Some sports stuff for @ABCD

Hi @ABCD,
I thought it would be better to post on a different thread so @John58’s O5 thread isn’t hijacked :hijacked: too much!
(For reference, John’s thread is here.)

I few comments and thoughts to share with you.

I am very glad you got some experience with injections before going to the pump. It really helps you get a better understanding of how everything works!

There is definitely an impact with adrenaline and cortisol with sports. It is not only the physical activity, but the mental component as well. On top of that, when a pump does a higher BG target or you do a manual cut to basal, that makes the spike even worse.

One way to help mitigate that is to do BG checks whenever he is able. Like if he is coming off the field for a substitution and he will have a few minutes to do a BG check and can take insulin to counter the spike. Or at halftime he can do that. When he has a few minutes of not being on the field, a BG check is super useful.

Let me counter this suggestion with a different idea.

Do you know much about muscle glycogen?

Yes, cutting basal can help mitigate a drop after a game. But do you know what cutting basal can’t do? It can’t help him replenish his muscle glycogen after a game. The only thing that can help him (or anyone) efficiently replenish his muscle glycogen after an activity is carbs and insulin.
:astonished:

I have preached this a million times on FUD. You are thinking that’s nuts. Taking insulin after an activity. Sure, it’s nuts if you don’t also take sufficient carbs with it.

Ask @daisymae. She has been doing this for a while now.

Muscle glycogen is stored carbs your muscles use for fuel during an activity. After an activity, your muscle glycogen is depleted (how much depletion depends on the intensity and duration of the activity).

Replenishing it rapidly after an activity is not necessary for things like walking, hiking, or sports that are less endurance-based, like baseball.

But for something like soccer, what will help him quite a bit is to make sure he restores the muscle glycogen quickly. That will help reduce the lows that will follow in the 24 hours after an activity (as his body is trying to recover), and will also help him perform better if he has another game or practice soon after.

A reduced basal is fine for the hours that follow a game. That will help reduce the lows. But I suggest he also bolus and take carbs immediately after an activity.

His bolus amount won’t follow his normal ratio. After an activity, he can take much less insulin per gram of carbs than normal. So it take a bit of practice to get the amount dialed in correctly.



A few other suggestions for helping to manage BG. I am a big fan of BG checks whenever possible. The CGM delay can make it less useful for sports. But during a game, a BG check may not be possible. A great tool that can be used is the Bluejay watch. (Very affordable, about $100 and everything you need is included.)

While an apple watch requires the phone to be nearby, the Bluejay watch does not. It reads directly from the Dexcom sensor.
(Since he is using the O5, you would need to set the watch to use the phone slot, and make sure you turn off the phone while he is using the watch. We can discuss the details about this if you want to try that watch).

Some specifics to soccer (I played for my college JV team, and I’m also a state certified coach where I live). In soccer, a lot of refs will tell the kids they need to remove their watch. I would just cover it with a sweatband. That way it’s totally unnoticeable. He can pull the sweatband away to look at the number when he wants to check his BG. It’s a very inconspicuous way of doing it.
(You could probably also go the route of saying it’s a medical device and should be allowed in the game, but that’s just more hassle and calls more attention to him. I would just cover it with a sweatband. It’s super easy and stealthy.)

Finally, for soccer another important thing is for him to have carbs with him on the field. Most of the higher level soccer leagues do not permit shorts to have pockets. It’s a safety concern, because fingers can get caught in a pocket when jostling for a ball.

My mom sewed a small pocket INSIDE my soccer shorts. So the refs would never say they were illegal. I carried little sugar packs inside the pocket.

The best place to put the pocket is on the front, but not on the hip. If he falls in a game, most likely anything in there would hurt to land on it.

The best place is on the front of the shorts, midway between where his bellybutton and hip are. It’s easy to get to, but it’s generally a place you do not land when you fall. (The back is a little harder to get to.)

Anyway, a bunch of stuff here. Hope this stuff helps.

BTW, is he eating sufficient carbs in his diet? For sports, I am a big believer in the value of carbs as fuel.

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I strength train. Have had diabetes for 54 years.
Have some breathing problems so most everything is more difficult LOL
After 54 years I have CKD
My kidneys are “insulted” lowering my GFR but my real number is 89 not bad.

I use plant-based protein a little bit of boneless skinless chicken.

But I’m having some real problems that you seem like the person I need to speak to outside of the format here.
I talk to people at my gym but 99.9% of them have no clue about diabetes or any sort of health problems.
I am getting results they are slow going. But I sure believe I could use your knowledge if you don’t mind?

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Much of what you were saying.
I completely agree with however I am having a hard time accomplishing it myself and I need some tips.

I find it funny also how many diabetics are trying to build muscle while on a keto diet LOL

Aren’t keto diet and muscle growth and maintenance a contradiction in terms?

