Tips for swimming?

My 14 yo son, dx’d 4 months ago, is on the autism spectrum AND is a competitive swimmer with Special Olympics. His BG drops crazy low while swimming. (100 points after 30 mins of “easy” (for him) laps. It seems that the water temperature is a factor, as much as the actual exercise. When I say competitive… it means he competes, not that he gets the adrenaline rush. The boy just loves to swim!
How do swimmers keep their BG up? We have carb-loaded… to no avail. I’ve not found a ratio of fast-acting/long-acting carbs, protein/fats to make it through a practice without incident. Finger sticks every 20 mins is ridiculous. There has to be a better solution…

@BigBee hi Karyn, what is he doing for long acting (basal) insulin? is it a shot of “long acting”? The difficulty here is he {probably} needs 25% of his normal basal during swimming. If he is 100% of normal basal (pump or shot) he’ll drop low no matter what kind of carb loading you are trying to get him to eat.

Is swimming happening within 4 hours of a meal? . if he eats a meal his fast acting insulin will still be active for up to 4 hours. Lets say lunch with a bolus for carbs at 12. If he swims anytime before 4 PM his meal time insulin will still be “on board” and can still cause big blood sugar drops.

If I am going to be active within 4 hours of a meal, I take less insulin with that meal on purpose. This will be harder if it’s 3 hours after a meal because this will cause significant high blood sugar before the event. If you tie the meal before at lets say 1 or 1-1/2 hours before a meet you can experiment with less bolus for that meal. I also pump so it’s very easy to dial back my basal insulin 90 minutes before exercise. A shot has to be planned the day of.

at 4 months after diagnosis, he may still be making a little insulin and then any amount of injected insulin will likely be “too much” for swimming. try to error on the low side of insulin because it’s easy to take more.

good luck keep up the swimming git’s great exercise.

Joe… thanks for your reply. He does get long-acting insulin… which, we’ve been lowering the dose steadily since dx, since he clearly is making insulin on his own. The evening before swimming, I have lowered that dose by 1/3. I’ve also given no insulin on the day of swimming. (His insulin requirements are really low… average one unit per meal.)
We just received his pump the other day, haven’t even opened the box. Perhaps that will be a game changer?

@BigBee pumping, especially when he’s making inuslin and needs only a smidge… could help a lot.

check in with his doctor… 66% basal (lowering the shot by 1/3) seems like a lot of insulin for such an activity… and it could easily be crashing his sugars. you are allowed to change that shot (on swim days) to a special “activity day” shot. see what the doc says but my gut says lowering by 2/3 is a good start point and you can always add insulin.

with the pump you can adjust to 25% or even 0% for short duration, allowing me to do vigorous exercise without dropping.

good luck!

You don’t mention whether he is on a pump, or what his pre-exercise regimen is (food), so it’s hard to recommend a solution. I am a T1D for many years, competed in grade and high schools, and university, and am still a competitive athlete and I swim, kayak, cycle, and go to the gym on a regular basis.

I use a pump, and adjust (lower) my basal rate for exercise. Additionally, I also adjust (lower) the bolus amount for meal if this meal is within roughly 4 hours prior to exercise or competition. I also use a CGM, and look at that periodically during an event or exercise.

If he is NOT on a pump, he can still adjust his basal rate with a long lasting insulin, but it’s less accurate to do so.

I heartily recommend his continuing to swim competitively and otherwise exercising. With that, I also suggest that you keep a log of food intake, exercise, and insulin so that you can begin to adjust to the exercise regime to avoid the extreme blood sugar changes, and share that with his doctor to create an appropriate plan.

I agree that testing many times during an event can be difficult. Have you considered a CGM?

There’s no silver bullet; it’s a matter or planning appropriately and monitoring during exercise.