Showers on insulin

Hey everybody,
My daughter has insulin at school around 12 comes home and takes a hot shower at about 4 everyday . Her lows are pretty severe around 5 everyday and I’ve still not been able to figure out why because shes on maybe 1 unit for lunch . I thought it was PE but there was no PE today and she dropped. Now I’m questioning if it’s the shower. I’m going to test it but has anyone heard of this

Heat definitely affects blood sugar: a few minutes in a hot tub can drop my daughter 100 points.

I’d agree with you that it’s worth checking her BG for a few days before she showers and then again after, to get a sense of how it affects her. And then you’ll know if she’s less than (whatever number) before she showers, she should have some carbs first.

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Does she shower at this same time everyday? What happens around that time of day if she doesn’t shower?

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@stixxs512 , there is more here that what you have shared.
[1] is she on a pump?
[2] does she use a CGM?
[3] is she using something like Tandem CIQ where you can do a screen grab of the t:Connect app?

Some of the people here can do detailed analysis of a tC screen grab and give you details if that is available.

Hope this helps.

j

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I’ll do that. She never drops when she showers after dinner so I’ll definitely be checking her before and after . I’m almost sure its causing the low

All 3 questions the answer is no

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She showers everyday mon through Friday when she gets home . On weekends there isnt a drop like this because she doesnt shower until after dinner

As others have already shared, hot water can lower blood sugar - people with diabetes need to be very cautious about using saunas for the same reason. It sounds to me like having a snack before showering would be the simplest answer, short of moving dinner up or showeeing later, which may not be desirable.

As others have said, the temperature of the water is the primary culprit now. For you to go thru a check list, there is an industrial process mnemonic of 3MEP to give a check list of areas to check. Here they are:

METHOD - what are the time relationships to meds (insulin), does she walk home from school (activity), someon mentioned PE. How long has this been going on (growth spurt)?

MATERIAL - is there any documentation about any of her meds interacting with heat, like tetracycline and sunlight? I went from MDI to a pump eons ago due to an irregular bump in the impact of my long acting insulin that was [a] time inconsistent and [b] unpredictable in amount of impact.

MACHINE - no pump. eliminate any other devices, medical or in and around the shower.

ENVIRONMENT - the only mentions are the temperature of the shower & absence on weekends. Look around for other issues.

PERSON - does her body have a quirky intersection of [a] insulin metabolism, [b] increasing her own metabolism with the shower, & [c] having a lull in her systemic glucose level such that all three of these or other culprit rear their gremlin like mischief on your daughters glucose in this scenario which is absent in showers at other times.

Run the situation past your daughter’s endo’s nurse educator. This is a true conundrum.

Hope this helps.

This is somewhat off topic, but if your daughter were using a dexcom G6 you wouldn’t have to come here and ask us.

You could just look at her real-time blood sugar graphs over the last several days and it would become immediately apparent when you compare days when she does or doesn’t shower. Additionally, you could configure her CGM so that it alerts YOU when her blood sugar is dropping. Even if you’re nowhere around, you could text her to make sure she’s okay.

I can’t begin to tell you what a critical leap forward in technology CGM has been since I was diagnosed in 1986, when the fastest insulin took 4 hours to work and blood glucose tests took 5 minutes. CGM is enabling the next level of automated insulin pump therapy which is here already with pumps systems like tandem t-slim. In 5 years, it’s very likely that the only diabetes related thing your daughter will need to do is change her cannula every 3 days. The pumps will do everything else automatically. We’re quickly getting to the point where your daughter won’t need to think about her diabetes everyday. If you have to be diabetic, now is a pretty good time to be one.

And that’s all enabled by CGM. If she’s type 1, she absolutely should be on it now. There’s no good reason (other than cost) for any type 1 to not be using it.

Excellent points @schleima . And if I might add, you do not need a pump to use a CGM. I think @stixxs512 knows, but this is for anyone reading this who may not. Dexcom has a receiver, and it works with smartphones (at least Apple) so you can use that instead.