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@Eric is indeed the perfect person to seek out as he is definitely the expert here! I’ve learned so much from him and his postings that have made a huge difference in my BG management, esp as it relates to exercise!

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Hi @Menmypod,
Yes, let’s work on it. Tell me about the problems.

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I certainly will. But not tonight, it’s bedtime. Thank you very much!

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@Eric - Wow! That is a lot to digest, so please be patient as I take it all in a little at a time. I am sure I will reread your post at least a hundred times before I reap all the benefits of your experience and expertise!

So first thing, that Bluejay Watch sounds like a great idea. When my son played soccer in the spring, there were many times that we lost track of his BG because his phone was in his bag on the sidelines, and he often was positioned on the opposite side of the field out of range. This wasn’t usually an issue in baseball because he’s usually catching so close enough to the dugout. My husband and I use the Dexcom Follow App…any idea if that will still work if he’s connected to the watch instead of his smartphone?

As far as eating carbs after an activity like soccer, is there anything specific that you recommend? We usually try to do something that has protein as well…his go-to after his soccer games were either chicken and cheese pitas, or egg-cheese sandwiches.

If increasing basal or giving a correction bolus for an elevated BG during a game to keep it in check, won’t this exacerbate the drop afterward? My son could get out of the car around 100, and by the time he got on the field and the game would start, he could be up in the mid 200’s…we typically would just let him run high during games (there was a basketball game where his sensor started to alarm from a high right as a player from the other team was taking a foul shot! Oops!). But we came to expect his BG to skyrocket during games (definitely more with soccer and basketball than baseball), and we would basically let it ride that way knowing that the minute the game ended, his BG would quickly fall.

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The watch does not share. But it won’t interfere with sharing. In this case, you would want to connect to both the watch AND the phone at the same time.

Protein and carbs are both important after exercise. Protein helps muscles repair.

I take rapid carbs, to hurry it up. But really anything is fine. Whatever he likes.

Yes, it can make the drop afterwards happen faster. But if you are going to refuel after an activity, it isn’t really too much of a concern.

As long as he is willing to eat and drink when he is finished, there isn’t too much that you need to worry about. I mean, most boys can polish off a glass of chocolate milk or two pretty quickly.

Also, if you reduce his basal that would help the lows that might follow in the hours later and at night. Lows at night when he is asleep are more of a problem. A low when you are awake is super easy. You just get to have a treat!

These things take practice. To figure out how much he should have after he finishes. How much insulin, and how many carbs. Just takes a lot of repeats to get it figured out. Everyone is different in those things. So you have to find numbers and amounts that work for him.

At what BG number would a low be a concern for you?

Being 200 when he is playing is going to impact him. I know it takes a lot of work to get it dialed in correctly.

In something like basketball, there are a lot of breaks and more time when players are on the bench. So he can test and adjust his BG before he has to go back out on the court. Having something like Gatorade on the bench would allow him to run a bit lower, and still take carbs if he starts to get too low.

I would suggest to him that every time he comes to the bench, he should check his BG with a meter. I can send you something that can make that much easier to manage if you want.

Soccer is more challenging because there is generally less stoppage time and less chance to adjust his BG. But at least at halftime he can do that. And the sugar packets in a pocket would give him something while out on the field.

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I’m still not sure of the Bluejay watch. I looked it up a bit, and it sounds like a great thing to have under a wristband during a soccer game considering he often lost connection with his phone on the sidelines…but not being very tech savvy myself, it is hard for me to understand all the “slots” and what we’ll actually be able to do. Right now, he runs the Dexcom app on his android smartphone and also is connected to the Omnipod 5 (uses a controller for that since the Omnipod app isn’t compatible with his Samsung model yet). My husband and I use the follow-app which of course is only good when my son is connected to his phone. His doctors follow his tracings with Clarity as well as Glooko. I can’t wrap my brain about how the watch fits into all of this.

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Yes, this is the type of thing that is not explained well by Dexcom, or pump companies, or doctors! It’s stuff we learn on sites like FUD. :grinning:

The Dexcom transmitter (i.e. the 3 month battery attached to the sensor in his skin, just so we are all on the same page here…), well the transmitter allows 2 “things” to connect to it.

Of those 2 “things”, only 1 phone is allowed to connect to it at any time. And only 1 “non-phone” device at any time. Those are the 2 “slots”. A phone slot, and a non-phone slot.

So the 2 things that can connect at any time are a phone and a non-phone. But the cool thing about the watch is that is can actually use either the phone slot or the non-phone slot! Whatever you set it for! How cool is that.

With me so far?

The Omnipod 5 communication with the Dexcom uses the non-phone slot. It uses the non-phone slot so that people can still use their phone for sharing, like you are doing. Otherwise nobody would be able to use their phone for Dexcom and use Follow, and everyone would be upset by that of course.

