School’s Out!

School’s Out….for….Summer!

Does anyone actually read that and not hear Alice Cooper in their head? Yea, me neither.

I’m so excited that school is done for this year. No, I mean it—-I really am! My kids needed a break from the routine, the early mornings, the strict bedtimes…all that jazz. Now ask me in a few weeks, and I may be singing a totally different tune. But as of right now, I’m super stoked for them. Summer is the best—-you can sleep in, stay up late, swim all day, hang out with friends, watch movies. Basically just live your best life. And I love that for my kids. However, as with anything, you have to take the good with the bad. And with this good and gaining some summertime freedome comes a loss of control over blood sugars.

It’s fine while she’s sleeping in. We have her basal rate nailed down, meaning that we know how much insulin she needs to control her blood sugar when she’s not eating. It’s the eating part that gets tricky. I don’t know about anyone else’s kids, but when my kids are home it becomes an absolute free-for-all.

Let’s start with breakfast. During the school year (since I wake the kids up at the butt crack of dawn) my daughter will bolus and then slowly get ready for school. Eating breakfast is just about the last thing she does before she gets on the bus. But in the summertime, she hibernates like she’s a little bear. And by the time she wakes up, that bear cub is ravenous. She is ready to eat from the second her eyes open. And not anything remotely nutritious or might keep her blood sugar semi-stable——of course not. That’d be way too easy if she woke up and wanted scrambled eggs or something with even a tiny bit of protein in it. What she wants is ALL THE SUGAR. I obviously can’t blame her, nor do I really restrict it (debatable, I know—-but I’m a dietitian with the philosophy that all foods fit and she’ll eventually make different choices). Typically, she wants things like muffins, pancakes, waffles, cereal, or donuts for breakfast. So the struggle at breakfast, besides that she’s eating simple carbs with no protein, is the prebolus—-which is essential when we know there will be a quick rise from the simple carbohydrates she’s eating. Since she’s ready to eat immediately it takes A LOT of encouragement to bolus…and wait. We joke a little about it because her siblings will all remind her she needs to “bolus… and wait” while they put their hand up like a stop sign. Honestly? Despite all of this, she does alright——typically she doesn’t go above 170 mg/dL, but I can’t say that’s always the case. This is one of those times where I’ve accepted that I can’t control the situation perfectly and she’ll get better as she ages and matures. We correct her blood sugar with more insulin if necessary and move along our day.

Breakfast is a challenge, but what REALLY tends stress us is the snacking. OMG the snacking—-it’s NON-STOP. I swear if someone walked into my house and saw how many snacks my kids eat, they’d think I hadn’t fed them for days before that. The even trickier part is that I don’t always see when they grab a snack or know when they do. So the prebolus thing? That’s basically non-existent. I’d love to hear how others deal with the snacking and blood sugars because I’m starting to run low on ideas. The best strategy that we’ve come up with is making some adjustments within her pump to be slightly more aggressive when it comes to how much insulin she gets per gram of carb that she eats. I have low-carb snacks available—-and there are some glorious times that she’ll choose those—-but more often than not it’s the crackers and cheese (gluten-free of course), chips, cookies, and all the things they normally wouldn’t be snacking on if school was in session. I’ve learned I have to pick my battles with this one though—-there was a time period where she would sneak food and knowingly not bolus at all. I’m very aware of the fine line of controlling blood sugar and creating an unhealthy relationship with food. I do think it was a bit of a rebellion period, so I am absolutely not restricting the snacks that she can have, and just encouraging her to bolus the correct amount even when I’m not policing it.

We do have a little bit of a secret weapon in the summer to help deal with snacking and some of the higher blood sugars that she has. Apprently my kid reminds me of a few different animals. A bear when she sleeps, and also a fish when she’s awake—-she LOVES to be in the pool. And thankfully (or not, depending on how you look at it), her blood sugar will drop quickly when she swims. That’s extremely helpful when she’s high and we want her blood sugar to go back to normal. A bit scarier when she gets in the pool and her blood sugar is normal., but over time we’ve learned that’s manageable too.

Since she spends so much time in the pool, we’ve really had to figure things out through trial-and-error. Luckily, she also can feel when she is low (she’s hypo aware)—-not everyone can sense that so I’m thankful she can. She wears her Dexcom, her CGM which will still give readings when it’s not fully submerged and her phone is within 20 feet (since her pump is disconnected while she’s in the pool I can’t see any numbers there). That’s great and all, except how often is a kid in the pool and their arm or stomach isn’t fully submerged? So…for the most part, we’re guessing. I used to make her get out and sit on the deck until I could pick up a reading from her Dexcom, which would take anywhere from 5-10 minutes of her fuming so the blue tooth could reconnect. But like I said, she’s a fish. Getting her out for even those 5 minutes was torture for everyone involved. So now our strategy is a little different——if she gets into the pool and she’s high, we kind of just know about how long until her level goes back to normal. And I may have her come out so that I can get a baseline since she really does tend to go down quickly. If she gets in the pool and her blood sugar is at a normal level I’ll have her sip on juice or regular Gatorade every 10 minutes or so. That seems to be enough to keep her blood sugar stable. And since she’s aware of how she feels when she goes low, she will get out if she starts to not feel well.

Lunch and dinner tend to be okay in the summer. So really no new issues there. But during the summer, after dinner treats—especially ice cream—are frequent in this household. We still fight a bit with high blood sugars from ice cream, but it’s become SO much easier over the last few years. I know her blood sugar will rise in about 4-5 hours after eating it. And I’ve become confident in bolusing about 30g in her pump to go through 4-5 hours afterwards, which is typically when we’re sleeping at that point, knowing that it’ll prevent a rise. It used to be scary because her blood sugar would be normal at bedtime, and I worried she’d drop low with the extra bolus. But we’ve learned that’s just how her body reacts to ice cream and now it’s not so scary.

So like I said—-I’m SO happy for the kids that it’s summertime, despite some of the challenges it now presents for us. They all needed a break. Now remind me of this in a few weeks when I’m counting down the days until school starts and saying that it’s important for kids to have a routine.