FUDiabetes

Swimming and LOW, LOW, LOW overnight

Last night was the worst night we’ve had in a while.

We went to a kids’ swimming pool yesterday and Samson spent two hours frolicking in the water. But then last night we were just seesawing from low to not-low. We had to give him 7 separate carb treatments (honey shots while he slept) between 9pm and 4am. He spent much of the night between 40 and 50 on Dexcom (slightly higher when finger-tested…but not enough to not be low). Finally at 5am, when he STILL wasn’t rising, I woke him up so he could drink a half-glass of Fairlife chocolate milk and a scoop of peanut butter. And of course, at that point he spiked to 267 and we’re still waiting for him to come down enough before we serve breakfast.

I guess I’m wondering what we can do to stop these incredibly persistent lows overnight when he has a day of intense swimming activity? And just generally how to deal with prolonged swimming – he’s off his pump and we often have a lot of chaos and other factors to manage so it gets tricky to precisely time boluses, hooking up, unhooking etc.

For the swimming itself, we took him off his pump and he was 165, he spent two hours with no basal and was in the 150s, then started crashing and so we gave him about 15 g carbs (apple slices, cheddar crackers and bell pepper), reconnected his pump and gave him about 75% of the missed basal he received… and of course then he spiked to 250 for 3 hours despite receiving 1.2 units of insulin over the next hour. (there was also a sunblock miscommunication meaning his arms got a little burnt, which could have been a factor).

For dinner we went to a Malaysian restaurant and he only ate the carbs (left the shrimp, satay and tofu, and ate roti and rice only :frowning:).

My questions:

  • He ate plenty of carbs yesterday – so why did he crash so hard and so persistently overnight?
  • What can we do to prevent such intense lows overnight?
  • When he does have those types of post-exercise lows, will it help to give him some protein & fat with it to prevent boomeranging back down? And if so, what is something with protein and fat I can literally squirt in his mouth while he sleeps? I was sort of debating making some kind of peanut-butter/protein powder mini-smoothie but I doubt I could fit that into a 5mL syringe or something compact enough to feed him overnight.
  • How should we have bolused him after his swim so that he didn’t spike to 250+ for 3 hours?

Any suggestions would be most helpful. Samson adores being in the water and we’d love to do this more, but last night was a long, long night and we’re still dealing with the BG hangover. I don’t want to let this stop us, but it’s super frustrating as well.

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Tia, I can suggest maybe trying less carbs if you can get away with it. My son is very carb sensitive and we generally treat lows with 6g of carbs for the first treatment. If we catch it going low, we treat with 2 g of carbs. Only about 1 out of 5 times will he need a re-treatment with 6 more carbs.

During exercise there are so many variables that it is hard to nail it down until you do it a bunch. It took us 1/2 of a baseball season to come up with a strategy that works.

well in this instance we weren’t really treating the low with the carbs – it was his snack because he was hungry. I was sort of hoping he’d just eat 4g and then we’d reevaluate before dinner… but I didn’t want to limit what he ate because he was swimming for a few hours and I figured if he was hungry he should eat. We probably underbolused for the carbs we did give him though.

Our son is not very carb-sensitive in the typical sense – or at least I feel like it’s easier to keep his BG in range when we let him eat as many carbs as he wants. Plus he has been systematically rejecting a ton of foods that contain protein – we’re basically down to paneer, chicken strips, tofu, and the nut butters at this point.

We typically treat with 4 g carbs and he spikes about 40 to 50 points from that. In this case it’s possible he spiked more because he had a basal deficit from 2 hours off his pump.

Our Endo had told us being off the pump is fine and at the beach is the proper procedure.

The Endo said every two hours we should hook back up and bolus for the missed basal taking into account any reduction (like temp basal) that we would want to do based on activity. This was fine to continue the whole day like if a full beach day.

Sucks about the sunburn - sorry about that. I know how that feels as a parent. One good thing is you will not make the same mistake any other time this summer when the sun is really intense. A sunburn can definitely impact BG.

If we get multiple lows during the day, it makes lows at night more likely and if they occur much more difficult to treat. After multiple daytime lows, I will attack a nighttime low at night more aggressively (combination temp basal and carbs) coupled with more frequent monitoring.

@TiaG

  1. Omnipod
  2. What are honey shots?
  1. WEll, we’re on openAPS and most of the time we don’t mind the tubing, so it’s not worth it to get a whole new pump system for the one-off-situations where he’s swimming
  2. They’re literally 5mL syringes filled with honey, without the needle. They are syringes I think for IV drips because they have a wide outlet. Perfect for putting in his mouth when he’s unconscious.

@TiaG, we use enormous amounts of carbs during/ after a long swim session. Even then, occasionally we run low.

For instance, this is what we did last week for a long and intense 2-hour session:

  • 17 carbs before swimming to go up to 155
  • 15 carbs about every 20 minutes, 5 times
  • 12 oz of milk immediately after the session, with 1/2 insulin dose from normal (17 carbs)
  • 100 carb dinner, with about 2/3 insulin dose from normal, within 75 minutes of end of session
    (total total about 220 carbs for a 135 lb kid)
  • overnight basal down by 10%

Most of the time we don’t run low, but sometimes we do get into night lows anyway, if we misestimated the effort level.

What I believe works well:

  • replace the carbs as we go
  • get some carbs RIGHT after exercise
  • big carb intake within 90 minutes of exercise

check out my swimming post : Daisy Mae’s Swimming BG

i am a pump/swimmer too. i take my pump off for 2 1/2 hours and no IOB from any previous boluses before i jump into the pool. i swim for 2 hours w/out my pump, totaling 4.5 hours w/out my pump or any basal IOB. i am getting to the point where i can flatline while i am swimming. huge accomplishment that required a lot of experimentation. but its working for me now. i have to bolus after i get out of the pool, too, to replace the lost bolus which i missed while i was detached.(if i don’t, i will VERY quickly spike from around 70 to 300)

and as far as refueling goes to avoid lows while swimming, i have found that eating 1/2 to 2 Swedish Fish give me instant carbs and i don’t have to wait at all to jump right back into the pool.( i found that trick on my thread.)
PS: since i have no insulin running through my body by the time i jump into the pool, i no longer crash. :smile:

hope that this helps

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@TiaG, where do you get the syringes? Are they already filled with honey or do you do that?

Well, so they’re just basic syringes we get for things like giving antibiotic syrup or whatever, and we wash them and fill them with honey.
They look like this, although somehow we got some caps that make it a little less messy. We just fill them up (also with maple syrup) and then have them ready to go. But lately at night we have rarely needed to correct so we haven’t been using them as much:
http://www.vitalitymedical.com/5-ml-syringes-without-needle.html?gclid=CjwKCAjwos7NBRAWEiwAypNCe4gDh4dtf3cmyhTTB2ng887X4_z7u86geLrt-8q4ml2she_m8GAb8RoCjMIQAvD_BwE
5ml-syringe

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