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June 8, 2010

Diabetes treatment changes with seasons, exercise

Dear Dr. Beach:

I have been reading the last few columns and have a question concerning diabetes treatment and the seasons. It seems that various summer and winter activities in the North Country may be easier with adjustments to treatment. Do you always wear the pump? What do you recommend for students in sports, or folks with various summer/winter hobbies, ie: swimming, hiking, hockey, and skiing?

Thank you for your input, H.P.

Dear H.P.:

I couldn't agree more. Various activities may require significant variations in any medical treatment, and this could not be truer when dealing with diabetes. If you have been following the columns, you have read my statement that this condition not only affects everything you do but is affected by everything you do, and this is an important fact when considering the various activities we engage in throughout the seasons in the North Country. Without a doubt, the activities you mention have the potential to cause low sugars and likely require less-intensive insulin therapy. However, it is important to discuss therapy plans and changes with your provider.

All children with diabetes who are involved in sports need to be cautious with their care. No matter what type of sport or therapy is used, frequent blood testing is essential. I remember that, as I grew up, the dose of longer-acting insulin was always reduced for soccer season, and similar changes may be necessary for anyone with diabetes involved in sports. Those folks with pumps may find it easiest to remove the pump during the activity, but it is very important that they test frequently and treat high sugars with caution. Remember — activity can improve insulin sensitivity and reduce the amount of insulin necessary for meals or corrections. I frequently ask patients to reduce the insulin before exercise, during exercise and for a few hours after exercise. Intense exercise has a lag effect with blood sugar and can improve sensitivity to insulin and cause low sugars for hours after completion of the exercise. I encourage all patients in this type of situation to discuss planning with their health-care provider, carry extra food/sugar and blood test frequently.

Although I try to always wear my pump, there are many times when it is appropriate to take time away from it. During the summer months, I frequently take the pump off while swimming. Testing frequently and hooking myself back up to the pump ensures good blood-sugar control. Although some pumps are said to be waterproof, there is no evidence that they can survive water submersion after any type of micro-fracture. A micro-fracture can occur any time you drop or bump your insulin pump and may leave it open to water damage. It is clearly safer to take it off and enjoy the water. I also recommend covering your infusion site with the protective cover or some form of tape. It should also be noted that any contact sports necessitate the removal of the pump. I have patients in hockey, basketball, soccer and baseball that remove the pump during games or practice. They simply blood test before removal and before hooking back up. These patients also use the temporary basal option to improve blood-sugar control.

You mention seasonal sports in your question, and I have to state that I believe therapy changes depend on the sport and comfort level of the participant. I wear my pump while I ski, and as you may have read last year, I wear it for swift-water technical rescue training. Some folks may not be comfortable with that and I encourage all patients to ask their trainer or provider about their specific situations and concerns.

Dr. Jonathan Beach, who has lived with diabetes himself since age 4, heads the Northeast Center for Diabetes Care and Education at Urgicare of the Northeast in Plattsburgh. Send questions to him for this column, which runs the second Tuesday of every month, to: The Northeast Center for Diabetes Care and Education, 79 Hammond Lane, Suite #2, Plattsburgh, NY 12901 or diabetescenter@urgicarenortheast.com.

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