Summer is almost over (officially) for us, and I have been taking notes and pictures all season long. But let’s get real. We live in Alabama and it will be hot through October! So these tips and products are relevant for us most of the year.
This is our fifth summer with type 1 diabetes tagging along. For us summer means longer days, and playing in water. Sprinklers, rain puddles, wading pools, our neighborhood pool, the Gulf. You name it, my kids want to play in it. Summer also means more physical activity that can lower blood sugar, heat that can affect insulin absorption and effectiveness, and sweat that can make medical device adhesive slip off faster than my makeup on an Alabama July afternoon.We have found a few things that have helped us enjoy the season with a little less stress and thought we would share what we have found so far. Here are seven things that make Grasshopper’s summer with T1D a little bit better.
1. Overpack Diabetes Supplies
Overnight trip? Pack like you’ll be there for three days. Four day weekend? Pack like you’ll be there a week. Vacation with water involved? Pack. All. The. Things. (Ok, you don’t have to bring your kitchen cabinet, but you get the idea.)For Memorial Day weekend we went to the beach with family. We planned to stay four days from Friday through Tuesday. I had just changed Grasshopper’s insulin infusion site on Thursday so he wasn’t due for another site change until Sunday. Technically I should be able to just pack 1 site change for the whole trip but… we know how playing hard can rip off a site or bend a cannula.
With the extra friction of sand, salt water, and an active day, sites can fail. I packed enough supplies to change his site once a day if needed. We didn’t need all of them, thankfully, but since we had more than enough when his site did fall off we were able to put a new one on and go about our day of fun.
Pack backup supplies too, if you can. If you use a pump, or a pen, pack syringes in case of equipment failure. If you use syringes, pack more than you think you will use. If you are in the USA, consider using a national chain pharmacy. If you need to transfer a prescription to another location in the same chain near your vacation spot within the USA, it is relatively easy to do. Also consider asking your doctor for a printed copy of your prescriptions to keep on hand when you travel.
2. Hydration Is Key
Playing in the sun can make a body lose water quickly. Everyone regardless of T1D should stay well hydrated, but high blood sugar in people with T1D can cause dehydration to happen more quickly. High blood sugar plus a lack of insulin plus dehydration can lead to diabetic ketoacidosis (DKA) and it can progress rapidly. Not drinking enough water can increase the risk of DKA. Remember that caffeine and alcohol have a diuretic effect and can make it harder to stay well hydrated. Plain old water is great, but if you want some variety, there are plenty of options.
If you are trying to avoid artificial sweeteners and dyes, here are some beverages to try:
- Add a slice or two of lemon, lime, or your favorite fruit to your water for a hint of flavor.
- Spindrift is unsweetened carbonated water with a hint of flavor from real juices. There are 8 flavors with between 0-3 grams of carbs.
- Zevia soda is carbonated, sweetened with Stevia and available in 14 zero carb flavors including fruit flavors, cola, caffeinated and non-caffinated.
- Hint is water with a hint of flavor in over 15 zero carb flavors.
- La Croix is carbonated water with a bit of flavor in 20 varieties, all at zero carbs per can.
- Celestial Seasonings herbal teas make great zero carb iced tea for the summer.
- Stur liquid water enhancing drops and powders are sweetened with stevia, use organic flavorings and colorings, and have between 1-5 grams of carbs per serving.
Other drinks we use which DO have artificial sweeteners and colors include:
- Sparkling Ice is a carbonated, fruit flavored soda sweetened with sucralose in 16 varieties, all at zero carbs.
- Crystal Light is a well known zero carb powdered drink option sweetened with aspartame which comes in many flavors.
- Crystal Light Pure comes in five flavors, is sweetened with Truvia and sugar and is 1 gram of carb per serving. There are 2 servings per packet.
- Sprite Zero has zero carbs, a classic lemon-lime flavor and is sweetened with aspartame.
- Mio liquid water enhancing drops feature 10 original flavors, all zero carbs and sweetened with sucralose.
- Koolaid makes a water enhancing drop in 7 flavors, sweetened with sucralose and zero carbs.
- Dasani drops are sweetened with sucralose, and come in 6 zero carb flavors.
3. Bring Snacks & Low Blood Sugar Supplies Everywhere
The last thing you want to do is interrupt your day by leaving your summer fun to raise your blood sugar. Bring plenty of fast acting sugars to treat low blood sugar and plenty of longer acting carbohydrate snacks to keep blood sugar up wherever you are.All the heat and the outdoor summer fun activities can mean you need to have more supplies at your side than normal. If you have it on hand you can easily treat a low while you still have your toes in sand and waves. It is difficult to see Grasshopper’s Dexcom graph in the photo above but it indicated his blood sugar was 94⬇️ so his blood sugar was dropping rapidly. If we were having a quiet day indoors I might have let that go and just watched the graph for a bit. Since he had already been running around playing on the beach for an hour already, I treated it as a low with a glucose tab of 5 grams for fast acting carbs and a mini box of raisins with 11 grams of carbs. For Grasshopper dried fruit is not a fast acting carbohydrate but it will help bring up his blood sugar and keep it steady for a little while.
