I'm looking for suggestions. My 9yr old daughter is taking advantage of her time off from school to take multiple dance classes back to back (up to 3 hrs in a row, 4 days a week). During dance she does not wear her pump, she says it moves too much etc.... Any suggestions on how best to prevent these post exercise highs we're seeing as a result of the missed basal? It takes a few hours for her sugars to come back down and they are climbing to the upper 200's lower 300's. I have had her connect up between classes and do corrections if she is high during class which has shortened the duration of the post highs but should I maybe set an increased temp basal before the start of her first class for a couple hours? Last night I gave her a bolus in the amount of the total missed basal for one hour after her last class in addition to a correction and 2.5 later she had a mild low (10 carbs took care of it quick). Thanks!
I would try to figure out a way to keep the pump attached. I have recently purchased a FlipBelt and I think it would stay in place. Or shove it inside her leotard or tights or whatever it is she wears. You could definitely try increasing the basal right before taking it off but you don't want any lows happening. I have found that when I shut my pump off or low during longer runs (60minutes plus) I experience highs for up to three hours after I've finished the run. And sometimes it lasts through the next day! So I've had to figure out a lower temp basal during the run and then turn up the basal afterwards. It was strange...But hey, the life of a diabetic!
I agree with this. 3 hours is a long time to go without any insulin, and for a kiddo who is exercising I would be very concerned. I understand the reason for removing it, but finding a way to secure it so it won't move is worth a try. The replacing of the bolus later and then corrections are really stacking and not the safest way to manage this. I hope your daughter will consider keeping her pump on.
Hm... I think your best bet would be to keep it attached somehow. Have you tried those spandex type wraps they make for active kids to keep their pump in place?
I agree keeping it on is the best solution. Just wondering if there are any other work arounds people use with success. If it were me, I'd keep it on. It's not me, it's my 9 yr old and I was hoping not to make this a big battle - she really doesn't like to wear it during class (and corrects in private between classes). She does wear her pump at home when she dances which is all the time. Hummmnnn.....
caseylynn suggested a FlipBelt which would work. There is another one called SPIbelt, they have different size options. Your 9 yr old could pick out her own, and then she is making the decision. She should not be making the decision not to wear the pump at all. I suspect she may be embarrassed or not want to be different or look different than her peers at the class. Now is the time to try to eliminate those type of feelings and help her find ways to enjoy the things she loves and not put her health at risk. Don't forget that you are the mom Alissa, I think it is beautiful that you want to be thoughtful for your kiddo. Sometimes we have to say no :(
do they make Spibelts(sp?) for kids? I heard it is a good choice for securing the pump, but I have not used it. The issue is probably not the pump interfering with dancing, as she dances at home with it..Maybe she is feeling "different" as a diabetic? Any chance you can get her in a children's diabetic group in person or online?.. Maybe too late for diabetes summer camp; But worth a try so she can see that other diabetic kids wear their pumps when dancing and exercising.. Any diabetic dance divas out there who can help to advise Alissa and her young one?
God bless,
Brunetta
Naomi has a belt that will work, she wears one every day. I'll see if she would want a different one that would more closely resemble the top of workout pants/shorts to make it less apparent. I realize I'm the mom and there are times I have to say no. I thought I'd check this site in case there was another route for this particular situation that I hadn't thought of. I really didn't want to have to force this one. I say no to Naomi all the time. I am trying to let her be a kid first, diabetes second. Oh and she's going to camp, it's in August - wouldn't miss it!
Yay, Alissa, I am glad to read all that. How great that she is going to camp / she will have so much fun. I hope you don't have to say no to often...LOL. I think your ddd is a lucky kid.
Oh, And they do make SPIbelts just for kids and just for diabetes :)
If you're running up with activity, the only way to avoid it is with insulin. You could try bolusing to make up for missed basal but I don't like to do that with activity. I wore a pump through about a year of strenuous Tae Kwon do classes and it worked fine.
I got a Tummietote this summer because I needed to keep a ton of supplies on me at once. I chose it over the Spibelt partially because it seemed it would move around less.
The Tummietote stays exactly where I put it, unless it's on a curve. Even then, the only reason why it doesn't stay is because I have 2 epi-pens in there and they mess everything up because they're big and completely inflexible.
If you're just putting a pump inside the Tummietote, it shouldn't show through her shirt at all unless it's a tight shirt. They're adjustable, too, so you can make it tighter so it won't move around at all.
Overall, I actually find it so comfortable to wear that I wear it around the house to keep my iPod in when I'm doing chores. I'd wear it 24/7 if my sister wouldn't make fun of me for being weird since there'd be nothing in it then.
AGREE! These tummietotes are so comfortable that you don't want to take them off. And you can hardly see the pump. All kinds of neat colors - I really think an 9-year old would love them!
www.tallygear.com
Hi. What I would do is reconnect once per hour and take a bolus equaling one hour's basal, reduced for exertion.
Doing a large pre-boulis or pre-basil is dangerous and likely ineffective. Usually the insulin the pump will peak in about 2 hours, and dissipate in 3 to 4. So just as your 9 year old is hitting her stride in dance, she will be hitting her peak in an over used insulin. I would really be leery of doing that. I think the belts are a great idea.
Here is another off the wall idea. (Remember this is off the wall so everyone else don't jump on me for being uneducated) What you might do is call the doctor and tell them of the issue and see if they can prescribe a longer peak insulin. Maybe a 4 hour peak or even an 8 hour peak to be given by injection. In this way when the pump is off she will be getting an ever increasing effective dose of insulin with a longer peak time. Then when she is done she can go back to the pump and adjust basil as needed. I would suggest maybe 60%, then an hour later 70% etc. I mean do what you doctor says for sure, that is just a random thought.
In the days before pumps we woudl attack this with longer acting insulin and then short blasts of shorter acting insulin if needed. This is sort of the same thing I am suggesting, but just throwing in the pump to get restarted. Just an idea. not a prescription.
PS: the belt is the best way to go even if your doctor figures out a plan like that I suggested, you will have better control longer if you can use the belt.
As a cheerleader who practices in somewhat teh same ish clothing as dance I would suggest the tummie tote as it won't get caught on clothing or people if they are close together for lifts or anything like that. The tummie tote kinda looks like the top of lululemon pants (yoga pants) so I think this would be the best option to be able to wear the pump while dancing.
Thanks everyone for your suggestions! Naomi had a 2.5 hr long class yesterday and wore her little black belt that she wears all the time. I offered to buy her a new belt in a fabric she liked from Tallygear and she didn't want one. I gave her -10% basal starting 2 hours prior to dance starting, decreased her I:C ratio and ended the temp basal 30 mins before class was over. Guess what? 110-140 the entire time and had GREAT numbers all day. Guess who had pizza for a late lunch and even the pizza never went over 170! I call it a fist run success! Now hopefully her other dance classes will go as well (they are normally in the evening, this one was in the morning) and the kids won't stare and give her looks like she is weird.
Sounds like you have it down! Congrats :)
Here is my late to the game, off the wall idea - what if she took a pump break for the summer and went back to long and short acting injections? Just some food for thought!
or un-tethering?: http://en.wikipedia.org/wiki/Untethered_regimen
Thanks Kate! I offered the idea of MDI to my daughter and she looked at me like I had totally lost my mind. :) I had thought about the un-tethering a bit myself and if she runs into problems on a regular basis then that is something I will surly consider. :)