- advertisement -

Does and don'ts and kids being kids

Discussion in 'Parents of Children with Type 1' started by Theo's dad Joe, Jun 15, 2015.

  1. Theo's dad Joe

    Theo's dad Joe Approved members

    Joined:
    Jun 7, 2015
    Messages:
    802
    Do I let my 9 year old:

    Ride his bike around the neighborhood? When, how long, what do I do to keep him safe?

    Does he need a phone. Does he need to have rescue carbs on-hand?

    Can he be active in the 1-2 hours after a meal without adding a snack? Is he likely to go low after a meal with insulin when he's active if he doesn't go low when he's not? He didn't get low at PE an hour after lunch for the first 4 months post dx.

    If I go to pumping, is it dangerous to get in a hot tub AFTER a meal, within an hour, etc.

    With injections too, I was told no hot tub an hour before or after an injection. Is that right, or is it really a smaller time frame before or after?

    I haven't read on this one yet: If a kid gets diarrhea suddenly is he at risk of a low because of lack of nutrient absorption, or is it more of a dehydration issue. Do we have to take an anti diarrheal. His Lantus currently will not take him much under 70 if he doesn't eat.

    At the beach for the first time with a honeymoon should I consider just feeding him and only correcting highs at the next meal? Right now if he eats breakfast uncovered he's still under 90 by lunch. Would he/why would he go low with activity if he's only on 1 unit of Lantus.
     
  2. njswede

    njswede Approved members

    Joined:
    Feb 9, 2015
    Messages:
    385
    I wouldn't let him ride a bike without a CGM and a phone (for calling and/or connecting the CGM to the cloud).

    Always, always have rescue carbs on hand. I forgot it for a 10-minute trip yesterday and of course he went low. That wasn't fun at all.

    About the diarrhea, I think the concern is that he goes HIGH and not low. Dehydration, combined with impaired glucose uptake by the cells sends him to uncontrolled highs and uncontrolled ketones. This is how people with controlled diabetes go into DKA. We had an episode with vomiting and diarrhea and it landed us in the ER when I could no longer control his blood sugar and he was spilling large ketones. Luckily, we caught it in time and they could hydrate him before the DKA kicked in.
     
  3. Theo's dad Joe

    Theo's dad Joe Approved members

    Joined:
    Jun 7, 2015
    Messages:
    802
    That is what I thought. Someone on a thread mentioned that they had to use glucagon for the first time when their son had diarrhea.
     
  4. Christopher

    Christopher Approved members

    Joined:
    Nov 20, 2007
    Messages:
    6,771

    Not sure you want to hear from me but take it with a grain of salt I guess:

    1. I would not prohibit him from riding his bike. Just be aware that activity may lower his bg and that he should check his bg before going out to ride. If he is in range he might want to eat something to bring him up a bit to counteract the potential drop in bg. I agree with njswede that rescue carbs should always be kept on hand.

    2. As for the phone, 9 seems a bit young. I think you need to assess how often he is actually out of your supervision and somewhere where he would not have access to a phone. If he is often out alone without adult supervision, then a phone might make sense.

    3. Activity after a meal. I think this is not something that is set in stone. It is going to vary by certain factors: What kind of meal he ate, what kind of activity he is doing etc. Meaning if he eats a meal of pizza and then wants to go swimming, there is a good chance between the fat in the meal causing a delay in food absorption and the intense activity of swimming, he is going to have a pretty big drop in his bg. So this is one of those issues that need to be assessed individually for each situation.

    4. The issue with the hot water is that it can cause the insulin to be absorbed faster. So that is why people say do not put a child in a hot bath for at least 2 hours after dosing with insulin. As for the pump and hot tubs, I am sure some pumpers will chime in with their experience. I have none.

    5. I think the diarrhea concern is more one of dehydration. There is a Sticky at the top of this page about how to handle sick days with Type 1 diabetes. Good information there.