4. Keep Insulin Cool
Insulin should be kept cool in order to keep its potency. We use a Frio Wallet to keep insulin cool in the ridiculously hot Southern USA summers. We got the Frio before Grasshopper was using an insulin pump and we used it for everyday insulin carrying. We still use it now to hold his current vial of insulin, plus his insulin pens in case of pump failure. Usually we don’t have the cooling pouch activated and we store it in the fridge. When we travel we put the whole pouch in our cooler, but not directly on ice packs. The pouch also helps to insulate the insulin from getting too cold and freezing. Insulin is like Goldilocks. The temperature has to be just right! For a day of playing on the beach, in the waves, and in the pool, we keep Grasshopper’s Animus Ping pump on him in his pump pouch around his waist. The fact that it is waterproof is one of the main reasons we chose it. We were distraught when the company closed operations and exited the insulin pump market. We will have to choose a new pump. In any case, during this trip Grasshopper decided he wanted to try the hot tub. He did, but we removed his pump while he was in the hot water. I didn’t want to risk the insulin in the tubing and pump reservoir getting too hot and reducing its effectiveness.
If you use multiple daily injections (MDI) instead of an insulin pump, heat can still affect insulin in your body. Avoid getting into a hot tub, hot bath or hot shower immediately after giving an injection of insulin. Immersing the body in hot water can cause blood vessels to expand and can cause insulin to be absorbed more quickly than usual, resulting in rapidly dropping blood sugar.
5. Try Products to Help Keep Devices On, Safely Nearby, and Comfortable
Adhesive Overlay Patches
No one wants to have a infusion site or continuous glucose monitor (CGM) fall off before it is time to change it! Devices and medical supplies are expensive and some are painful to insert. Keeping them on saves money, time, and effort. There are a variety of patches on the market which help keep medical devices securely on the body and help keep devices on for their full duration during hot, sweaty, and water based summer activities. Most come in a wide assortment of colors, patterns, and with a choice of cut out shapes to accommodate the various medical devices worn by people with diabetes.
- Grif Grips are the adhesive patches that Grasshopper uses to keep his Dexcom and Animus Ping infusion sites secure while playing in the water. The company is based in Huntsville, Alabama and their adhesive patch products come in a wide variety of shapes, colors and cutouts for different medical devices.
- Sugar Patch uses a medical grade hypoallergenic nonwoven spunlace polyester tape.
- Stay Put Medical features a two part application.
- RockADex is based out of Australia. There are satellite Rock A Dex sites in the UK, Canada and the USA, so check out a location closest to you for faster shipping.
- Rock Tape, KT Tape, and Kinesio Tape are all flexible kinesiology tape that can be cut to accommodate devices or applied over them.
- Opsite Flexifix is a transparent tape that can be used under or over medical devices.
- Skin Tac Liquid Adhesive Barrier and Adhesive Barrier Wipes provide a tacky surface on the skin so that medical device adhesives can stick to the skin better.
- Johnson & Johnson Tough Pads are wound care pads made for helping to seal out dirt and heal cuts and scrapes. Some people with diabetes develop itchy allergic reactions to the adhesives used to keep medical devices attached to the skin. Tough Pads are used as a barrier between the skin and medical device adhesives.
- CVS Hydrocolloid Pads are a more affordable version of Johnson and Johnson Tough Pads.
- Sleeves can help keep medical devices secure so that even if they loosen, they don’t fall off the body. Here are just a few sleeve companies: Sleek Sleeves, Bands 4 Life, Wearing Dabbee.
- Stretchy self adherent wraps like Coban and generic vet wrap can be wrapped around limbs to keep devices extra secure.
- Belts like Spi Belt and Flip Belt can keep medical devices safe and accessible at the waist. Devices such as tubed pumps, personal diabetes managers (PDM for OmniPod), continuous glucose monitor (CGM) receivers, and cell phones used as CGM receivers can all be carried hands free in belts.
- Various brands sling bag: A small cross body bag can hold your supplies close while keeping your hands free.
6. Check Infusion Sites and Continuous Glucose Monitors Often
Playing all day in the sun, sand, and water can affect how well infusion sites and CGMs stay on the body. Even if you have some help via tape or some other extra adhesive to prevent a site from loosening, periodically look at the site to make sure it hasn’t pulled off.
If you find you are having more lows or highs than usual, talk to your endocrinologist about possibly changing dosages and or basal rates for the summer. The change in activities and routine can affect bodies differently.
7. Have A Worst Case Scenario Plan
Situations can go from bad to worse quickly when type 1 diabetes is with you on vacation. Before you go, look up hospitals near you, know how to get in touch with your endocrinologist on call and save the address of your nearby hospital of choice.
If you have to make a trip to the hospital you want to know where to go, how to get there, and you’ll need to get your on call endocrinologist to talk to the medical team to work out a plan of action. Be the best advocate for yourself or your child. YOU live with the day-to-day of T1D and you can and should bring your own insulin and supplies. Don’t expect ER staff to understand the nuances of type 1 diabetes, pediatric or otherwise.