Crazy highs

We just got back from a family ski vacation (1st since daughter’s Dx about a year ago, and only the 2d time our FL kids have ever seen snow). We had them in lessons, and both came back as legit skiers. A fun time was had by all. The only downside was my daughter’s BG, which went up from the plane flight to UT (sitting still for hours, I figured), and then stayed crazy high the whole time we were there. Hot chocolate was one culprit, I’m sure, but after that first experience, she skipped it. Does altitude cause highs? Did we under-count the restaurant food? She was ridiculously active all day, which I expected to bring her lower, but it sure didn’t seem to. Air temps were colder than she’s used to, but if anything, she was hot from being overdressed (spring skiing under sunny skies). She had a cough, so I assume she was sick, and that contributed. I’m sure learning something new is stressful, too, even if it’s a fun stress. We’re home now, and she’s had some lows, so I’m dialing it back, but what the heck? She was over 400, over 300, over 200, for four days while I increased her insulin, trying to get it right. No ketones, though. Any insights?

Hi @srozelle,

Certainly you undercounted the restaurant food - with 59 years trying to guess those carbs I’ve only really done it right when I befriended the chief chef who would offer guidance.

Also, temperatures have an effect on how my body manages insulin - warmer overall temperatures allow my body to more effectively use insulin - about 30 years ago I reported this to Joslin where it was later confirmed in other patients. Also, there is evidence that some insulin pumps and infusion sets [does your daughter use a pump?] develop air bubbles during take off and landing - I have never noticed this and have worn a pump during many flights.

I’m not suggesting that BG readings of 300 or 400 could be good for her, but keeping her BG up while skiing is advisable - for many years before I moved to Florida we had a ski house in the White Mountains where I skied a couple of days every week, and on ski days, downhill or cross country, I would have a big stack of pancakes for breakfast.

So my educated guess is that a combination of at least three things plated against “perfect” BG control; the different activity, foods with unknown carbs, air flights. Add to that her excitement at a new experience. I’m happy to see that you are letting her to be a real girl and not keeping her in a protective bubble - and all the times being an aware, knowledgeable and caring parent.

Thanks, Dennis. I appreciate that! And no, no pump. Definitely restaurant food was at least contributing to the issue. Now that we’re home and I know what she’s eating, her Humalog ratio is right back to normal. NPH needs are still higher than they were before the trip, though. (She doesn’t have anyone to help during lunch at school, so the endo put her on NPH plus the Humalog so she can make do with just breakfast and dinner shots, which has worked well for us so far.) She doesn’t seem sick anymore, so maybe the higher NPH needs are as simple as more beta cells dying off, and the ski trip timing was just a coincidence. It has only been about a year, and I know for sure that she was benefitting from a very strong honeymoon phase there at first. Ah, well. “Follow the numbers,” right? Thanks again!

I think you nailed most of the possible culprits. You may have left out time zone change as another contributing factor to your daughter’s high blood glucose levels, the possibility of slight dehydration from being in the altitude and drier air, a change in the normal daily schedule, growth hormones…figuring out which or a combination of all will drive your crazy! Unless you do ski often, I don’t think you will ever nail a true cause.

Another factor we have found with my son is when he participates in “burst exercises” (what we call them) he tends to run higher than normal. We know this to be the case and try to even his highs out as best as we can with square wave bolus and setting temporary basals and of course, checking his BG more often. With day-long exercise, you run the risk of an evening or nighttime exercise-induced low, which it seems you did not encounter, good for you! And good for you checking for ketones! I am glad you did not have to deal with fighting that monster!

We are flatlanders who live in the midwest that ski/snowboard during spring break in the Rockies or Wasatch. You were so on it by keeping your daughter’s BG a little higher, although it was a bit too high for comfort. Ski resort food usually has more fats, protein and calories than I cook with at home but skiing all day is more activity than my son normally gets at home. It is always tough to “guess” the resort food nutritional content. We carry packets of low sugar/no sugar hot chocolate that you mix with hot water so our son does not have to skip out on that yummy mid-day warm up. Even though we have skied many years, we have never had a great BG week. But we have learned from year to year how to keep his bg closer within his range.
The biggest thing we have done is we try to keep to our meals of breakfast, lunch and dinner close to our home time zone rather than adjusting to the vacation time zone. (Hawaii was a totally different story!) Checking BG every two hours or if he is feeling “wonky”. Drinking some water on every ski lift ride. And taking more breaks than we used to before skiing with diabetes to check BG. The break gives us a chance to adjust/correct his insulin throughout the day.

