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Managing blood sugars with increased activity.

Discussion in 'Parents of Children with Type 1' started by MMMMMMM, May 12, 2017.

  1. MMMMMMM

    MMMMMMM Approved members

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    Mar 29, 2017
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    Hi all...

    This will be our 1st Summer managing our sons diabetes.
    I knew that increased activity could lower blood sugars but I'm shocked at how much it effects my son!

    Last night he had McDonalds as a treat and we bolused for a little less carbs (50g rather than 65g) due to activity. He played with his friends for about an hour before and after dinner. When he got back home an hour after dinner he was feeling low... blood sugar 41! The lowest he's ever read. So we treated with about 30g carbs and rechecked... 120. About 45 minutes later he said he was feeling low again so we checked and he was low 60s. Treated with about 18g rechecked and he was 150. An hour later he felt low again and he was 102. Normal but we figured he was probably dropping so he had milk, peanut butter and a few chocolate chips. He was stable the rest of the night. Needless to say, it was a long evening and he was up till about 11. I let him sleep in a little later this morning to make up for the lack of sleep.

    So 2 questions...

    How do you manage blood sugar and activity to prevent lows like this.
    I'm thinking either less dinner insulin or frequent snacks (5-10g hourly?)

    And do you think it's appropriate to keep them home after a late night of managing lows? (He's 7)
     
  2. Snowflake

    Snowflake Approved members

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    Do you use a pump? We reduce basal insulin a small amount while she's on the playground (25% or so), and a lot while she's doing vigorous sporty things like swimming and gymnastics (50-75%). If possible, we start the reduction about a half hour before hand. We find that the basal reduction heads off the immediate lows during and right after the activity.

    Alternatively, and especially if you're MDI, if playtime is snack time any way, you can give some uncovered or partially covered carbs while he's playing to keep his bg up.

    Also worth looking out for: Some people see overnight bg crashes several hours after intense activity, such as a day of skiing. That hasn't been a huge issue for us with our daughter's normal sports and playground time, but be on the look out for it. Do you have a CGM? (If not, consider one!) The CGM is the best way to catch these, and then if you send a trend, you can start to run a reduced basal overnight also.

    As for staying home after a rough night: our daughter is 7 also, in first grade. We try to strike a balance. We can't keep her home after every crappy night, because they happen pretty regularly. But after an epic bad night -- for example, if she was high fighting ketones for part of the night -- if she seems wiped, we occasionally let her sleep in. T1D is draining and exhausting and I figure she needs the occasional mental health holiday even on days when she wakes up in range. It's totally a gut call which days qualify. She LOVES school, so if she doesn't feel like going, we tend to listen to her.
     
  3. MMMMMMM

    MMMMMMM Approved members

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    No CGM or pump yet, we were told we had to wait 6 months. I really want to get the dexcom, I know it will make a huge difference. I just hope that he will be ok with using it. We watch his blood sugars intensively so it'll help reduce finger pokes and maybe we'll get a decent nights sleep once we get it.

    We'll have to start the playtime snacks and if that doesn't work we'll probably need to get a little extra help from endo. Every time I think I've figured this whole blood sugar insulin thing out it changes.

    I agree with mental health days and not doing to many partial days home but I don't really know the protocol or the accepted, expected way to handle those situations. Do you have a 504 plan? If so did you make accommodations for days like that? We didn't put one together this year but plan to for next.

    I can't imagine having a 2 or 3 year old with diabetes... you're a trooper. :)
     
  4. Snowflake

    Snowflake Approved members

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    We do have a 504 plan. I don't think it specifically addresses absences. However, the school has never given us a hard time about either excused absences or tardies.

    Good luck getting the CGM! It's really a game changer! It does help with overnights, and really with everything. :)
     
  5. MomofSweetOne

    MomofSweetOne Approved members

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    Lots to answer:

    1) If you want a Dexcom now, I would call the company directly. They will contact your doctor and your insurance and get the device to you asap. If there is truly a 6 month wait, they will learn it. If you need documented lows (which you already have with that 41!), they will ask you for what they need. Seriously, that 41 in a kid should be an automatic approval. Dexcom has fabulous customer service and works to keep us in supplies at the best deal, or at least tells us coverage options. In my opinion, they're the best diabetes company we deal with.

    2) Exercise: we were taught to bolus 50% when exercise will be immediately after eating, 75% when exercise will be an hour later, beyond that carb as necessary. For trampolines, every cell in the body gets exercise and the BG will drop much faster than other forms of exercise, though swimming and snow play are also high. For those events, we turn basal to 50%, but unless you know it will be a significant portion of the day, that isn't a good strategy with MDI.

    3) The every time you figure out what is happening, it changes...is life with D. There are so many factors that affect BG, and most of the time multiple factors are at work. It's hard. Really hard. We've been at this 6.5 years, and I think burn-out for us both is at the highest level we've experienced. I'm so looking forward to the closed loop systems hitting the market, but even then there will be site reactions, bubbles, pulled out sites,....but still ever so much better than now.

    4) Most of our kids have become proficient at sleeping through blood sugar events at night, and the sooner your son can, the better. It's amazing how they can suck a juice box down in their sleep. At 7, you have years before you need him to wake to alarms, so let him sleep while you carry D for evening and night lows and highs. Sleep makes such a difference in how they (and we) cope and focus.
     
  6. Snowflake

    Snowflake Approved members

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    This is great advice. The pump is cool and makes life easier in a lot of ways, but the CGM is a total game changer. Documenting the lows in order to expedite CGM approval is a great idea.
     
  7. msschiel

    msschiel Approved members

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    We got dexcom ust just over a year ago, after starting the pump. I wish we had gotten it sooner! We had it in less than a week (pump took almost 3 months because of paper work issues). I would give up the pump before I gave up Dex. When we were on MDI, and my son was active and his numbers were running low, we just gave some uncovered snacks. You also need to watch out for lows at night following activity. Last summer was my son's first on the pump and he used quite a bit less insulin than during the school year. He has been riding his bike quite a bit this spring and his numbers are definitely better.

    I would encourage you to look into the dex asap. It definitely helps out a lot!
     

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