Gym Win

Out of all the anticipated diabetes challenges of high school, gym has been the biggest thus far.

Marching band's 14 hour days, including an outdoor week in the August heat? We handled it.

New nurse? She's great.

An intense and stressful academic schedule? Intense and stressful, but managed.

Gym? A disaster since day one.

I wrote about it in the fall. Gym is always in the morning but that's where the predictability ends.

Gym class happens three out of every four days. At 8 or 9 or 10 a.m. Some days are 'fitness days' with sprinting or other heavy cardio. Some days they play volleyball which my kid enjoys playing at a moderate pace. Some days feature floor hockey, during which the senior boys apparently dominate the puck and give nobody else a chance to play. Some days gym is preempted by 'peer leadership,' which can involve either active or sedentary group bonding activities. All we can be certain of is that the whole thing is totally unpredictable. Therefore, adjusting basal rates didn't help. And changing the breakfast bolus was useless. Our next best hope was this:



Squeezy Applesauce!

Toddler applesauce has greatly reduced trips to the high school nurse's office. It's fifteen carbs provide slightly more nutritional value than a straight juice box. It's easier to consume while changing into one's gym clothes than a clementine or a handful of grapes. It's even sort-of fun? And, most importantly, it's working.

She makes the decision whether to consume a pouch before gym based on three factors: what her blood sugar currently is (usually based on the Dexcom, inclusive of arrows), what the day's anticipated activity is, and what time it is (she's more likely to drop fast if there's still a bunch of breakfast insulin on board). There are occasional problems, like when an anticipated floor hockey day becomes an unannounced outdoor running day due to good weather, or when she's had an unusual breakfast and the 'insulin on board' factor is harder to predict. But overall, this tactic is (thus far...knock on wood...fingers crossed) a winner.

Also a plus? We won't be running out of squeezy-sauce anytime soon due to today's 5/$9 sale at the grocery store. She's not sure about the new 'applegrape' flavor, but if you're sucking it down in three gulps, how much does flavor really matter?

Locked

On the first day of outdoor gym, after running increasingly fast sprints for half an hour, my daughter's blood sugar was low.  She grabbed a friend and went to tell the teacher.  The teacher, apparently a man of few words, pointed to my daughter's friend and said in what my daughter describes as a deep, gruff voice, "You. Take her to the nurse."

So off they went, to the door from which they had exited the building.  Locked.

They tried the 2 other doors on that side of the building.

Locked.

As they debated whether to go back to the gym class (a couple of hundred yards away) or to go to the building's front door which has an intercom system (maybe a bit closer but out of sight of the gym class), someone discovered them trying to get in and opened a door.

Yesterday there was more running outside and, despite an interim round of insulin adjusting, another low. 

"You. Take her to the nurse."

"Is the door unlocked?"

"Go to the front."

They were buzzed in.  Ten minutes later, still in the nurse's office, my daughter heard the bell ring.  She was still wearing her gym clothes and all of her belongings were still in the locker room which, they had been told, was locked when nobody was in it.  The nurse walked her to the gym (her bg was still 60) where the locker room was, indeed, locked. 

As my daughter wondered what her next move should be, the gym teacher of few words appeared . Unlocking the door, he asked,  "You wear a pump?"

"Yes and a dexcom- it's a continuous glucose monitor."

"Does it go to your phone?"  (Wait- what?  Does this guy speak my language, however succinctly?)

"No but my new one will."

"My niece has that."

"Cool.  Thanks for unlocking the door."

Gym blood sugar management may take a while to sort out and there are probably more impeding locks to contend with.  But at least we've learned that the gym teacher of few words gets it.  Even if he's a little brusque about it.

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.