    6. Danielle never really had a Honeymoon so I will let those who have dealt with that answer the beach question. But just looking at it logically, and based on your previous experiences, it seems like it would be fine to just feed him and maybe do a little extra checking of his bg. And he is on such low doses of insulin to begin with. With the swimming and the excitement and all the running around, he may burn off those carbs pretty easily, you may actually have to feed him fast acting carbs to keep his bg up.
     
    Last edited: Jun 15, 2015
  5. Nancy in VA

    Nancy in VA Approved members

    Joined:
    Jul 16, 2007
    Messages:
    7,308
    I don't think a CGM and a phone is a must. If Emma isn't wearing her Dex, because she goes out to ride her bike or her skateboard, she checks her BG. If she's under 100, she treats and then goes out to play. She always has sugar on her - she'll often tuck a pack or two of fruit snacks in her pocket on the way out. If she's going to be out more than 30 minutes, the meter goes with her. If not, she just will eat a couple of fruit snacks if she thinks she's low, and we'll deal if she's a little high later. Kids went out and played before there were CGMs and cell phones and I don't think they are at all required for your child to go out and have fun.

    Hot tubs aren't really recommended for kids that age anyway. I wouldn't go in a hot tub after a meal, regardless of the method. Heat increases the absorption of insulin, which can result in low, however it was administered.
     
  6. nebby3

    nebby3 Approved members

    Joined:
    Jun 5, 2007
    Messages:
    923
    Every kid's different and every illness is different. My experience with D and diarrhea is that it does not tend to cause lows but that is not to say it can't.

    Always take carbs everywhere. If not using a CGM I would send a meter along on a bike ride. Can your son check himself yet? And of course check before he starts. In general activity leads to lows but there can be so many scenarios. After a meal activity might not cause immediate lows but help with the spikes. But activity lows can come much later too -- like 8 hrs later. Often we find that what happens in the day comes out at night. Your son is honeymooning so you might not see this yet. And some activity causes highs. If adrenaline is flowing we get highs in the short term and crashing down later. For the beach I just tend to give uncovered carbs all day. If you're pumping and disconnecting there is more to think about.
     
  7. nebby3

    nebby3 Approved members

    Joined:
    Jun 5, 2007
    Messages:
    923
    Oh and the danger with hot tubs or even hot showers is that they make the insulin absorb quicker so yes try to space them away from shots. Unless of course you're trying to bring down a high. But even so keep a close eye on bg #s
     
  8. susanlindstrom16

    susanlindstrom16 Approved members

    Joined:
    Nov 29, 2012
    Messages:
    371
    Regarding diarrhea, this is one of those cases where you should follow the "sick day" instructions given to you by your endo. But the first time you guys have to deal with it, you should call the endo's office and speak to the doctor/ nurse on duty and they will walk you through the tweaks that you should make to your son's insulin dosages until it runs its course. Once you go through it a couple of times you will instinctively know how to adjust.
     
  9. Lisa - Aidan's mom

    Lisa - Aidan's mom Approved members

    Joined:
    Dec 3, 2011
    Messages:
    405
    My DS (10) always has, at minimum, 4 glucose tabs with him. I bought a package of little plastic bags (tiny bags for jewelry at a crafts store) which can fit 4 glucose tabs easily and he slips it in the pocket of his cargo shorts/pants. I have a bag in my car and my husband's car that has fruit snacks, crackers and juice boxes. We keep an extra meter in each car as well. Perhaps you can get a little bag that attaches to his bike seat and put glucose tabs and a juice box in it. Being prepared helps avoid panic situations, good luck!
     
  10. MomofSweetOne

    MomofSweetOne Approved members

    Joined:
    Aug 28, 2011
    Messages:
    2,747
    Welcome to the board! If you haven't yet heard the expression, YDMV (Your Diabetes May Vary), you will soon learn how true it is. No hot tubs here, but hot tub soaks are the between sensors self-pamper treat, and we commonly bolus her while she's in the hot water and feed her there, too. No lows ever, but I've read of other kids going into the 5os with a quick shower after eating. I'd completely forgotten that hot water could drop BGs, but I remember feeling panicky about taking her swimming in a warm pool soon post-dx.

    My daughter drops with excitement; most kids go high. We see beautiful straight line in-range numbers despite munching while traveling as a result. The return trip is another matter. No excitement working in our favor, so we need to increase the basal.

    My kid used to eat low carb (and I think she still is lower carb), high fat/protein due to allergies (this was true before D struck), but as she's less reactive to foods and a busy teen going away from home more and more, so her carb count is creeping up. I know we'd see better BGs with the lower carb stuff again, but as others have said, it's a toss-up with high risks. We now see HIGHER numbers from the fat and protein spikes than carb spikes if we don't calculate for it and do an extended bolus, often over 8 hours. The highs are unreal if we forget, much higher and more stubborn than we see with carbs. This morning my daughter had apple muffins for breakfast and needed 6.5 units for carbs and another 5 units for fat-protein over 8 hours. Life is not as simple as we were taught at dx. At the same time, we're juggling the letting go process at a time when the last thing a teen wants to deal with is diabetes hassles because life is so much for them to figure out without D. I'm lucky because my teen wants and needs good control or it could cost her her dreams, but I'm doing more D-care than I did the first year she was diagnosed. She's now aware that this is a life-sentence and in a few short years, she'll be on her own. Her philosophy is to take the help while it's available.

    As far as sickness, each and every one is individual. I've seen 40s 20 minutes post-eating because carbs weren't absorbing right, and I've seen basal needs go from 0.7 units per hour to 3.3 units per hour with a site infection recently. Overall, her usual virus basal is 160% of her normal profile, but the hospital recommends 120%. You will become the expert on YOUR child.

    I'm glad you're getting a Dexcom. It is a game changer. We went for a year without, and even so, we were the 2nd family at our hospital using one full-time. I do not miss the mornings she hit 50s and then couldn't think. Those are now few and far between. I saw her stagger and slur that year, and I told our endo, "I never want to see that again." She responded, "You will." Thus far, we haven't, and I think it's due in large part to the CGM.

    As far as parenting decisions, those of us on this board and those who aren't manage D in many different ways and styles, just as we do non-D life. You'll find what works for you and your family. We were at a diabetes event once, and I was talking with a CDE we knew when I realized the d-kit was in my hand. She about panicked, whereas I didn't. My daughter had the cgm on her, and there were food samples everywhere. Now, the morning we were on our way to church and my daughter was at 83 with double arrows down with insulin on board for a breakfast she'd forgotten to eat or bring with her: that invoked panic in me as I didn't think we were going to stay ahead of the insulin.

    But life goes on. The hardest parts of D are not the dosing and the management, but when others want to exclude your child from activities because they don't want the hassle or don't feel that accommodations are needed because they have no idea what goes into living with this disease non-stop. Parenting D feels like parenting through land mines in every direction, physical and emotion.

    To answer your original question, my daughter goes on her bike with her CGM receiver (low alarm set higher for more warning) and juice. She's older and she responds to alerts, so that makes a huge difference. I like for her to take her phone just in case, but she's never called me.
     
  11. quiltinmom

    quiltinmom Approved members

    Joined:
    Jun 24, 2010
    Messages:
    1,189
    Fwiw, we can't afford cgm or a phone for Ds and things have been ok for us. He rides his bike, plays outside, and even goes on camp outs, etc. I wouldn't send him camping at age 9 without a parent, but he does fine now, at 13. I teach the adults what to do of course.he takes something for lows everywhere he goes.

    My philosophy is to Try to live as much as possible like we would without diabetes. If I would allow him to do something without d I will let him do it and work around d. (And the opposite--if I wouldn't do it before d, I wouldn't do it with d, such as the cell phone question.). Once in awhile I have to break this rule but I try not to. I think it helps him not hate d as much.

