exercise and hormones

Ok, moms of teenage boys, get ready to chime in! Taylor had another big hockey weekend. I reminded him to watch his numbers closely while driving, because he tends to really spike when he's sitting in car/plane for a long time. He stayed in the upper one hundreds throughout the drive, spiked into upper 300's (hormones, or missed carb count?)after dinner,... then dove into the 40's twice overnight. Day 2, into the first hockey game at 199, came out at 565!! He gave 1/4 the correction calculated by the pump, down to 130 for the next game, a little low for our comfort!!! He felt so awful, all he could do was recover in bed between games, of course his teamates were chillin' I think it's a crazy combination of exercise, hormones, and shotty carb counting. But the bottom line is, as always, he's trying to do his best. What a rough time, forced him to put in a sensor tonight so I could sleep, hardly fair do you think? At least the coach apologized for yelling at him in the first game, it's a start! Anybody who can relate?

Cathy Gipson
Mother of Taylor, 18 year old college freshman

Hi Cathy, that is sooo hard on all of you. 40s overnight is too close for comfort, so you both benefit when the sensor goes on for bed. I know from traveling with Michael that the plane ride can really bust up his numbers, so we test more often, but I remember it was unpredictable and frustrating so I feel for you. We had a real serious scare due to exercise, faulty covering, and hormones, so I am all over this. What's been working for us so far is: Michael tests before gym and he goes regularly at about 4:30. He needs to be 180-225. If he's under that he'll eat something, (pb crackers, zone bar) if over that, he'll correct for half. If he's over 300, he doesn't work out, but that is rare. He always brings a vitamin water/sport drink like G2 or Propel that has about 15 carbs per serving and he drinks that over the hour. He always tests when he returns and can be 90-150 depending on his workout. He'll only cover for half his dinner. He is not allowed to snack after 7:00 so that his number at 10 is a true number before bed. He'll snack after ten if he wants. He always go to bed, regardless of the gym or not, making sure his number will be 150-200 and snacks or covers to get it there. When he plays football or the drums, it's close to the same routine.

It's very regimented, but it's second nature now. And since he went on the omnipod, his control is much better. I read a very interesting study that came out recently that found that the accuracy of the insulin delivery through the tubing is dramatically affected by its placement. I'm always a little leary of "studies" but I think this is legitimate and makes sense:

Kathy, Mom of Mike, 16 yr old T1 since Aug 2007

Kathy,
Sounds like our boys were separated at birth! The big challenge for us is that the hockey games can be so late at night, he often gets off the ice about 10-11 p.m. We do the same, exercise, eat, 1/2 to 1/4 correction (only over 300), test, test, test. I agree with Val to a point,(about self-care) as you said, but as my endo said after his first seizure, if they are really low, they can't make decisions for themselves. He crashed last night again (39 @3:30 a.m.), gave him 50 g. of juice, he did not want me to leave. Wanted me in bed with him, he was scared. Please tell me Tammy is preventing these extremes!! I know Rachel has reassured me, but the more testimonials, the better I feel! thanks

Cathy Gipson
Mother of Taylor, 18 year old college freshman

Yes Cathy - Tammy definitely prevents these extremes. Tammy is consistently 30 minutes ahead and (at times) she's been 45 - 1 hour ahead of a slow drop. After running, swimming, soccer, or other sports, he drops so much more quickly, that she's usually only about 20 - 30 minutes ahead. Our exercise routine is very similar except that it does not matter what his BS is at bedtime.....lots of exercise almost always "shows up" 6 - 9 hours later....usually 2 - 4 a.m. As a matter of fact, that's how his first seizure 9 yrs ago (at age 6) came about. Those were the days of syringes (humalog & NPH), sliding scale corrections, limited carbs, and scheduled snacks. Since we've gotton Tammy, I sleep a lot less! I know.....you're probably saying "LESS! I thought a DAD is supposed to allow me to have a peaceful nights sleep". I never realized how much Brady fluctuates during the night until Tammy. She lets me know when he gets <90 or >180. However, we've been able to get a clearer picture of Brady's basal patterns & I've seen a slow improvement.