So since we know the Omnipod 5 is connected to him and it uses the non-phone slot during a game, you’d want the watch to use the phone slot during a game.

But what about his actual phone and Follow? Well, you couldn’t use that, but only during the game when he is using his watch instead.

So the setup would be like this. You set his watch to use the phone slot. Game time, he puts the watch on and turns it on. And he turns his phone OFF. His Omnipod 5 still talks to the Dexcom with the non-phone slot. His watch will talk to the Dexcom using the phone slot. His actual phone is off, so it does not interfere with the communication.

After the game, he turns his watch off, and he turns his phone back on. All back to normal.

The only thing lost is that you don’t get Follow during the game. That is the only thing missing. But since his phone can’t pick up the signal during a game anyway, it isn’t too big a deal.

Does all of that make sense?

@John58 does something like this for hockey games. Let’s get him in here for comments! :grinning:

But listen to me on this. Checking his BG whenever he has a few minutes on the bench or during halftime will be a huge benefit for him to learn what to do. If he relies on the Dexcom alone his knowledge of his BG will always be many minutes behind what his actual number is.

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Can not recommend this enough. My son was a very competitive baseball catcher and also played a lot of soccer. He would often check his blood sugar when he hit the dugout or the sideline. The current information is so important when the Dexcom has a trend, so that you can see how fast the drop is progressing. Also if you look at the professional football players that have T1, they get their blood sugar checked by the trainers on the sideline very frequently.

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That is very close to the way I have been using the Bluejay during hockey games. A couple details that work for me: I leave the phone turned on but turn bluetooth off (in settings) about an hour before the game and turn the BlueJay watch on at that time. It can take a while before the watch catches a signal so I want to get it connected well before game time. Then after driving to the rink I turn the phone off and stow it away, after I’ve confirmed that BlueJay is connected to the Dexcom.

There is no way to use Follow when the phone app is turned off. After the game, when Bluejay watch os turned off and phone/bluetooth are back on, Dexcom app will backfill the missed BG values so at least you can look at that history. But real time Dexcom data with Follow won’t happen.

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@Eric
@John58
Thank you for the specific setup info for the Bluejay watch. We just ordered one and will update when we receive it and get it going (hopefully in time for the start of soccer season). Anxious to see how the combo of having the watch plus the Omnipod5 will affect (hopefully for the better) my son’s soccer season…we have been having better success recently with the Omnipod -running mostly in automated mode…not sure if automated mode or manual will be the way to go during practices and games. I’m interested to hear how you guys handle that for your respective sports.
Prior to having a pump, my son would bolus normally before a game but would drastically cut his IC ratio when eating afterward. Do you find that you need to “override” the suggested bolus amounts calculated by the pod?

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I only do manual. I almost always just turn my basal off completely, and I do that a small amount of time before I start.

For something like soccer it will take some trial and error to figure out. It might not be a zero basal, but would probably be a significant reduction. It also depends on if he has access to carbs while on the field. If he has access to carbs, you can be more aggressive with it.

It also depends on how accurate his Dexcom is.

I actually do not use any pump suggestions or ratios ever. I just know what I need. After 49 years, I have it pretty much figured out. :grinning:

But after exercise, yes he will need less. And it becomes less and less on consecutive days of exercise. It is somewhat cumulative.

His basal needs will also depend on how much he is replenishing his glycogen after he finishes. If he eats enough and replenishes quickly, it will not be as drastic. If he does not eat much right after, then it becomes a bigger impact.

For example, for basal changes, if he has a big carb-centric meal post-game and eats soon after, you will see less of a change than if he has a smaller meal. And after 5 days of practice and a game on Saturday and Sunday, you will see a much bigger change than if he only has a few days of practice and 1 game.

For those reasons, I have never been a big fan of formulas.

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I’ve been using Auto mode (but NOT “Activity” mode) for Omnipod 5 during hockey games and skates. If his BG drops during soccer it works just like setting a zero temp basal. I figure you can’t get much lower than zero so I use Auto on the off chance that the algorithm needs to set something other than zero basal (has not happened yet). Just remember to switch back to manual after the game to get some carbs/protein etc.

Yes for every meal bolus or correction bolus I do my own calc in my head and override the Omnipod “Smart” bolus calculator. This is especially important when switching from Auto to Manual…the algorithm does some surprising IOB calcs (seems to calc more IOB than I would normally) and the algorithm overdoes it when calcing a trend from the Dexcom data.

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Bluetooth is line-of-sight, so if his phone is close enough to the game and there are no intervening bodies it might just work to use the phone; the phone connects to the O5 pod, the pod has the G6 readings. It’s probably going to be intermittent and it does raise the obvious privacy concern of using the player’s 'phone, but it would definitely work when he comes to the pit (is that the correct term?) given a close enough seat to said pit. Maybe an op. to get a good seat for medical reasons :slight_smile: