, Cortisone cream, and Band-Aids in the swim bag.  Too many times to count that I have had to use them, so now I feel like it is a necessity.  If you numb your child's infusion site, bring along the EMLA cream or the boo-boo ice pack because there is nothing worse than needing a site and watching a little one melt down at the thought of it. 

Enjoy your time at the water!!!!!  I hope I see you floating by soon!


Marjorie said...

Great advice Amy!
We're heading out on vacation in two weeks, and it will be interesting to see how pump use will change how we do things.

beth said...

Really fab post! I love my pump, but when I look at this I think about when i went swimming as a kid - hypos and keeping things cool enough and snacks were the issues, but kind of easier without disconnecting/reconnecting pump as I had injections. Not many things (activity-wise) that are easier with injections but no pump to worry about in water/out of water.

Last week i went on holiday with my diabetic friend, and we went swimming. My pump is waterproof and goes down the front of my suits - her medtronic isn't waterproof so has to get taken off. We had a lovely time though :)so good to be away with someone who "gets" it!