Swimming with pump

OK! It’s my son’s first summer with his pump and how in the heck do you all manage swimming with the pump? We pretty much had it figured out with pens and now it’s just a whole new ball game! He used to have to get out every half an hour or so to eat something. Now, he eats something because he’s used to having to do that, and then he is sky high a half an hour later! What is your strategy for staying in range on swimming days with a pump!!!

It sounds like your son’s need have changed so he doesn’t need as much or as frequent a snack . You/he will want to keep track of his numbers so he should “swim by” his CGM or get out to check it periodically. Adjusting insulin and figuring out snacks when exercising is really a matter of trial and error but the CGM should help you see if you’re on the right track.
My first pump was a Minimed and it came with a sports guard - a big heavy duty plastic box with a rubber cap that had a slit for tubing and a belt so you could wear it around your waist while swimming or playing contact sports. It was not discrete or aerodynamic but I wore it because I had to (with their older pumps you could not disconnect). But I’m guessing he will be disconnecting for a while and the exercise plus being of insulin might more or less balance things out; however people find that certain types of exercise raise them while others bring them down, so use his CGM to keep an eye on things.
PS - some people worry (understandably) about their sensor coming off with exercise. There are patches you can wear and Dexcom provides some for free on request. Of course you can get them from Amazon and some have a strap that goes over the sensor in addition to the patch that goes around it. There are also sports bands to wear on the arm.

Hi @lucyinthesky827 the difference here is he is not getting his basal when disconnected from the pump (I’m assuming you don’t have an omnipod) so he has to test or check CGM, and then option to eat, correct ,or both about every hour. It’s only a little different. :four_leaf_clover:

Hi Lucy @lucyinthesky827 , I see two questions combined together here, First: “knowing if or how to bolus for snacks”, and Second: “swimming and removing pump”.
This response is based on what has worked well for me.

Beach [and pool] activity includes both swimming and running about - well, these days walking about for me. When not going in the water, I wear my pump in a soft fabric belt with a pouch [Medtronic Store] about my waist; other than with my iAIDs pump I’d set a temporary reduced basal rate. Before going in the water, I disconnect my pump [put both plastic caps on] and for safe keeping place my pump in a closed container - often my insulated food bag- to keep sand from gumming up the works. At least hourly, I leave the water to check BG and eat if necessary. I have found that my body activity compensates for the missed basal flow; my pump Profile settings avoid overbasalization.

Snacking, and especially hydration are necessary for me when spending the day on the beach - I drink Gatorade [with sugar] in addition to water to maintain proper hydration. Proper body hydration is a key to maintaining level body glucose. As with any snacking, bolus insulin may be needed - although he may need to reduce or eliminate bolus depending on his activity level. It is usually safer when running around away from home to be a little higher rather than risk hypoglycemic events. With snacks, his and your judgement [and experience] for insulin is key. Play it safe.

On a side note, there are diabetes camps you might want to check out. It might be late for this summer but you could plan for next. I spent time over a few summers and had a blast. I was just having fun but I think my parents - especially my mom - appreciated knowing I was in his hands while she got a break for a while. During my time we were all in on injections but now I’m sure kids spend time comparing technologies.

Not snacking if he doesn’t need it (and keeping alert for signs of a low) seems like a good start.

But is wearing the pump while swimming an option? You could try a waist pack like this to keep the pump in place while he swims instead of disconnecting him. My Medtronic 670g and Tandem t:slim x2 are both rated as waterproof up to 6 feet. You wouldn’t want to go diving with it, but it should be fine for splashing around the pool as long as the pump and tubing are secure and not likely to be jostled too much.

