What Time is Gym?
Here's our latest challenge:
The high school has block scheduling. This means that while kids take 8 classes, they only go to 6 per day. There is a continuous rotation through A,B,C and D days. Each day has 3 morning classes and 3 afternoon classes which always remain in their own day parts, but not at the same times. The first challenge is, of course, end up in the right classroom at the right time more often than not.
Then, to up the degree of difficulty, add diabetes.
This schedule means that gym, like all of the other classes, only takes place 3 out of every 4 days. It's always in the morning, but rotates between 8 a.m. 8:58 a.m. or 9:54 a.m. depending on the day.
Yesterday was the first day the kids changed and had a full gym class. It was during the 8:58 time slot. It turns out, to provide an additional diabetes challenge, that one day per calendar week the class has a 'fitness activity.' Yesterday's was running sprints outside, promptly followed by the first high school visit to the nurse's office due to low blood sugar. Other days will be spent on traditional gym units like volleyball and badminton. This fitness activity day will not occur predictably, so it is not as though we can know that every 'A' day will be different.
Every school year has required an adjustment in the basal insulin delivery rates on my daughter's pump. The summer schedule of waking, sleeping and activity is different from any school schedule. Each year of elementary and middle school brought a different time for lunch and daily gym class. A couple of weeks into September we were able to see the new patterns and tweak insulin doses to prevent most post-gym or pre-lunch lows. There were still variables like going outside on a gorgeous spring day to run the track instead of playing badminton; and half days threw everything off. But generally there was some predictability to the daily schedule and its requisite insulin needs.
This year? I really have no idea how to proceed. I dropped the morning basal rates a bit last week after it became clear that being up and active at 6 a.m. was leading to a different pattern than the more civilized summer hours did. Last night I further lowered, and changed the timing of, the morning basal rates as the first stab at addressing the gym issue. But I fear that on no-gym days highs will creep in, and that the changes will be more effective on some days than on others due to the range of class times and activity levels.
In a perfect world, my daughter would check her blood sugar an hour before gym class and then again when class was beginning. She would know what the day's activity was and use all of the available information to decide whether to set a temporary basal rate or have a snack. Or we'd have a few different basal patterns set up and change them based on the day's school schedule. Maybe she would eat different breakfasts depending on when gym was scheduled in order to, theoretically, stabilize her blood sugar at the right times of morning.
Life as a high school freshman is nothing akin to a perfect world.. At this point she's lucky to make it to the gym at the right time and to find the locker room. Arriving at school for 7 a.m. choir fed, bolused and with enough insulin left in the pump cartridge for the day (oh- and dressed, homework finished and carrying her backpack containing everything she needs for the day) is almost more than we can ask. So for now at least, we'll play a little bit more with the basal rates to hope we can find a happy medium for the mornings. And she'll keep the juice boxes close at hand.