Diabetes and Schedule changes in Vacations
For some families, holidays mean that children go to bed later at night and sleep until later in the morning. Waking up later, in turn, means moving insulin’s “peak hour”, as they won’t match meal times because all meals and snacks will be compressed within a shorter time. Breakfast and lunch can be particularly closer because the child gets up later and in the afternoon goes out to play or do sports. Organized activities, such as baseball or tennis, are the factors that influence breaking meal schedules the most, especially when these are done at dinnertime. The question every parent should ask himself is how to balance these three factors: insulin dose, dinner, and activity, to maintain good control of their children blood sugar levels.
Keep your child within a range of no more than an hour and a half outside of their regular school day schedule. For example, if your child usually gets up at 7:00 am and insulin is injected at 7:30 am, during the holidays should try to wake them up at 8:30 am and get injected at 9:00 am If your child wants to sleep, they can go back to bed once they’ve had their insulin and breakfast.
- A child over six years of age who during schooldays has a mid-morning snack, might not need it on vacation, or may need a smaller one, especially if the time between breakfast and lunch is less than 4 hours. A (midmorning) snack won’t be necessary unless your child does a lot of activities in the morning. However, it is advisable for them to get the calories from their mid-morning snack (which they didn’t get) in a meal or snack in the afternoon or evening, when the child is more physically active, to avoid hypoglycemia or low blood sugar levels. Don’t refrain from giving them these calories (contained in the mid-morning snack); remember that at this age, the child is in full growth and needs a specific amount of food every day, besides, their nutritional plan is based on individual nutritional needs.
Children under six years of age should not stop getting their midmorning snack. Therefore, it’s important to consult a nutritionist for advice regarding eating pattern changes.
- Children with too much activity in the afternoon, will need two snacks after dinner, one at 7:30 pm and another one before bed, so they can prevent their glucose levels from dropping too much, that is, to avoid a hypoglycemia episode.
- With help from your doctor or Diabetes educator, you can better understand your child’s insulin action, and thus be able to know when their peak insulin action reaches its full potential. Then both can schedule their meals and snacks during vacations.
- For the case of a possible ballgame scheduled at dinnertime, there isn’t a perfect solution. Usually a large pregame snack, getting their insulin dose and dinner after the game will be effective enough to prevent a possible hypoglycemia. In other cases, insulin and dinner before the game can also work well. In both situations, you’ll need to reduce their crystalline insulin (rapid acting) dose.
Your child will surely be safe with three daily insulin injections: NPH and crystalline (fast action) before breakfast, crystalline before dinner and NPH at bedtime.
This regimen offers two advantages: first, the crystalline insulin (rapid-acting) dose may be reduced, depending on the amount of activity carried out or whatever the situation requires. Second, there won’t be too much NPH insulin in the blood flow to increase the hypoglycemic effects of a busy afternoon.
To decide which plan will have the best results in controlling your child’s Diabetes, consider their schedules, eating patterns and normal blood glucose control.
To get a better idea of how a particular activity affects your child’s blood glucose levels, frequently check their capillary glucose levels before, during and after each game. This information can help you decide the amounts and types of food you should give your child and at what times they should get them, as well as helping you adjust their insulin dose.
Here we’ll see how a family copes with their child’s inconstant meal times on vacation. David is a 10-year-old baseball player and has Diabetes. His regular Diabetes regime on vacation is: NPH and crystalline Insulin at 8:30 a.m., breakfast at 9:00 a.m. and lunch at 12:30 pm. Snack at 3:00 p.m. and NPH and crystalline insulin again at 5:00 pm, dinner at 5:30 p.m. and snack before bedtime at 8:30 p.m.
Problems arise on days David has a game, as game time is 5:00 pm. First David’s parents tried to solve this problem by giving him a lower crystalline insulin dose in the afternoon (4:00 pm) and dinner at 4:20 pm, eliminating his afternoon snack as he was dining too early. However, this regime provoked repeated hypoglycemia episodes (during and after the game) which meant David had to ingest extra juice and crackers to counteract his low blood glucose. These Hypoglycemic episodes were probably caused by the morning NPH insulin dose which was still affecting him in the afternoon, without a snack to cover for it. If increased exercise is added to this, it’ll result in low blood glucose levels.
After consulting with their doctor, David’s parents treated the problem by giving him his afternoon snack at the same time (3:30 p.m.) and an additional sandwich before the game (4:30 p.m.). After the game he’d get insulin (7:00 p.m.) and had dinner at 7:30 p.m. Afterwards he’d get a snack before bedtime at 9:30 p.m. This schedule worked much better.
Other evenings, the family had dinner at around 6:30 p.m. to maintain a proper schedule on game days, keeping it within a one-hour range. This plan kept his glycemia levels well controlled during the afternoon and evening. However, occasionally, at mid-morning he’d get hypoglycemia, perhaps due to his NPH insulin dose from the night before, but by reducing the morning crystalline insulin dose, this problem was solved.
David’s glycemia levels were well controlled in his vacation days as well as in his school days, so all that time and effort to achieve a perfect regime was worth it.