Swimming with T1d

It’s been a late, wet, and chilly winter

for those of us in Los Angeles, California. If you’ve read our About Us page, you would know that we were used to living in a warmer tropical climate and spent most of our days at the beach. We started using the Dexcom G5 continuous glucose monitor in April of 2016 and have perfected our very own personal technique of keeping it on through sunscreen, sweat, pool, rain and bubble baths. We use a similar technique called the Tegaderm Sandwich for keeping her Animas OneTouch Ping insulin pump through those same challenges. Read on for more tips on swimming with a Dexcom and pump.

We’ve acclimated to living in the bustling city of Los Angeles and now prefer swimming in our resort style heated pool and jacuzzi during the Summer over the sediment-rich, cold, mysterious, and kelp-filled oceans here.

Don’t even get me started if you live on the east coast or mid-west. Nothing compares to the year-round warm weather and clean waters of Hawaii. Unless, you live on another tropical island in the Pacific near the equator.

Old pic from end of Summer 2017

Here are some of the basics you should always bring with you before heading to the pool:

1. Eat a high protein and fibrous meal or drink a protein shake prior to swimming to hopefully prevent any lows.
2. Juice – bottles, boxes, bring more than you think you’ll need. Coral needs 10g or about 10-12 sips of juice to bring her BG up from 60 to low 100’s when swimming (I’m comfortable running her a little higher during this and other intense physical activities if doing MDI).
3. Bring snacks preferably with a bit of carbs and high protein to keep you going
   • We like One Brand protein bars in Maple Donut and Birthday Cake flavors
   • Find what works best for you
4. Check your BG prior to swimming – I always make sure Coral is cruising in the lower mid-100s before swimming otherwise I give her half the bolus her pump suggests based on her BG
   • If the Dexcom trend arrow is straight or slight arrow up, I’ll usually give her a micro-bolus of 0.10 to 0.15 and disconnect her pump before she jumps in the water
   • This will make up for the basal she will be without for at least an hour
   • I reconnect and give a small correction bolus of said amount if needed (rising over 180)
   • Slight arrow down or straight arrow down – obviously, I give her juice and/or a snack as needed
   • This is why it’s so important that you know your or your child’s insulin sensitivity factor (ISF), BG Target, and I:C prior to taking on new activities immediately after diagnosis – READ PUMPING INSULIN (listed below)
5. Your Dexcom G5 receiver, iPhone, and/or Apple Watch – make sure ALL devices are FULLY charged
   • A waterproof pouch to keep the Dexcom G5 receiver and iPhone closeby (recommended within 10ft for Bluetooth connection). Doesn’t apply to G4 users
6. D-kit or Diabetes Kit w/ compartment for ice pack – syringes/pen needles, insulin vial/pen, non-alcoholic spray sanitizer, glucose meter, test strips, pump battery(ies), lancing device, TiniBoy lancets, and IV prep wipes
   • We use this generic nylon Diabetes Organizer from Amazon but you may also want to look into Myabetic or Sugar Medical as well
   • If you don’t want to use an ice pack, you may also try a Frio pack – which takes more time to prep and best done overnight before planning to head out
7. Sunscreen – Broad Spectrum SPF 50 or higher, water-proof, BPA free, UVA/UVB, preferrably one with titanium dioxide and zinc oxide
   • Reapply every two hours or as needed
8. Turkish towels – I like these from Kauai brand Hoa Kai since it features tropical prints, is lightweight and dries quickly
9. Water resistant tote bag like these from my fav brand, Aloha Collection (they sell quickly)

• Be sure to check the reading on your CGM every 15 to 30 minutes (varies per person)
  • OR poke if you must check with a meter as often as needed
  • In case you happen to lose signal from loss of Bluetooth range
    • Inspect transmitter making sure it is still in tact
    • Are you and/or your child properly hydrated? This is rarely the case, but lack of fluids may cause less of of an interaction with the enzymes at tip of sensor in the interstitial fluid of skin causing loss of a strong enough signal to be transmitted to your devices
• Remember, physical activity always brings down blood glucose since the body is burning it for energy much quicker than when not exercising and will continue to increase insulin sensitivity for up to hours or even the next day later (again, varies per individual)
  • If blood glucose spikes while exercising, it is likely due to a stress response such as HIIT or competitive sports
  • Use this knowledge and be aware of any basal adjustments needed that night
  • Or you may see a decrease needed for the insulin to carb ratio for dinner that night if and when this increased insulin sensitivity takes place
    • For example, Coral’s I:C for dinner is usually lower than that in the morning due to her being physically active during the day and more sensitive to insulin
    • therefore, we have it set at 1:12 or 1 unit of insulin should cover for 12g of carbs at dinner
    • If she were to go swimming earlier that day or do any other intense activity like at the playground, I might change her I:C to 1:13, but not likely
    • However, I most certainly will have to decrease the basals that night and/or compensate with a greater amount of Fairlife Milk/Protein shake before bed to keep her from dropping low (less than 70 mg/dL) multiple times overnight
• Aside from our Tegaderm Sandwich method, you may also want to try these other dressings to help keep the Dexcom on that particular part of your body as long as you’re not as sensitive to fabric dressings and SkinTac like Coral
  • Grif Grips – available in various shapes and sizes, be sure to select the one with the pre-cut Dexcom or OmniPod hole cutout before purchasing online
  • Pump Peelz – patches for pretty much all diabetes tech devices
  • FixiC Patches – just found this on Amazon and it’s very similar to Grif Grips
  • Sim Patch – also just found this on Amazon (like most T1d items), similar to above
  • KT tape – water resistant sports tape
  • Opsite Flexifix Tape 2″ width – which is the only additional dressing we use for Coral once the Tegaderm starts lifting at the edges from moisture. We trim a bit off and replace it with a precisely cut rectangle of the Opsite tape. This helps to keep her Dex or pump site on as long as needed.

Remember, it is still possible to have fun living with Type 1. We keep practicing with timing of insulin and adjusting temp basals to see what works best. Read more T1d books. Learn how to make proper adjustments without dire consequences. It requires patience and persistence and log keeping either writing it down or using diabetes apps like Sugarmate – the BEST by far!

Hope that helps you out! As always, I am not offering any medical advice whatsoever. Use this information at your own risk and please make healthy decisions. Feel free to email me any further questions at Typeonediabeticlife@gmail.com or add some of your own tips for the T1dCommunity on this subject in the comments below. Also, please be sure to follow @type1diabetic_life on Instagram and/or @typeonediabeticlife on Facebook. Mahalo for your support and just keep swimming!