Kathy (with a K ) - What do you mean by "went on the OmniPod"? Did he switch from a different pump? We will have to switch to another pump next fall because the warranty on his discontinued Cozmo will expire. I had looked into the OmniPod but my Endo said she wasn't very impressed with the OmniPod but to keep my eyes open because she thought they were working to improve it. Please give me your opinion.
Also, what do you mean by "placement of the tubing"? Do you mean the actual tubing or placement of the site? Kathy - you are very lucky that your regiment always has such predictable outcomes . That's awesome! We've had many routines through the years. They'll work until the next growth spurt, then we have to come up with something new. The word "control" always makes the hair on the back of my neck stand up. "Control" for Brady means inevitable lows........that's just the way he's made. We try not to even use that word around here.....it only makes Brady feel unsucessful

***I'm so glad this section was created. Teenage, hormonal boys are a very different battle **

Bridget - it wasn't always so, and it may not last forever, but for now Michael is fairly predictable. We were first on syringes, then pens, then after his seizure I insisted on the pump. He tried the medtronic but didn't like it and eventually went to the Omnipod. My endo has nothing negative to say about it and neither do I. He likes it a lot. Sorry I freaked you out with that word "Control!" I can appreciate that, but it means something very reassuring to me. Figuring this out is an art, not a science. We thought we were doing so great when Michael was on the pen and his A1c at 6.4. But just like Val said in an earlier post, tight control (meaning staying within a desirable range 80-150) has shown to cause hypo events 3x more than staying higher. And sure enough, we had a real scare. So now our normal is different for different times of the day and different days of the week. We are "aware" more than "in control." The tubing issue is not something I mention out of experience, just an article I thought would be helpful to others so I passed it on. I thought I included the link in my post, but I don't see it. Sorry. I'll try to go back and find it. Google "tubing placement diabetes study" and you'll find it.

Kathy, Mom of Mike, 16 yr old T1 since Aug 2007

The link was in your post - but it was sort of tricky - I think you actually have to "click on" your name- for some reason, the hyperlink is embedded in your signature. I read the article and was very interesting, but I have to add: Abi LOVES her Animas Ping!!

Rachel, mom of Abi and biggest fan of Mr Darcy!!
Wildrose Diabetic Alert Dogs, Masters of Scent

Kathy - you didn't freak me out Since Tammy, people have thrown that word in my face more-times-than-i-care-to-mention. I've heard "wow - I didn't realize he was so out of control" or "does he have a hard time controlling his diabetes" or (my favorite) "i thought you always had good control of his diabetes". ...... I need to change the subject........

Anway, I thought the OmniPod looked cool because of the remote inserter. Brady is 5'6" - 110 lbs.....very, very lean so he can only use his "back side" which makes it very hard with the Quick Sets - unless I do it but he'd much rather do it himself. Remember those self-inserters they came out with a few years ago that was supposed to be the greatest thing ever (i think it was called CLEO???). Great idea but it never stayed in. He would always find it laying in his boxers, not attached. Is the OmniPod as easy to insert as it looks? I think maybe Brady could use that in his arm, too. He has NO stomach or legs so his sites are limited.

Rachel - the PING looks awesome, too! What kind of infusion set does Abi use?

Bridget,

Abbie is five, and we use the Animas Ping. The Inset 30 is great for her lean little tummy. It also works good on her arms and legs. The needle goes in at a 45 degree angle, so less fat is needed.

Shana, mother of Abbie (6 yo Diabetic) & Gracie (Wildrose DAD pup)

Bridget,
Sorry, got Tammy and Trigger mixed up! Yes, my favorite question is "is his diabetes bad?" Is any diabetes good!!! We definitely have different limits for times, days, and activities. Thank goodness our DNE is diabetic herself, and so in tune to Taylor. She just raised his target from 100 to 130 because he was in a 2 week low...and she says, "I know he doesn't like to get low, and that's o.k." She doesn't have a problem with him waking up at 200 if he doesn't get low. She just gets it! We have also been trying a reduced basal for the entire night after hockey, that seems to help as well. Taylor has such a crazy schedule, different classes and different activities on different days, that doesn't help either! Just my "2 cents" on lean kids and sites, Taylor is stout, but lean (does that make sense?) He has no fat!! He uses the Minimed with the Silhouette sites (angled) He's always asking for the "straight-in" sites, but Tami, the DNE, laughs at him and says it will never stay in. She's just an angel, she has even offered, more than once, to "shadow" him for several days to help figure out his issues. She would do it too, for nothing! Taylor has promised her that when he makes the NHL (his dream), that he's going to hire her as his consultant and build her a house next door. She's definitely one bright spot in all of this! I just appreciate hearing from other moms in the same "boat", thanks