Hi @WearsHats . The manual for my TSLIM shows it to be watertight for 30 minutes up to 3 feet. I think my pump is a couple of years old and maybe things have changed a bit in construction so I’m wondering where you got your info?
Also there is a difference between
Waterproof, which means covered or treated with a material (such as a solution of rubber) to prevent permeation by water; and
Water resistant (aka water repellant), which means treated with a finish that is resistant but not impervious to penetration by water
(Websters dictionary defs)
Part of keeping water out of the pump is making sure the gasket that covers the battery port (Tandem) is in place. I’ve had a couple fall off over time but I did get replacements.
You may very well be correct, but for the sake of the investment I wanted to point that out. On the occasions I do go swimming I just take my pump off for a while - although a few years ago I did wear a bulky sports guard when I took a water aerobics class. The waist packs are great for convenience but won’t protect against water if that is needed.

Thanks, Dorie. Seems you’re right.

Tandem manual:

Your pump is watertight to a depth of 3 feet (0.91 meters) for up to 30 minutes (IPX7 rating), but it is not waterproof. Your pump should not be worn while swimming, scuba diving, surfing, or during any other activities that could submerge the pump for an extended period of time. Your pump should not
be worn in hot tubs or Jacuzzis.

Seems I was remembering the Medtronic training:

At the time of manufacture and when the reservoir and tubing are properlyinserted, your pump is waterproof. It is protected against the effects of being underwater to a depth of up to 12 feet (3.6 meters) for up to 24 hours.

So you can go swimming with the Medtronic pump, but not the Tandem. Good to know. Not that I swim if I can avoid it.

Thanks for providing the additional info!

Hi, here is what we do for swimming with a pre-teen. (I am not a doctor). We look at his sensor reading before going into the pool. If he is low-ish, we disconnect and put the pump in a small lunch-box insulated bag and put that in the shade or cover it with a light-color towel. If it’s really hot I will put an ice brick in the bag. If he is to the high-ish side on the sensor reading, I will give a bolus that is approx equal to the basal that he would have received, for the approx time that we expect to be in the water. Then disconnect and store the pump as above. In both cases, we will cap the site on his body using one of the little caps that come w/ the infusion sets. And as always, carry snacks and water.

Then check him in half an hour to an hour … get him back within signal range of the pump /sensor combo and acquire a sensor reading. Take whatever steps we need to, based on the sensor reading (or finger stick if need be.)

The Tandem pump is supposed to be waterproof but I would rather not worry about the pump somehow drifting to the bottom of the deep end of the pool.

We have been extremely lucky in not having too many sensor sites or pump sites peeling off due to swimming. We use Skin-Tac for the pump sites prior to insertion; and I swab around the sensor adhesive’s perimeter , after it’s inserted, with Skin-Tac. Of course, I hate to lose a site, but feel like the fun of swimming is a reasonable trade-off.

At a swimming pool (cement pond !) I don’t worry about sand.

As someone noted, sand can be problematic if it gets into the infusion set when you are trying to reconnect the site. If possible, I do my disconnecting / reconnecting at the car to try to keep sand out of the equation. If that is not practical, we’ll rinse our hands before doing anything with the pump, to try to keep the sand away.

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And … sorry but I forgot to mention: If you are using Tandem pump with Control IQ, you likely will want to Stop the insulin flow when you disconnect for swimming. Otherwise the CIQ will count that insulin flow as insulin on board in its calculations, when it’s not on board but more likely pumped onto a towel or something.

Suggest verifying w your pump rep , though, so that if you are using automated insulin flow, the calcs will not be disrupted.

Your post doesn’t mention if your son uses a CGM. If yes, you can easily manage his blood sugar levels. I’m a little confused how you were using the pen for injections. Did he get an injection before swimming? If so, do the same with the pump. I’m an older guy (70) who swam all my youthful life and never really had any problems swimming in the summer. Whether it was in a pool or ocean, I always tested my urine (that’s how we checked our blood sugar levels) before jumping in. Occasionally my blood sugar would drop while swimming, but from ages 5 until 21 I can count on one hand where I had any issues of low blood sugar. I can relate to rising blood sugars when disconnecting from the pump though. When you do that, he’ll have no basal in his system. I disconnect, swim, get out of water, test, correction bolus. That’s my approach