# Swimming lessons and hypos



## Telle88 (Oct 9, 2022)

Hi everyone I'm looking for some advice about my 5 year old twins. They've recently started doing swimming lessons on a Sunday morning (11am) they're 30 minute lessons but they are having hypos after their lunch. I'm doing a 40% reduction on insulin as instructed by the diabetes team but its still happening. I'm just wondering if I should reduce the insulin by more than 40% as it made my son sick in the end treating his hypos. Any advice would be greatly appreciated


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## everydayupsanddowns (Oct 9, 2022)

How frustrating for you @Telle88 !

And sorry to hear treating hypos make your son sick - that!s really grim 

I guess they are only guidelines from your clinic, and different kids will react differently - and be more or less energetic in the lessons themselves?

You could try adding some carbs in advance (not too close to the swim to avoid the risk of cramps)

Or perhaps some follow-up carbs after the lessons without bolus depending on how their levels are behaving during the swim itself?

I always needed top-up carbs as well as insulin reduction when distance running 

Exercise and activity can increase sensitivity to insulin for hours afterwards - sometimes as much as 24 hours!


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## Telle88 (Oct 9, 2022)

everydayupsanddowns said:


> How frustrating for you @Telle88 !
> 
> And sorry to hear treating hypos make your son sick - that!s really grim
> 
> ...


Thanks for the reply. It's really frustrating because straight after their lesson they have a quick snack and then we're straight home for lunch. I've been reducing their breakfast in anticipation of the lesson and then reducing lunch in anticipation of the drawn out drop in levels. My kids are both super active as well they cannot sit still. They also have a 2 hour session of PE at school followed by football training on Thursday afternoons but we've managed to control that one  it's just this swimming that needs tackling now


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## everydayupsanddowns (Oct 9, 2022)

I’m sure you’ll find the magic combination of dose-tweakery-and-biscuits before long.

Mmmmmmmm biscuits!


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## Telle88 (Oct 9, 2022)

everydayupsanddowns said:


> I’m sure you’ll find the magic combination of dose-tweakery-and-biscuits before long.
> 
> Mmmmmmmm biscuits!


I think I'll try a biscuit between breakfast and the lesson and see how that goes and continue with the snack after the lesson.


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## everydayupsanddowns (Oct 9, 2022)

Telle88 said:


> I think I'll try a biscuit between breakfast and the lesson and see how that goes and continue with the snack after the lesson.



…oh, of course I meant fruit. Lovely healthy FRUIT. It just looked like I’d said biscuits   

Let us know how things go. Have they got Libre or another sort of CGM so that you can keep an eye on things easily?


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## Thebearcametoo (Oct 9, 2022)

We found swimming tanked BG more than lots of other sports. It depends on timings of meals as to whether you reduce boluses - if swimming is within 60-90 minutes of breakfast then reduce the breakfast bolus*. If not then give carbs so that they’re at about 10 before the lesson and if necessary add a snack after too. It can take a bit of trial and error. We generally went with more carbs earlier in the process. We found with some exercise we got a hypo the next day so don’t forget that exercise can impact BG for quite a while afterwards. 


*If you’re using novorapid then think about the profile of the insulin - it starts working  20-30 minutes after the bolus, peaks at about an hour then stays in the system up to 4 hours. There’s not much point reducing the bolus if the hypo is happening a long time after. Giving a snack before swimming will mean the carbs hit at the point you need them.


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## Telle88 (Oct 9, 2022)

everydayupsanddowns said:


> …oh, of course I meant fruit. Lovely healthy FRUIT. It just looked like I’d said biscuits
> 
> Let us know how things go. Have they got Libre or another sort of CGM so that you can keep an eye on things easily?


Ahh the dreaded fruit  its hard to get fruit into these two! I don't know why but they just don't like sweet things, they're more savoury and love their veg (useless for swimming) They both have a dexcom g6 as they have no hypo awareness but I'll be sure to keep you updated


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## Telle88 (Oct 9, 2022)

Thebearcametoo said:


> We found swimming tanked BG more than lots of other sports. It depends on timings of meals as to whether you reduce boluses - if swimming is within 60-90 minutes of breakfast then reduce the breakfast bolus*. If not then give carbs so that they’re at about 10 before the lesson and if necessary add a snack after too. It can take a bit of trial and error. We generally went with more carbs earlier in the process. We found with some exercise we got a hypo the next day so don’t forget that exercise can impact BG for quite a while afterwards.
> 
> 
> *If you’re using novorapid then think about the profile of the insulin - it starts working  20-30 minutes after the bolus, peaks at about an hour then stays in the system up to 4 hours. There’s not much point reducing the bolus if the hypo is happening a long time after. Giving a snack before swimming will mean the carbs hit at the point you need them.


They are both on fiasp and breakfast is around 2 hours before their lesson. Their consultant wants them no lower than 15 mmol/l for any activities as they drop for fun! Even just playing with their toy cars for 15 minutes sees their levels plummet  if I'm honest I'm really struggling with the balance at the moment, we get a couple of good weeks with a healthy range then they have a growth spurt and its back to square one again, it's exhausting but I guess I'm preaching to the choir with that statement


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## Thebearcametoo (Oct 10, 2022)

Telle88 said:


> They are both on fiasp and breakfast is around 2 hours before their lesson. Their consultant wants them no lower than 15 mmol/l for any activities as they drop for fun! Even just playing with their toy cars for 15 minutes sees their levels plummet  if I'm honest I'm really struggling with the balance at the moment, we get a couple of good weeks with a healthy range then they have a growth spurt and its back to square one again, it's exhausting but I guess I'm preaching to the choir with that statement


The constant changes with growth spurts must be awful. It was bad enough with my older kid when we would get a month or so of stability in levels. When you’re thinking about long term health it matters that their diabetes is managed and that their HBA1C is decent but within that there is A LOT of variation. A really good HBA1C may include tonnes of hypos, which is really unhealthy. A perfectly fine HBA1C may include quite a lot of time spent at 10-14, which isn’t ideal but feels a whole lot more manageable as a parent.  

A pump may be the only way to really manage their numbers especially if it’s one with a managed algorithm that can even out some of the hypos.

15 is quite a high number but makes sense. But think about the timing of that 15. If the carbs went in 2 hours before they may be used up too soon so you’ll have had a high that didn’t help. It seems like biscuits before swimming will do the job for you. Giving you fast enough release carbs to cover swimming whilst not being as fast as sweets/fruit would have been. And then a snack after swimming too. Don’t forever dexcom is 15 minutes behind a finger prick so reverse engineer from that to get the timings. Did the doctor say anything about basal? It may be that you can lower the basal that covers swimming too but that can be a real juggle and make it harder to remember. 

Dealing with kids and diabetes means there’s a lot of what the maths says and then there’s scrying with bones and taking an educated guess


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