Cathy Gipson
Mother of Taylor, 18 year old college freshman

Shana - is the Inset 30 self-inserting? We used self-inserting sets for years because we could insert at a 30 degree angle but I had to do it (Brady could not insert these by himself into his back side). After about 5 years, Brady, said "NO" to anymore self inserting sets. Ours is 90 degree but because it's in the "back", there's no problem. Brady's stomach is a true "six-pack" with some skin pulled taunt over it. When I say no space, I literally mean if we were to insert at 30 degree, it would be an IM insertion. His legs are just as bad. Our Endo just shakes her head when she gives him the routine head-to-toe check. I really think he could handle one on the back of his arm, though, but unless it was tubeless like the OmniPod, I'm sure it would get ripped out or knocked out during any sport. Can you tell I'm leaning towards the OmniPod

I guess the whole point is we are all getting these high schoolers ready to be on their own so if they can't change their own infusion set, college life is gonna suck

I agree Cathy - our Diabetes NP has been seeing Brady since he was 4 - she's like his second mom. What in the world are we going to do when we have to transition out of pediatrics & into adult medicine??? I will be very sad.

Bridget,

I have to insert the Inset 30 for Abbie. Brady would have to have help with it. It is not tubeless, and I am sure it would get pulled out during sports.

Abbie was diagnosed at 4 and went on the pump 4 months later. This is all still relatively new. I am not familiar with the OmniPod, but it sounds great!

It is scary reading all that Brady, Michael, and Taylor are going though. I will keep them in my prayers. I really appreciate everyone sharing their experiences. I am learning so much just by reading your posts. Thank you for sharing.

Shana, mother of Abbie (6 yo Diabetic) & Gracie (Wildrose DAD pup)

Yes, the Omnipod is really easy to insert, but it takes a little getting used to the sensation. You insert the insulin into the pod, peel off the backing, stick it where you want it, and tell the PDM to activate the pod and it inserts the cannula. It's nothing for him to change it. It can get pulled off and it can come undone during serious athletics, but you can put an elastic bandage over it or put extra tape on. I find the only drawback is that if there is a problem with the pod or it comes undone, it cannot be reattached and the pod and the insulin inside is lost. I'm a real "waste not want not" type so that bugs me, but now that we've ironed out the kinks, it doesn't happen very often.

He mostly wears it on the back of his arm and the fatty part at the hip above the butt.

Shana you are sooo good to remember my kid in your prayers, and I will do the same for you and your Abbie! I learn so much from hearing about everyone's experience, it's truly priceless.

Kathy, Mom of Mike, 16 yr old T1 since Aug 2007

Kathy - if you get a chance, can you share the "kinks" you worked out so that (if/when we switch to the OmniPod), we can start off on the right foot. I wonder if I could use some of my cartridge sets (I have a ton) & just suck the insulin out of the Pod? Would that work? Just wondering because I'm like you, I hate wasting anything....especially insulin. I remember just how horrible/scary our life was about 4 yrs ago when we were un-insured & had to buy insulin on our own....it nearly destroyed us Even when we change cartridges in his pump, now, I remind him to suck out every tiny bit of insulin left behind in the old cartridge!

It's nice knowing there's someone else living the same life. No one else understands our world. Thanks SO MUCH for sharing - I have a special spot for little Abbie.....I understand how hard it is when they're so small - my prayers are with all of you

Kindest Regards

Hey Bridget - for instance, Michael kept on pulling the pod out when he took his backpack on and off, and he just repositioned his pod a little and put his backpack on a little differently and now it never happens. Also, checking in with the pdm to see how much insulin is left in the pod so you're prepared. It's just a new awareness, and like a lot of change is a little frustrating at first. The DNE had him wear a pod and work it with saline for a week to prepare for pump day so the transition was very smooth.

I wish!! we could reinsert a pod and/or get out the insulin, but no, not unless there's a trick I don't know about...

Kathy, Mom of Mike, 16 yr old T1 since Aug 2007