Showing posts with label swimming. Show all posts
Showing posts with label swimming. Show all posts
What's That?
Little kid (pointing at Dexcom receiver on my daughter's belly): What's that?
My Kid: I wear it to keep me healthy!
(Little kid swims away/ continues eating popsicle/ asks about something completely different)
This conversation has repeated itself several times this summer at our town pool. These are usually kids who know my daughter's friends (neighbors, kids from camps they've volunteered at, relatives). These kids enjoy the opportunity to hang out with the 'big kids' for a while in the water or on the volleyball court. My daughter chose her stock answer at the beginning of the summer and so far it's worked every time.
These conversations are in significant contrast to those she's had this summer with new peer and adult acquaintances. These people want (or the case of the band director, for example, need) more complete answers to what the devices she wears and uses are, and how they work.
Through middle school, her social circle remained fairly static. As she starts to spend more time with the band kids, and with the people her middle school friends are collecting as they start new activities and endeavors, the explaining has begun again and the conversations have become longer. Recently examples include, 'why do you still have to poke your finger if you wear the dexcom?' and my daughter's personal favorite, 'what's your blood sugar usually?' These are a little harder to answer but they're thoughtful questions.
I'm glad her friends are interested in and concerned about her diabetes. High school means she'll be spending lots more time with her friends. The more they know, the better.
Though the conversation is certainly simpler with a 4 year old.
Watching
This summer marks the first when my daughter is sometimes hanging out at the town pool without me. She and her friends gather there in the afternoon after their assorted camps and volunteer activities. They bring snacks or money for the snack bar. They play volleyball, swim, and walk in circles around the pool grounds to see and be seen.
For me, it's an exercise in trust. First, I have to trust that our general routine and a healthy helping of good luck will keep her safe from any diabetes emergencies. Second, I have to trust her that she will keep an eye on herself and be aware of impending lows so that she can treat them. Thirdly, I have to trust that she will choose and bolus for her snacks wisely. And fourth I have to trust that she will 'remember' to reconnect her pump within a reasonable amount of time after swimming.
I still like to go to the pool too. On a hot day, some time in the lap lanes is my favorite form of exercise. When I can arrange to meet some other moms there in the late afternoon, it's fun to catch up. When I go, my daughter still sits with her friends and does her own thing. Which is interesting to watch.
One day as I watched, she ate a cookie, and bolused for it. She reconnected her pump after swimming, clipping it onto her bathing suit. She checked her dexcom after getting out of the water the second time and grabbed a handful of goldfish crackers, later telling me she was 80 and felt like she was going down.
Another day I watched as her friends waited patiently for her to reconnect her pump and gather her little bag before they headed for the snack bar after a swim. She bought sour patch kids and bolused for them, as evidenced by the blood sugar of 77 when we got home for dinner.
Would I rather she bring a container of grapes or pre-portioned packages of whole grain crackers to snack on? Of course. Do I worry about whether she's going to forget to reconnect her pump and end up super high? Yes. Do I wonder if she's relying too much on the dexcom and not actually checking with a meter while she's there. Sometimes.
But here's the thing: She's coming home with nice looking dexcom graphs and excellent pre-dinner blood sugars. She's obviously responsibly reconnecting her pump and bolusing for the junk food. She's noticing when she's trending low and grabbing a handful of something to stop the slide.
Really, this is a great opportunity to practice dealing with all kinds of diabetes issues on her own. She'll make mistakes this summer, I'm sure. I've made my fair share of them over the past 12 years when I've been in charge. Nobody's perfect.
But so far so good.
What Did I Miss?
Today, we'll look back 2 years to a pool party for all girl scouts from our area. As troop leader, I was there, in charge of feeding and keeping track of my group of fifth grade girls.
This was our first pool visit of the season. My daughter disconnected her pump and got in with her friends. They then got out and opened a couple of bags of chips. "Can I?" "Just a few." We'd delivered a correction bolus for a 200-ish number on the way to the pool. With the exercise, I figured a couple of chips couldn't be too bad. Plus, to be honest, it seemed like such a 'normal kid' thing to sit on a circle on beach towels with your 11 year old friends, talking, braiding each other's hair, and muching on chips.
After another swim, the pizza arrived. I did (to my credit) remind her to plug her pump back in and check. 230. I juggled the meter-remote, paper plates for all the girls, opening the grapes and watermelon, pointing out the drink cooler and providing napkins. I bolused for pizza and watermelon. I might have added the bg.
She ate, unplugged, and headed for the water slide. An hour later they came back for dessert. A cupcake and 2 mini girl scout cookies. She was already partway through the cupcake when I realized she hadn't checked again. She was reading the box for the cookies (reclaiming a bit of good will). "4 each, mom." I had made the cupcakes, so had a number in my head for those. Still juggling dessert requests and napkins, I bolused. I glanced over. She had no pump attached. She plugged in and we bolused again.
