I think we’ll probably start with just setting a high temp basal before class, unplugging openAPS, and plugging it in if he’s dropping. We’ll program a different default basal program for Saturdays if we see it’s a persistent trend.
So it sounds like you can kind of do a “remote control” adjustment? Like you can do that without needing direct access to the pump? If so, then yes that would be great.
Another thing - at some point this will become much easier for Samson - when I was very young and played soccer, my mom had sewn a small pocket on the inside of my soccer shorts and I put sugar packets in there. During games if I felt like I needed it, I would take some sugar.
When you are looking at his CGM while he is in his class, at some point you both can work through this sort of thing where you can just give him a signal for taking a glucose tab that he has in his pocket. And eventually he will be able to do that by “feel”.
Hi @Eric,
So this is only tangentially related to this thread… but I didn’t want to hijack @daisymae’s swimming thread!
I was able to get a last-minute 30-minute private swim lesson for Samson this evening at 6pm. He usually eats dinner at 5:30. Learning to swim yet isn’t a necessity for him, but I do think it’s important safety-wise for his older brother. And then once older bro was signed up, Samson was just begging and begging so I signed him up for a trial lesson. Samson loves being in the water and we always have to restrain him from jumping into the ocean, so I figured it was only fair to at least let him try and see if he likes it. Not sure we’ll do it again; it depends on if he likes it.
Any suggestions for what to do beforehand? It’s thirty minutes long, with a private instructor, and he’ll be most likely kicking in someone’s hands or with floaties, possibly blowing bubbles, and making “digging motions” in the water. He won’t have his pump on so at least 30 minutes of no basal. I think he probably should eat something beforehand because he goes low if we wait too long for dinner. On the other hand I don’t want him in the pool with too much IOB. I’m thinking we should aim for him to be in the 200 to 150 range before class?
Should I maybe give him a light dinner/snack and bolus partially for it, then unplug just before class? Like a chia seed bar or maybe a slice of toast with peanut butter (9g carbs?)?
I would go super safe to start with!
Since it is not as much an athletic event as a learning opportunity, a high BG is not too devastating to his experience.
A target BG is not really easy to say. And is not really a thing I focus too much on. It depends more on which direction it is going and his IOB, and how much food he has.
As an example, a few days ago I started a run with a BG of 66. Insane, right? Nope. I ended at 90. The BG is not really as important as which way you are going to be…
So factor in the unplugging, maybe lower the basal a bit before to be safe, give him a little snack before, and try to have minimal IOB.
Peanut butter with toast sounds like a very good snack before hand.
Be safer with this the first few times. If he is nervous though for first time in the water, he might spike! But that’s ok.
So it went totally fine! I gave him a piece of bread with a thin smear of nutella, some chicken strips and some cucumber before class. He started at 125 with no IOB, crept up to 160 by the end of class He did start rising, and currently at 204 but I feel pretty confident he’ll plateau or start dropping as I gave him 0.5 units about 10 minutes ago.
Definitely not an athletic endurance event but a few kicks and paddles here and there.
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So, today was a pretty great performance!
6:45 a.m. – English muffin with peanut butter and honey, 22grams of carbs, 1.3 units of insulin
10:00 a.m. – class starts. BG 138 mg/dL, IOB 0.1 units
He was set at a zero temp basal during class.
10:00 a.m. - 10:30 a.m. – between 138 and 145
10:30 a.m. - 10:50 a.m. – starts dropping by about 4 or 5 points every five minutes.
11:00 a.m. – 118 mg/dL
Even more encouraging – he felt GREAT during the class and was super into it! So clearly keeping him in a fairly narrow BG range does help him enjoy the class more.
He did wind up going slightly low (68 mg/dL) after class because I wasn’t sure if he’d start rising or dropping, so I didn’t give him a (6g) snack until after I started driving and saw he had dipped to 81 mg/dL, and it was clear he was going to keep dropping. If I had just given him the snack right after class he probably would have leveled out at about 95 mg/DL.
I guess for next time my goals will be starting him with absolutely 0 IOB – this is tough because they eat when they wake up, and no way am I waking a peacefully sleeping toddler at 6 a.m. Plus that early he often doesn’t finish his food.
But i can probably set a high temporary target (say, 150 mg/DL) in the 45 minutes before class, which will ensure that he gets 0 basal not only during class but in the time prior, which should deplete his meal IOB a little faster. And I should really aim for feeding them before 7 a.m.
This time the openAPS super micro-bolus actually gave him a 0.1 unit bolus just before class while I was driving there – which would have made sense if he wasn’t going to do the class, as he was rising, but doesn’t make sense for gymnastics. So maybe I will set a high temp target before class, ensure it’s 0-temping him, and then just unplug it a little earlier so it doesn’t give him insulin right before class. Pretty sure the drop was mostly about the IOB and would not have occurred with the exercise!
Anyways, it’s good to know that the class itself doesn’t seem to cause the spikes – or at least not reliably. It seems like what was happening is that the IOB has more of an effect during class, and then he goes low, and then we give him carbs, and those take longer to digest while he’s exercising, meaning it all hits him after class and he only spikea AFTER class. So having no IOB is really key.
It’s just a relief to know there IS a way for him to do this class and not spike at all before, during or after… even if each time isn’t a perfect example, the fact that different experiments yield different outcomes is so encouraging!
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Great day and good news!
A lot of good observations and comments. Having no IOB is vitally important. That’s exactly what DaisyMae is working on. And insulin is much more powerful when you are exercising.
Really good news to hear this happened!
Does your pump algorithm have an exercise option that reduces the amount it uses to treat rising BG? Personally, I do corrections at 40% of normal for the 1st hour of exercise, and then drop them even more drastically for each subsequent hour. Is there an adjustment for exercise you have available?