Not to be rude but I come to this forum to ask questions and get insight not to be judged on if my daughter has a dexcom or not. Whether she has a dexcom I’d still ask about the hot showers. She has been a type 1 since she was 3 so for almost 7 years she has not had one. Until last year she was very much controlled a1c under 7 but due to puberty and growth spurts things have changed. In addition not only does she feel every low and every high and has never been wrong shes very in tune with her body and is never not around an adult . She is either around me her mom or at school with teachers and nurses. Shes very monitored.
When she was first diagnosed a dexcom was never pushed but all of a sudden within the past 3 years everybody feels they have to have one. I never tell people what I think they should get their kid nor do I judge people by what they feed themselves or their kid (whomever has diabetes). There are many things I may not agree with on this forum but I dont voice them because what is working for you is for you . There is a difference between being an adult with diabetes and having a child with it. Not only does the child have to physically deal with it but there are issues of mentally dealing. My daughter is 9 and though she has gotten accustomed to diabetes she doesnt feel comfortable wearing a dexcom. I cant force her being that she technically can take it off . Eventually when she gets older if she says mommy i want one or there is an emergency she can have it no problem. MY INSURANCE COVERS IT .
Also a dexcom does not stop a low or a high yes it shows if youre trending up or down but it’s not the end all be all of treating diabetes. There is still soooo many other things that must be done to care for yourself.
There will never be a time where I or my daughter wont think about her diabetes. It’s a thought in my mind almost every second no matter what her blood sugar is. But until then I have to care for both her mind and her body. This will be my LAST post on this forum because judging is something I dont do and I refuse to receive it.

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In case you read this, I apologize if anything I said made you feel I was judging - that was not my intent. Overall I’ve found this forum to be very open and positive, providing suggestions to consider and :+1:t4: or :-1:t4: as you see best for your situation. If you’re reading this I hope you’ll consider coming back to continue sharing your learnings and wisdom. Either way, all the best to you and your daughter.
PS - I meant that a CGM is a very helpful tool to have. However the decision to use one or not belongs to you and your daughter, no question.

I agree with Dorie. One might not agree with every posting on this forum….one doesn’t have to agree or see oneself as judged. The idea is to read the suggestions and think about them. That’s all.
The main thing is that there are many wonderful, well-meaning people who contribute (and try to be helpful!!).
I have a daughter with an intellectual disability who also has Type 1. This forum has been invaluable to me and I cannot sufficiently express how grateful I am to learn from it.

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My 4th grade science project was on my hypothesis that my blood sugar dropped during my baths. I checked my blood sugar at the same times in the evening every day for 2 weeks and marked the days on which I had a hot bath and found that my blood sugar was always lower at the second test on the days I had a bath.

[Just a note that this was a very long time ago. I’m 35 now.]

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I agree with you 100%. Continue to do what you think is right for your daughter and don’t let anyone shame you for needing help or advice.

I was the same way growing up. I didn’t feel like I needed a CGM or pump at all while I was in school and I hated the idea of wearing something on my body all the time. I’ve had diabetes for 28 years and I’ve only had a CGM for the last 2-3 of them because it’s hard for me to check my blood sugar while I’m at work. I’m not on a pump, either, for the same reason. I never felt like I needed one until last year, then I tried it and the experience was awful so I went back to MDI. There are so many options out there for treating diabetes and so many obstacles. We each need to decided what works for us and I applaud you for speaking up!

@stixxs512 I am really sorry to hear this. We are better and stronger together than fighting and learning separately. You don’t “need” a pump. You don’t “need” a CGM. I know this because I didn’t even have a blood tester when I was diagnosed. In those days, we went by feel or we died. So we went by feel.

You already know hot water,weather, etc. causes lows. This is actually common. I am sorry if someone said or inferred otherwise but I thought your observations were very complete.

I hope you change your mind but wish you luck and continued success regardless :four_leaf_clover:

I’m not even sure how to address this criticism in a way that wouldn’t be misconstrued in a negative way, but all I can do is my best.

In the 1970s people used wildly inaccurate urine strips to test their glucose, because doctors felt people doing blood tests at home would be impossible to achieve. But for years, that’s how it was done.

We are at a similar moment in history with CGM. Just as blood tests were the future of diabetes therapy in the 1980s, CGM is the future of diabetes therapy now. No doctor in their right mind today would recommend urine strips over blood tests. And in 30 years from now, finger sticks will be as obsolete as urine strips were back then. There’s just no way to compare the quality of continuous blood sugar data with pinpricks in time.

