What do people with diabetes need to know (that they may not know already) about getting through the summer months with diabetes? We posed that question to Berrie Center pediatric endocrinologist, Mary Pat Gallagher, MD, and here is her list of things you may want to consider during the summer—especially if your child has type 1 diabetes:
1) Activity: Glucose levels do seem to go down in the warmer weather, but it’s probably related to increased activity levels during the summer rather than the heat. Since lower blood sugars usually mean lower insulin requirements (when you’re using energy and muscle, you’re burning glucose more efficiently) you need to plan accordingly. Whether your child is jumping up and down in a bouncy house or walking around Disney World for 8 hours, be prepared for lower blood sugar levels.
2) Heat: Heat is a big factor for everyone in the summer, whether you have diabetes or not. This is especially true in NYC where the temperature is often brutal. Most people with diabetes already know that they need to keep insulin cool (below 86 degrees Farenheit) through refrigeration or cold packaging or it will degrade quickly. However, did you know that glucose and ketone strips, as well as glucose monitors and sensors, also need to be kept cool in the heat or readings will be inaccurate? Be aware that the insulin in an insulin pump is also subject to heat degradation—especially if you spend the day outside in 100-degree weather.
*Recommendation: Instead of changing the insulin in a pump every two or three days, change the reservoir every day or two to keep it effective.
3) Travel: Always bring extra diabetes supplies (including snacks) and make sure they remain with you when you are on an airplane (because flights can be delayed and baggage can be lost) or in the car. However, never leave supplies in the car without you when you have turned off the air conditioner. Be aware that on a long flight or road trip your blood sugars will likely go up because activity levels go down.
*Recommendation: Monitor your blood sugar levels more often and give yourself a little more basal, or background insulin, to compensate for higher blood sugar if needed.
Did you know that most insulin pumps and glucose monitors should not go through x-ray machines or body scanners?
*Recommendation: When traveling by air, always bring a letter from your doctor explaining the various issues for people with diabetes—from insulin pumps and body scanners to bringing insulin needles on board a plane.
4) Time change: If you usually take your long acting insulin at 9 pm and then again 24 hours later, a time changing trip to Europe can be confusing.
*Recommendation: Discuss with your doctor or nurse a plan to move that dosage slowly, so it can be given at a convenient time during your trip. Time changes are easier to manage if you use an insulin pump. When you arrive at your destination country, switch to local time on your pump. As soon as you get home, remember to change back.
5) Camp: Kids with diabetes can, and should, go to regular camps (including overnight camp) as long as there is a nurse who is, or can be, educated about the condition. Generally speaking, parents can pack all of a child’s supplies and as long as they can be reached in case of an emergency (just like they need to be for a child without diabetes). Children with type 1 do very well at camp.
*Recommendation: We suggest that you factor in an increase in your child’s activity level by lowering the long acting insulin by 20 percent before camp. You can apply the 20 per cent rule to vacations as well for the same reason.
6) Swimming: People should check their blood sugars hourly if they’re planning to be in the water for extended lengths of time. Everyone reacts differently to exercise and swimming is exercise. You don’t want a low blood sugar episode while you are in the water.
*Recommendation: If you take long acting insulin and are not using an insulin pump you may need to take extra carbohydrates during swimming, just like you would with any other activity. If your blood sugar is under 140 mg/dl you can have 10 grams of complex carbohydrates before going swimming. If it’s over 140 mg/dl, it’s safe to wait an hour and check your blood sugar levels again before considering a complex carb.
Disconnecting from an insulin pump to swim can be a real challenge for people who like to play in the pool all day. While some pumps are waterproof (Omnipod and Animas), many people choose to suspend the basal or disconnect while swimming.
*Recommendation: Talk to your doctor or nurse about how often you should hook back up to the pump. The general rule is to hook up every two hours and bolus some of the basal that you missed in the water. That way you will avoid high blood sugars later on. You may want to talk to your doctor or nurse about changing some of the basal to a long acting insulin so you will have a little bit of background insulin when you are disconnected.
7) Food: When you are away on vacation, there will food you eat without knowing the carbohydrate count. Be aware that usually, restaurant food in particular, is higher in carbohydrates than food prepared at home.
*Recommendation: Don’t stop eating! Instead we suggest a lot of guessing, checking and adjusting insulin dosage so your child can eat what everyone else is eating on a family trip.