Sunday, January 28, 2007


Why does it have to be so difficult? Not swimming in itself, but the part about managing the BG.

From I was 6 years old, I have been swimming once a week. Just for fun and exercise, never competition-minded (except for the personal competition you would have with yourself :-)). I continued this routine until I moved to Odense 6 years ago. When I began my university studies, I even went swimming twice a week sometimes. This was because I would sometimes use an hour in between classes to go swimming with some of my fellow students. There are swimming facilities at the university, and they are of course used by the sport students, but the “holes” in the timetable are free for other students, as well as employees, to use.

Those of you having read my blog from the beginning – or at least the recent post of January 16 – will probably, with some quick mental calculation, have realized that the D was introduced during the years that I have been practicing swimming. Besides the swims at the university, we would always go swimming on Saturday afternoons, usually shortly after lunch. Only once did this routine cause me a severe low afterwards. I could have slightly lower sugars (2.5-3.5 [45-63]), but never really posing any problems, except for that single one some 13 years ago.

The last couple of years I haven’t gone swimming. There is really no good excuse for that, just plain laziness in working it into my lab-routine. I took it up again in the fall, though. This time, being on the pump in stead of injections, I thought a lot about how to tackle this workout. The time in the swimming facilities specifically allotted for employees at the university is Fridays 12:00-1:00 PM. Being a bit annoyed with the time being just around the time where I will usually eat my lunch, I decided that I would work it in anyway.

My initial approach was similar to the one I used for soccer practice in the spring, where I would also disconnect my pump during the activity. I worked a lot with the timing of the snack and the amount of insulin to cover it before going swimming. However, only once have I succeeded in avoiding a low afterwards, despite the fact that I, of course, copied my approach from this successful day to the following Fridays. I have a goal of 30 laps (40 m each), or 24 laps (50 m each) when the pool is not split in two, within approximately 35 minutes. I have only fulfilled my goal a couple of times so far, because usually I will begin feeling this special fatigue and missing coordination in my motion, clearly telling me that I am low, at about 24-26 short or 20-22 long laps. I leave the pool, shower and get dressed, and usually get a reading of 2.5-3.5 (45-63). That I can handle without a problem. Sometimes I don’t even bother to chew more than a couple of glucose tabs (which is about half the amount that I will actually need to correct this if only treating with glucose tabs), while walking back to the lab (approximately 600 m) to get my lunch.

Since being on the pump I have had a fare greater share of readings below 2.0 (36) than I ever had with MDI. I believe the lowest reading after swimming have been 1.8 (32) or so. Until last week, that is.

Last Friday the pool was divided into two, and thus my goal was 30 laps. I had reduced my basal to 60 % a couple of hours before, and at 10:30 AM I had a snack of ½ slice of rye bread, a banana, and a few M&M’s. I bloused conservatively for this, using a combined bolus where a fraction of the bolus (0.3 U or so) was delivered during the course of an hour. Before heading for the swimming facilities I tested 6.9 (124), which I thought would be okay as I knew I would be disconnected from the pump for approximately 1 hour. However, once again I felt a low creeping up on me when I reached 26 laps. The symptoms weren’t too bad and I actually debated a little with myself, whether I would do 2-4 more laps before stopping. I didn’t though. I capitulated and headed for the shower. I didn’t feel too bad so I didn’t head for my locker right away to test and correct. I remember some music being turned on and one of a technician, who sometimes comes to perform experiments in our lab and whom I occasionally run into in the swimming facility, commenting on it, but I wasn’t really listening. Once I was dressed and sat down to test I got a reading of 1.2 (22). Damn! Just seeing such a reading automatically can make me feel bad. I was able to treat it myself, but I must admit that I felt a bit run-over when I made my way back to the lab to get my lunch. It scares me that sometimes I am apparently capable of functioning quite normally despite such a dangerously low BG. It also makes me seriously consider getting a medical ID that I can wear when going swimming too (I know, I know, I should wear one at all times, but the truth is that I never really have. I have a talisman-type ID, but never wear it because I am annoyed with it. It swings too much around my neck if I move just a little faster than slow walking, and I cannot tolerate that).

This scary post-swimming low was one of the things that I discussed with my favourite nurse, Alice, at my appointment with her this past Thursday. She suggested that I simply turned off the pump/set the temp basal to 0 % an hour or more before going swimming, as she believed that not only the swimming, but also my morning bike ride getting to work, is affecting my BG during this 30 min swimming work out. Also, to prevent those significant drops in BG that I still tend to see in the late afternoons around my bike ride going back home from work, she encouraged me to try to turn the pump of approximately 1 hour before my anticipated departure from work.

I set out to try this the following day. At 10:15 AM I set a temp basal to 0 % for 90 minutes, while getting my snack and a conservative bolus. I was busy in lab the whole morning, and just did a quick test before hurrying towards the swimming facility at 11:45 AM. I was 9.7 (175), and though about whether that was actually a little too high. I didn’t do anything about it though, just headed for the pool. This time the pool wasn’t split in two, so I was doing 50 m laps. I felt full of energy. Passing the 20 laps I began feeling a little tired, so I decided to end my session with just 2 more laps of slow, cooling down breast swimming. In the shower I ran into one of the technicians from our lab. We talked a bit, and I told her (she had heard the story of my scary low the Friday before, as I told the other technician about it one morning in the lab, where she told me that the music was folks music for a special team occupying the pool after us) that I felt a lot better today. I actually expected that I would be in the high 3’s (63-70) afterwards, but as you can see from my chart below, I wasn’t. 2.8 (50) was all it could be.