Half an hour later, she found me talking with a mom on the other side of the pool. A friend's sister's troop and given our troop mini fire cracker pops. Could she eat hers (which she was holding, open, in her hand)? From the cobwebs of my brain came the knowledge that these were 'only' 9 carbs. I gave the o.k. She was standing there with her friends, on the way to the shuffleboard court. She bolused for it when she got back to the table.
Once we'd packed up and gotten in the car, her blood sugar was around the 250 mark. She corrected and had some water when she got home. An hour later, still 250. Obviously, the whole evening was riddled with diabetes mis-steps. Chips with no insulin (probably more than a few), not accounting for missed insulin in the pool, a dinner diet of pizza, chips, watermelon, cupcakes, cookies and popsicles. Everything was bolused for on the fly, often after the food was partially consumed.
Yet, you diabetes detectives out there, there's one more big reason that high number didn't come down.
Anybody guess it?
I had bolused for dessert while the pump was detached. Then again when it was. The pump included all of that insulin in the insulin on board total. So when we went to correct the 250 after the party, it gave very little, assuming a whole extra cupcake and 2 cookie's worth of insulin was still hanging around.
Any 'party by the pool' event is a challenge, diabetes-wise. The level of difficulty rises exponentially if I'm in charge of more people than my own kid. In the end, it was a fun evening and the 250 came down quickly once I'd realized the error of my ways. But keeping track of diabetes at this kind of event is a full-time job.
This was our first pool visit of the season. My daughter disconnected her pump and got in with her friends. They then got out and opened a couple of bags of chips. "Can I?" "Just a few." We'd delivered a correction bolus for a 200-ish number on the way to the pool. With the exercise, I figured a couple of chips couldn't be too bad. Plus, to be honest, it seemed like such a 'normal kid' thing to sit on a circle on beach towels with your 11 year old friends, talking, braiding each other's hair, and muching on chips.
After another swim, the pizza arrived. I did (to my credit) remind her to plug her pump back in and check. 230. I juggled the meter-remote, paper plates for all the girls, opening the grapes and watermelon, pointing out the drink cooler and providing napkins. I bolused for pizza and watermelon. I might have added the bg.
She ate, unplugged, and headed for the water slide. An hour later they came back for dessert. A cupcake and 2 mini girl scout cookies. She was already partway through the cupcake when I realized she hadn't checked again. She was reading the box for the cookies (reclaiming a bit of good will). "4 each, mom." I had made the cupcakes, so had a number in my head for those. Still juggling dessert requests and napkins, I bolused. I glanced over. She had no pump attached. She plugged in and we bolused again.
Half an hour later, she found me talking with a mom on the other side of the pool. A friend's sister's troop and given our troop mini fire cracker pops. Could she eat hers (which she was holding, open, in her hand)? From the cobwebs of my brain came the knowledge that these were 'only' 9 carbs. I gave the o.k. She was standing there with her friends, on the way to the shuffleboard court. She bolused for it when she got back to the table.
Once we'd packed up and gotten in the car, her blood sugar was around the 250 mark. She corrected and had some water when she got home. An hour later, still 250. Obviously, the whole evening was riddled with diabetes mis-steps. Chips with no insulin (probably more than a few), not accounting for missed insulin in the pool, a dinner diet of pizza, chips, watermelon, cupcakes, cookies and popsicles. Everything was bolused for on the fly, often after the food was partially consumed.
Yet, you diabetes detectives out there, there's one more big reason that high number didn't come down.
Anybody guess it?
I had bolused for dessert while the pump was detached. Then again when it was. The pump included all of that insulin in the insulin on board total. So when we went to correct the 250 after the party, it gave very little, assuming a whole extra cupcake and 2 cookie's worth of insulin was still hanging around.
Any 'party by the pool' event is a challenge, diabetes-wise. The level of difficulty rises exponentially if I'm in charge of more people than my own kid. In the end, it was a fun evening and the 250 came down quickly once I'd realized the error of my ways. But keeping track of diabetes at this kind of event is a full-time job.
Armed (and Dangerous?)
The birthday party challenges keep coming this spring. The latest was an invitation to a celebration at a restaurant serving a buffet brunch. Mulling it over, I shared the invite with my daughter, offering her an alternative option. If she didn't want to manage the diabetes aspects of a buffet brunch alone, she could join the group after brunch for the pool party which would round out the afternoon.
"I really think I can do it!" was the overwhelmingly self-confident response.
What could I say?
What was the worst that could happen?
How would we ever get to an overnight road trip with friends without first allowing smaller steps like this one?
So she went to a very nice restaurant with beautiful water views to have brunch with a few of her friends and two brave parents. Armed with her pump, dexcom, cell phone and calorie king app, she was otherwise on her own.
After a two mimosa brunch of my own and a comforting mid-afternoon ice cream stand stop, I picked her up at the pool at 5:45. She was smiling from ear to ear and recounted in great detail all of the food she'd enjoyed. She loved the restaurant, being with her friends, and playing volleyball at the pool.