    I think you will find a lot depends on if they feel their lows. Being hypo aware has been a huge thing for us.

    As for illnesses or diarrhea.....just try to cross that bridge when you come to it. There is no way to predict how your Ds will react. Illness usually causes highs for us, not lows.

    I asked my endo about hot tubs and he said it isn't that big a deal. Probably just depends on the individual.

    Many of your questions are things you have to decide--the bike riding and cell phone and activity levels, and such. As you get more familiar with the day to day, the answers will become clear. You won't be perfect every day; sometimes you'll mess up. That doesn't mean you aren't a good parent. It doesn't mean you didn't do your due diligence. It happens to the best of us. Deep breaths. One day at a time. Soon you'll be able to take little breaks from thinking about d once jn a while.

    Hope this helps.
     
  12. StacyMM

    StacyMM Approved members

    Joined:
    Oct 22, 2010
    Messages:
    1,039
    My answers, for my kids at 9:

    Ride his bike around the neighborhood?
    ~I didn't. Not diabetes related, just hilly roads, blind curves and nowhere to really go.

    When, how long, what do I do to keep him safe?
    ~Our rules pre-CGM were that leaving the property meant you had testing supplies and quick carbs.

    Does he need a phone.
    ~Depends on the family. My daughter had a phone at 9...my son was diagnosed at 10 so can't answer for that. Practices, school, events. Haivng a phone makes life easier and I've never had a 'you must be this old to have a phone' mindset so when life reached a point that a phone made it easier, we added phones.

    Does he need to have rescue carbs on-hand?
    ~For us, quick carbs are ALWAYS around. In their belt/bag, in our car, all over the house, in the gear bags for sports, at relatives' houses, in all classrooms, on the buses...anywhere they spend time.

    Can he be active in the 1-2 hours after a meal without adding a snack? Is he likely to go low after a meal with insulin when he's active if he doesn't go low when he's not? He didn't get low at PE an hour after lunch for the first 4 months post dx.
    ~My kids have never relied on a snack to maintain a number. Life happens and lows happen and we address and move on. If it happens regularly, I change calculations. Diabetes isn't predictable. And exercise is different for everyone...and for each event. My son can go high or low from games and practices, my daughter only drops but not by much but stress sends her bg through the roof.

    If I go to pumping, is it dangerous to get in a hot tub AFTER a meal, within an hour, etc. With injections too, I was told no hot tub an hour before or after an injection. Is that right, or is it really a smaller time frame before or after?
    ~Well, hot tubs are avoided here. Even before pumping. Makes my daughter skyrocket, and since my son has a non-removable pump on his belly, heating up that insulin never seems like a good idea. He does drop during showers, though, so he times them to happen before meals or before correction boluses. No impact at all on my daughter, unless she disconnects for too long.

    I haven't read on this one yet: If a kid gets diarrhea suddenly is he at risk of a low because of lack of nutrient absorption, or is it more of a dehydration issue. Do we have to take an anti diarrheal. His Lantus currently will not take him much under 70 if he doesn't eat.
    ~Well, mine are past the age where I really know anything about their poop so unless they mentioned it, I wouldn't know. Vomiting, on the other hand, means a lot of lows around here.

    At the beach for the first time with a honeymoon should I consider just feeding him and only correcting highs at the next meal? Right now if he eats breakfast uncovered he's still under 90 by lunch. Would he/why would he go low with activity if he's only on 1 unit of Lantus.
    ~Again, it varies and it takes trial and error to see what to do. My daughter needs more insulin on vacation and doesn't reduce insulin for swimming. My son does, but not until many hours afterwards and not always. Again, you can't know these things.