Why does it have to be so difficult to figure this out? Anybody have some experience with swimming and pumping that they would like to share with me? I would like to make it work, and even if I don’t, I am not the type to give up because that would that I let the D rule my decisions in this matter. Only I don’t want to risk going completely sugar cold because of my stubbornness, so inputs are more than welcome to help change this pattern of lows caused by swimming :-)


Chrissie in Belgium said...

I have to mention a couple of things. 1. Before you swam a lot and it didn't affect your bg values so drastically. That is probably b/c you did it a lot. A new kind of exercise should cause a greater fall in the bg. 2. Pls note that I used the word "should" in the previous sentence - not will. There is a huge element of variation with diabetes. We have to just accept we do not really know EVER to 100% what the hell is going to happen this time. 3. You illustrated your example very well. HURRAH for Kevin's log! It makes me happy to see that you like them and are using them. I think they are tops!!!!! 4. But, even if you give us all the numbers in the world, it is hard for me or anyone else, I believe, to advice you with very specific instructions on how to change the insulin dosage. Why? - b/c we all react differently. If you log carefully you see the exceptions and the trends. When you see a trend, that is when you get the feeling for what to do. Obviously you have to either eat a little more or take a little less insulin or some timing component is off- but I cannot say how much b/c I am not you, I do not really know how YOU will react. Do you get my point? Timing is truly important. The amounts could be absolutely correct - but if the timing is wrong it all goes down the drain.

That is what doctors just do not get. How dam difficult it is to balance the different components. The struggle we go through and how often we fail - ie most of the time. They see our experiences as success when we don't pass out or no accident occurs. We see them as failures b/c we remember the horrible way we felt. No wonder we turn into perfectionists - see my blog for my huge issue with "perfectionism". Heidi, what is YOUR gut feeling for a possible solution? Try it and see if it helps. ME, I could never go swimming without having eaten my lunch first and then reduce the mealbolus significantly. I try and start exercise when the bg is in the 120s through 130s. I feel terrible when it gets up to the 160s and then insulin resistance CAN set him. Remeber nothing is set in cement..... I am so happy you like Kevin's log!!!!!! ME TOO!

Heidi said...

Chrissie - thanks for your comment. I have some comments for that too, though :-)

First of all, actually I didn't swim a lot more before. True, sometimes I swam twice a week, but the individual sessions were no longer nor more intense than the current ones. If anything they were the opposite. The last few years I swam in the club beforehand, we would have to put out the cables separating the lanes of the pool. That would usually cut 3-5 min off our 30 min scheduled pool time. Depending on the freedom of the program provided by our coach, as well as the number of swimmers in each lane, I would usually be able to swim 850-1000 m.

If I compare swimming in the club 7 years ago with the Friday noon sessions of today, the differences essentially are: 1) Timing of the session (approximately 1 h after lunch in the club in contrast to just before lunch currently); 2)MDI-therapy before and CSII-therapy now; 3)More continuous and a bit longer swimming today (lanes are longer and there are usually not as many other swimmers to consider).

You are right that I cannot expect you or anyone else to specifically guide me with regard to insulin doses, timing, etc. And I am not expecting that. Sometimes, though the experience of others may sometimes suggest alternative approaches to a given issue, and that was actually the thought behind this post :-)

And last but not least: True! Kevin's logsheet is awesome!

Scott K. Johnson said...

Hi Heidi!

Those lows just suck don't they?

I have had to change my routine around a lot trying to figure out the basketball thing. My meals and their times are very different than normal.

Looking at the differences between swimming now versus at the club before - the one that jumps out at me as most significant is the lunch. Do you think you can find a way to eat some kind of lunch or late breakfast an hour prior to swimming? I know that sounds hard - but I bet it's what's throwing you off...

Just my two cents of course. Please keep us posted!

And HOORAH for Kevin's logbook!

Chrissie in Belgium said...

OK, I am totally wrong. You have me totally stumped if you in fact did not swim more before. Maybe Scott is on the right track. Did you have a different eating pattern before compared to now? Please don't get me wrong! It is really helpful to clearly explain the problems, then maybe somebody will recognize a similar pattern and be able to help! Sorry for expressing myself so unclearly! I really didn't mean that you shouldn't explain the problem, just that it is so difficult to advise another what to do.

Totally love your new layout! The pale blue-gray background ......very, very nice! Thanks for adding me!

Heidi said...

Scott and Chrissie - yes, I did in fact have a different eating pattern before, at least for the swim sessions in the club. I can't really remember when we would go swimming at the university, although I believe that most times that would be around mid-morning. In the club it would be approximately 1 h post lunch.

I did think about simply eating my lunch before hitting the water. Without actually trying it, I dismissed that option though, due to the fact that it would mean that I would have to eat around 11:00 AM. With that I anticipate every possibility that I would get hungry at 2-3:00 PM, craving a lot of carbs, potentially throwing me off the BG-track there in stead of :-)

So what I am working on is the size and the timing - as well as the insulin coverage, of course - of a mid-morning snack. So far I have tried to eat about 1/3 of my lunch 1-1.5 h before going swimming, but apparently something is not right about this yet. I will keep working on it, though, and I'll bet that the day it works, I will be so proud and happy that I cannot keep quiet about it here ;-)

And Chrissie, thanks for the compliment about the new layout! I had to change into at least a new format of the blog to make the changes that I wanted (long needed up-date of the links!!), so I thought that I might as well change the layout completely. Glad you like it :-)

Chrissie in Belgium said...

Thank God you are not PISSED at me, Heidi. Sometimes I sound so damm "lecture-y".