This is not about judging. This is all about the information so that your little girl has the very best care and can live a long and healthy life.

You may not see it now, but there will be a point in her lifetime where she won’t have to think about her diabetes every second of every day. That moment is much closer than you seem to want to acknowledge.

We’re all here to help. Please be open to receiving this.

Hi @schleima . I’m not sure I’ve seen you prior to your earlier post here so if you’re new, welcome to the forum; and forgive me if you’ve been here a while and I didn’t recognize you.
I’m going to start by sharing my experience with diabetes technology:
I was diagnosed in 1963 so I came up drawing insulin into large gauge syringes (no pens in the picture until much later). We “tested our sugar” using the home chemistry set you referred to - the Clinitest kit. For those of you scratching your heads, it consisted of a tiny wooden stand that held a test tube and a dropper: the dropper was used to measure a certain number of drops of urine into the tube, after which you carefully added a chemical tablet. There was some exciting fizzing in the test tube and a few(?) minutes later you matched the color of the liquid in the tube to a chart on the tablet package - which showed you how you had been doing a few hours earlier😒.
The first home BG meters came out around the time I finished college and waiting for results was like watching paint dry, but it was one of the great advancements of the time.
I took 1 shot of long acting insulin every morning and that’s it until I finished college, when I started on MDI - initially taking NPH at breakfast and bed, and nothing to cover meals. As understanding grew in the medical community I started taking Regular with meals as well - 4 shots total.
All of that is to say that I’m personally and experientially well versed in “old school” methods.
In the early 90s my endo started recommending I consider an insulin pump, but I wasn’t interested at first: the thought of wearing something on my body constantly, didn’t appeal to me, and shots were still working well, even though I did have to have to lug my stuff around. But eventually the idea started to grow in me: at some point I discovered I was a “gadget person” and pumps started to intrigue me. There were several available at the time but my doctor recommended Minimed and my first was the 504: I moved up every 4 years, to the 506, 507C and 508. While I was on the 508 a new pump was announced by a company called Tandem, and I switched to their TSLIM after my 4 years on the 508. Medical necessity was required for a CGM so I did not get my first until a few years later. I could not have been happier: while I couldn’t do away with test strips entirely, it was incredibly reassuring to have my numbers available at a glance, even if they were running a few minutes behind reality.

And now that I’ve thoroughly bored you with my history I’ll move on:
I’m sure you understand that people put much thought and consideration into the devices they will use to manage their diabetes care. And while pumps and CGMS are considered “the” thing for us that is not a universal truth. Some people actually do better on shots than with pumps; and while @stixxs512 's daughter does not use the CGM you advocated for please keep in mind starting on one can be stressful.
When initially starting on a CGM some people become overwhelmed by having their readings constantly available - there have been some comments on the forum about that. When I first started on my Dexcom I might have been obsessive about it for a while, and wanted to take action immediately based on what I saw: “Uh-oh - I’ve got :arrow_up::arrow_up: - I should bolus - some more” or “:arrow_down: - I’m dropping - I’d better get a snack right now!” With time and “advice” from my doctor I learned not to be so fanatical about frequent peeks, to look for patterns rather than responding immediately to one reading - and to take some deep breaths when I saw those arrows and think through whether it was a truly emergent situation, or if I should wait a few to see if things leveled out. Having all that info at your fingertips can be stressful and you have to be ready to manage it.
Many of us on the forum used fingersticks for quite a while before CGMs came along; and while I agree with that they don’t give us as much data as is available with a CGM, we managed. And yes, there is a difference between managing and thriving: but while having a CGM might help Ndidi’s daughter in that regard (as well as give us helpful strangers on the forum more to work with) - if stress counterbalances the advantages she’s not going to reap the benefits. It’s up to them to decide if it’s a good choice and when it’s the right time to use the technology, if at all.
Also (as an aside) keep in mind that some people have allergies to the adhesive or the cannula used in CGMs or pumps and simply can’t use them, so they don’t work for everyone.

As a person who has had to figure out “Why in the world is this happening???” both with and without the benefit of technology, I urge you to try a softer approach when making recommendations. People mean well but how you say what you say can make all the difference up front.

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