Diabetes-wise? The Dexcom graph included dots on almost every level of its screen. By 6 it just read 'high,' and stayed that way for over an hour despite two major corrections. The meter's remote showed that over 100 grams of carbs had been bolused for at brunch, and that corrections had been given at 2 and 4 for numbers in the 150-200 range. She had unplugged the pump twice to swim but not for long since the water was "freezing."
As far as I can tell, she did all that she could, and I made sure she understood that. A discussion of the desserts she sampled leads me to believe she under-calculated their carbs but since miniature pastries aren't on our regular menu, she was forced to guess. The real problems didn't start until almost 4 hours after brunch, probably when the fat from the {still unclear to me number of} pieces of bacon she ate met the 105 + brunch carbs and the handful of pretzels she bolused for at the pool. Truth is, she could easily have hit 400 whether I was with her or not. Buffets are hard. Mystery foods are hard. Add into the mix frigid pool water which tends to spike her, unplugging to swim, and a healthy amount of excitement, and the results are not entirely unexpected.
All we can do is try to learn from the experience. Mini pastries have more carbs than expected and should be consumed in limited quantities. Balancing high carb and fatty foods from the buffet with a few lighter options might mitigate disastrous blood sugar results. Following a heavy meal with an adrenaline-producing dip in ice water while the pump is unplugged shouldn't be a regular occurance.
You may think it was dangerous to send a 12 year old with diabetes to navigate a buffet brunch. Perhaps a little bit. But really, on some level, it's dangerous to send a 12 year old with diabetes anywhere. The best I can do is to arm her with the tools and knowledge she needs to take care of herself, and with confidence. Despite the results, this was definitely a confidence-building experience. For both of us.
Swimming
It gets us every summer, this swimming thing. The afternoon goes like this:
Arrive at pool (or if on vacation - beach) around 2. Immediately disconnect and run into water.
Become hungry around 3:30. Test, reconnect, snack on crackers and/or fruit.
Disconnect to swim again by 4.
Reconnect between 5 and 6.
What I have learned is that, for my child trying to give the missing basal insulin before-hand can and usually does backfire. Two thirds of the time, she'll come out low by 3:30. Deciding this is dangerous anytime, but particularly when waves or water slides are in the picture, we've abandoned that tactic.
We do bolus snack, tacking on any needed correction and just a smidge more to that bolus.
That combination yields an acceptable number by the time she reconnects.
It's after that when the whole thing begins to catch up with her. Unless there's a brisk after-dinner walk or some other unusual evening activity, there's an inevitable high by 9:00.
Yes, a tubeless pump or the 'untethered regimen' could help with this problem, but neither option is on our table at the moment, so we continue our quest for the next best answer.
If only I were a more 'scientific-method' type of thinker. I'd make some charts and create a well-planned experiment.
In reality, though, using the scientific method requires accounting for all possible variables before you can claim you've proven a hypothesis. I can see us at the pool with a stopwatch, timing the connecting and disconnecting windows. She'd also have to engage in the same types of pool activities each day. Practicing her swimming strokes for an hour is different from repeatedly jumping off the edge. Eating the same dinner every night would get old too. That impromptu after dinner walk could skew a whole day's results.
Instead I hapahazardly try a variety of tactics, figuratively closing my eyes and hoping one of them will work (and that I remember what I did so I can do it again tomorrow). If I figure it out, I'll be sure to blog about it here so I can refer back to it next summer.
Arrive at pool (or if on vacation - beach) around 2. Immediately disconnect and run into water.
Become hungry around 3:30. Test, reconnect, snack on crackers and/or fruit.
Disconnect to swim again by 4.
Reconnect between 5 and 6.
What I have learned is that, for my child trying to give the missing basal insulin before-hand can and usually does backfire. Two thirds of the time, she'll come out low by 3:30. Deciding this is dangerous anytime, but particularly when waves or water slides are in the picture, we've abandoned that tactic.
We do bolus snack, tacking on any needed correction and just a smidge more to that bolus.
That combination yields an acceptable number by the time she reconnects.
It's after that when the whole thing begins to catch up with her. Unless there's a brisk after-dinner walk or some other unusual evening activity, there's an inevitable high by 9:00.
Yes, a tubeless pump or the 'untethered regimen' could help with this problem, but neither option is on our table at the moment, so we continue our quest for the next best answer.
If only I were a more 'scientific-method' type of thinker. I'd make some charts and create a well-planned experiment.
In reality, though, using the scientific method requires accounting for all possible variables before you can claim you've proven a hypothesis. I can see us at the pool with a stopwatch, timing the connecting and disconnecting windows. She'd also have to engage in the same types of pool activities each day. Practicing her swimming strokes for an hour is different from repeatedly jumping off the edge. Eating the same dinner every night would get old too. That impromptu after dinner walk could skew a whole day's results.
Instead I hapahazardly try a variety of tactics, figuratively closing my eyes and hoping one of them will work (and that I remember what I did so I can do it again tomorrow). If I figure it out, I'll be sure to blog about it here so I can refer back to it next summer.
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