I will say, we have tackled skiing while using MDI and pump. Pump therapy is much easier to stay in BG range, but as you know, diabetes life is never a perfect numbers day.

Congratulations on trying to create a normal life for a child who has T1D in tow! It sounds like you are very in tune with taking care of your daughter and you roll with the numbers. That will serve you and your daughter well.

Great comments here in response to your question. Of the list of things you mentioned, which ones were responsible? Honestly, could be “all of the above”. Travel, stress, food changes, timing of habits, and about 100 other things can all wreak havoc with blood glucose. Doctors love T1’s when we live life rigidly, eat the same things every day at the same times, exercise the same way and duration every day, avoid eating out and minimize disruptions in routine. But obviously that does not make for a quality life, nor a realistic one, especially for a kid! So you do the best you can, make logs to track how her BG behaves in a variety of circumstances, plan to check her BG at least 8-10x/day, and make corrections as needed. Overall it sounds like a successful trip!

Thanks to everyone for such great feedback! I am going with “all of the above,” and taking note of each of the excellent suggestions here to try to manage better next time.

And now that we’ve been home almost a week, I can add one more probable reason to the list: fewer functioning beta cells. Carb ratios are right back to normal, thank goodness, but her basal rate has stayed higher this whole time. Sigh. Bye, bye, honeymoon!

Still, definitely a successful trip. Our kids were basically “never-evers,” and by day 4, their instructors had them giggling like mad over a tiny kicker, and taking the “bear trail” (off-piste through the trees). We can’t wait to do it again! :slight_smile:

Wonderful, Great, GRAND!!!

At the bottom line, isn’t “living” a great life, kids being kids and older folks [parents] liking what they see and being able to relax and enjoy what life iski with you?s about. I’m supposing that your other kids were able to enjoy and your T1D daughter didn’t impede them.

Good too that you were able to see “another cause” and be able to adjust. After 59 years, I’ve [finally] learned that my life has been a constant series of adjustments. Remember that we, neither your daughter nor you, are robots or machines; we are ALL human and our bodies - think about your own - continually change and we somehow adjust. Next time mummy, may I get out of Florida and PLEASEEEEEE ski with you?

Welcome home.

We skied again last Dec. and March, and just got back from this Dec’s trip. And in case there’s someone else out there who might benefit, I wanted to post an update and my thanks again to all of you who were so incredibly helpful and supportive after that first trip.

We’re almost three years since Dx now, and her basal needs are higher than they were, for sure. Of course she’s bigger now, too — kids grow fast, as her old ski pants attest. The time change is definitely a factor, which we were somewhat more successful at bridging. We brought along the low-carb hot chocolate packets Isaac13 recommended (very special thanks for that!). We’re better at counting restaurant carbs than we were, and she checks her sugar more often, carrying both carb snacks and no-carb snacks in her pockets. (She’s still on just 2 shots of NPH mixed with Humalog daily. Her decision: she’s comfortable with the routine, and her last A1c was 6.8, so we figured we wouldn’t try to fix what wasn’t broken.) The hot tub lowers her BG 100 points or more, so she checks before and after. She and her brother both still love jumps and bear trails best. And yes, they both had a wonderful time.

So if any of you who post here wonder sometimes whether your words make a difference, the answer is “yes!” You’re the best, and we newbies to this world are ever so grateful.

I’m a little late to the party it seems. But, I do know that travel and skiing are tricky. The exersize of skiing usually makes my BS drop like a rock. I have to eat snacks a lot and take less insulin.

Your daughter’s experience is a little different, but no two people are the same. A lot of things affect BS besides just food, exersize, and insulin as the doctors try to tell you. I have had times I thought I’d be low due to exersize only to find out I’m high.

You do have to be flexible as the other guy said. As my endo says, “no on can do as well as a pancreas”. do the best you can. sounds like you’re doing a good job.

Hi @srozelle, it sounds as if you guys are doing good now and have the right approach to managing your daughter’s diabetes. I suspected that she would figure out that she wants to live a full, active and productive life and manage her diabetes to permit that.

Glad too that your ski vacation was a grand time!