Just Keep Swimming. And Swimming. And Swimming.

Sugar moves.

All.  of.  the.  time.  I'm not kidding.  When she's sitting still, her toes are still moving.  Mr. Rose and I have joked about it for her entire life.

She also likes to ride her bike.  And swim.  And take walks runs around the block.  And swim. And chase the dog.  And swim.  And climb the tallest play structures. And swim.  And play tag.

And did I mention that Sugar likes to swim?

Summer has arrived in the desert, and that equates to swimming.

Is she going to swim hard or just splash around?

Huh?  Huh?  

Tell me.  Because it makes a HUGE difference.  If she's hanging out with the swim toys in the shallow end, that's one thing.  But, if she's treading water like a maniac and swimming all over the deep end...that's an entirely different story, my friends.

Using the same psychic powers that predict how hungry she'll be at lunch every day at school, I must pre-determine how active she's going to be in the water.  As a rule, I generally plan for a lot of activity and hope I haven't screwed up.  Like I said before...Sugar moves...so, in my mind, she won't be hanging with the boring toys for too long.  Soon enough, she'll be pretending to be a mermaid in an underwater sea adventure.

We're embarking on our 7th summer with diabetes.  After a few years of ATTEMPTING to be her pancreas, there's a few things I've learned that works for Sugar throughout swim season. (And keep in mind that this IS NOT medical advice.  This is one tired mother reminding herself of the swimming plan that worked last summer, because the pools are officially open again, and said tired mother isn't exactly sure how that happened so fast since last year, and "hello" run on sentence.  This plan is subject to change, because.  That's all.  Just because.)

1)  The pump MUST come off for swimming.  Since her pump is waterproof, she could wear it **with a ZERO TEMP BASAL**, but her history dictates an equation that never fails:

swimming + basal insulin = LOWS.

We bring a cooler of drinks to the pool, stick the pump in a ziplock bag, and toss it in there to keep the insulin from overheating -- which, by the way, is REALLY important when the weather tops 110 every day for a few weeks.  Overheated insulin DOES NOT WORK. (DISCLAIMER:  Sugar's Animas pump is waterproof.  Before choosing to allow your pump to stay on while swimming, or putting it in a cooler, please make sure you understand the manufacturer's recommendations.)

2)  She needs a snack AND a bolus within the hour before starting to swim.  Once she's splashing, a few random sips of Gatorade here and there definitely helps to keep things stable. Sometimes it seems like we're replacing her basal insulin infusion with micro-carb basal sips instead.

I've tried a few variations of decreasing her basal 1-2 hours before swimming, but

• A)  We don't always know 1-2 hours ahead of time that swimming is on the agenda; and
• B)  Stubborn highs seem like a consistent challenge after the fact.

3)  Blood sugar checks every hour.  Period.  More often, if she feels "off".  She needs snacks with boluses about every hour as well.  The insulin on board (IOB) feature of her pump considers the number of carbs being entered along with her current BG (yes, even if the last bolus was only an hour ago), and balances it with the active insulin still circulating to help prevent an insulin overdose (which is bad).

I have the ultimate authority to administer the dose I feel is appropriate (hands on hips, sticks out chest) based on the pump's recommendation and variables the pump cannot take into consideration (i.e. types of carbs being eaten, true level of activity, anticipated total disconnect time, etc.)  We simply reconnect to bolus as needed -- easy peasy lemon squeezy.

She needs bursts of insulin to convert glucose into energy for all those crazy mermaid moves. This means she also needs glucose available in her system to be converted.  The whole thing is a delicate artistic balance with one goal:  Make sure those crazy mermaid moves don't leave her helpless at the bottom of the pool.

4)  Beware of post-activity lows.  They can occur for about 24 hours after the activity, and may strike without warning, seemingly out of nowhere.  If the next day (and the next, and the next, and the...) is full of swimming, keep carbing  (and swimming) and realize that, eventually, it's going to catch up.  Be on alert, and armed with plenty of fast acting carbs at all times.

School is out.  

Our community waterslides are open.  

Players, take your positions...

Let the games begin!