    ~There isn't a manual for your kid's diabetes...just see how things go, be prepared for highs and lows and figure it out. And then figure it out again after the next growth spurt, stage of puberty, cold, activity, etc. Deal with the number in front of you and move on. If you see a pattern, make a change.
     
  13. dpr

    dpr Approved members

    Joined:
    Dec 17, 2013
    Messages:
    399
    I would let him ride around the neighborhood but limit how far for sure.

    Emergency carb, yes always! A phone with Dexcom Share is an awesome thing to have.

    We're pumpers and my daughter likes hot tubs, we have never had a problem going low in one. We have more problems with highs being off the pump while in water. Our off pump bolus regime for swimming seems to have this summer and I don't have it quite figured out yet.

    We don't have much of a problem with diarrhea but vomiting can be a definite problem. If your trying to hydrate for keytones with an upset stomach don't push fluids too fast. Small sips a while apart or everything may come back up. Do a search for mini gluc's. We haven't had to use it but you need to know how to do it.
     
  14. Beach bum

    Beach bum Approved members

    Joined:
    Nov 17, 2005
    Messages:
    11,315
    I'm basing this on our history with our 10 years in child (recently diagnosed is a try it and see game as she's in a strong honeymoon).

    Do I let my 9 year old:


    Ride his bike around the neighborhood? When, how long, what do I do to keep him safe?
    If you would have before diabetes, then yes, but with ground rules. For example my daughter (pre-phone) was required to carry meter and carbs with her, test prior, and when I wanted her to test, I'd meet her at the end of the driveway (we live on two connecting cul-de-sacs (basically a figure 8, so every 20 minutes or so she'd come by).

    Does he need a phone. No, but he will tell you he does!
    Does he need to have rescue carbs on-hand? Always. Meter too. Non-negotiable.


    Can he be active in the 1-2 hours after a meal without adding a snack? For us it depends on the meal. If it's pizza, Chinese food, pasta, then she usually needs a protien snack even if she had dinner with protien. Just the nature of how her body works.
    Is he likely to go low after a meal with insulin when he's active if he doesn't go low when he's not? Hard to say. Each kid is different. You basically have to try and see how it goes. Diabetes isn't a science, it's an art of learning how to manage and balance things. He didn't get low at PE an hour after lunch for the first 4 months post dx. That's great, but be aware, things change.


    If I go to pumping, is it dangerous to get in a hot tub AFTER a meal, within an hour, etc.

    With injections too, I was told no hot tub an hour before or after an injection. Is that right, or is it really a smaller time frame before or after?

    For us, it definitely would be a wait at least an hour. We try and have her wait an hour for showering too.

    I haven't read on this one yet: If a kid gets diarrhea suddenly is he at risk of a low because of lack of nutrient absorption, or is it more of a dehydration issue. Do we have to take an anti diarrheal. His Lantus currently will not take him much under 70 if he doesn't eat.
    I'd be more concerned with highs and dehydration. But after a stomach bug, including vomiting, be aware that the gut needs time to heal and there are absorption issues and insulin needs will be drastically reduced for some kids.

    At the beach for the first time with a honeymoon should I consider just feeding him and only correcting highs at the next meal? Right now if he eats breakfast uncovered he's still under 90 by lunch. Would he/why would he go low with activity if he's only on 1 unit of Lantus.
    Early on, any type of water activity (pool or beach) usually meant minimal insulin dosing. As she got older, she needed insulin replacement at night as that's when things caught up to her.

    As I mentioned, diabetes management is more of an art form than a science. It's a lot of trial and error. I also compare diabetes to a game of Roulet. You never know where the ball is going to land on any given day. What may work one day, may not work the next.

     
  15. wilf

    wilf Approved members

    Joined:
    Aug 27, 2007
    Messages:
    9,652
    Hot tubs and hot baths and long hot showers can be dire for people using Lantus, because if taken shortly after an injection they can activate up to 24 hours worth of basal insulin at once..
     

Share This Page

- advertisement -

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
    Dismiss Notice