In terms of pumping insulin, my colleague Anton is just getting started. But when it comes to skiing, he's a real pro.
Now that he's had some time to experiment on the slopes with his new external pancreas, I wanted to know about his experiences.
Here's the official situation: intense skiing, OmniPod insulin pump, BG Meter (built into OmniPod controller), Dexcom CGM (Continuous Glucose Monitor). Backup supplies? Lantus and NovoRapid pens.
Scott: Anton, thanks for sharing your experiences with us! I'm excited to hear about what you've learned so far! Have you made many adjustments?
Anton: "Everything has been going very well! Like clockwork! I had to experiment with the basal rate, but am very happy with the results so far. I'm used to physical activity and have a good feel for how my body responds to different intensity levels. For me, a significant reduction in basal rate during skiing was just what I needed. Sometimes less than half of my normal rate, depending on intensity. I also found that I need to reduce my basal rate a little bit even after skiing. I usually start my temporary basal rate about a half-hour before the first run. This worked well for me, but it's sure to be different for everyone, of course."
Scott: Ok, you've talked a lot about your basal rate. But what about eating and meal boluses?
Anton: "You're right! Skiing is very demanding and takes a lot of energy! I like a good, hearty breakfast to start my day! Besides the temporary basal rates, I took less insulin for breakfast by increasing my insulin to carb ratio. I found that a typical skiing session amplified (tripled!) the action of my insulin, so I adjusted accordingly. The meal boluses are tricky because too little insulin makes the blood sugar spike quickly, and a BG of 300 mg/dl on the slopes is no fun either. Personally, I found a mix of slow-acting carbs work well to keep me stable during the run. Whole Grains with yogurt (not fat-free or lean) and fruit for example. I also pre-bolus about 20-minutes ahead of my meal. Before starting the first run I check my blood sugar, so I'm not rushing blindly down the slope. It almost goes without saying that if I'm below 200 mg/dl at the top of the run I'll have some extra carbs to prevent a hypo. What is the best solution? Everyone must experiment, test often, and work it out for themselves. In any case, the physical demands of skiing are not to be underestimated."
Scott: What about the Germknödel (traditional sweet dumpling treats popular at Austrian ski resorts) and other treats at the ski lodge?
Anton: "Oh yeah! No problem there! As someone trying to be fit and healthy, I'm usually careful about what I eat. But when exercising so much on the ski slopes I indulge a little. I need some good Tyrolean Gröstl (pan fried potatoes with meat and onions) to replenish my energy! Again, I have to be careful with the insulin. And just like with breakfast, I increased my insulin to carb ratio to lower my meal bolus."
Scott: Where did you wear the OmniPod while skiing?
Anton: "I usually wear it on my thigh. But when skiing in cold temperatures for a long time it didn't work well for me there. A couple of times early in the season the OmniPod alarmed and stopped working properly after only a few hours out on the slopes. So I switched to wearing it on my arm, which worked much better. But I would advise everyone to always have a backup insulin pen - better safe than sorry!"
Scott: I bet you worked up a sweat while skiing - did that cause any problems with the OmniPod tape? Did you need to do anything special to keep it attached properly?
Anton: "Nope, I didn't do anything special with the OmniPod tape. I often use physio tape to keep my Dexcom sensor on, and usually keep that attached while skiing, too. The extra tape helps the CGM sensor stays on in the sauna, too. I think the OmniPod would also stay on in a sauna, but I can't wear it because the insulin inside gets too hot and spoils. It's pretty stupid because it means I have to change the Pod each time I hit the slopes and want to relax in the sauna afterward. If you're really going to have a go in the sauna, then it makes sense to plan the sauna sessions at the same time as a Pod change. It might even make sense to switch to MDI (Multiple Daily Injections) for an extended ski holiday when I plan to enjoy a daily sauna, but for a short visit that would be too much hassle. Another OmniPod user gave me a tip to wrap the Pod in a cold, wet towel. Maybe I'll try that sometime."
Scott: What other tips come to mind about diabetes on the ski slopes?
Anton: "Always have extra carbohydrates with you to treat lows. I like gels and energy bars because they are easy to keep, they don't freeze, and I don't end up with crumbs in my bag or pocket!"
Scott: And your overall conclusion about skiing with an insulin pump?
Anton: "Generally it's no problem at all. Sure, there are advantages and disadvantages, just like everything else. For example, when using injections I had to eat much more to keep my blood sugar stable during exercise. This is much easier to handle with a temporary basal rate on a pump. But then again, on injections, using the sauna could be a little more spontaneous. Life is full of trade-offs, isn't it?"
More tips & tricks:
- Altitude may affect your BG meter and/or insulin pump. Check with your equipment manufacturer for specific limits and guidance.
- If your meter is affected by altitude, testing at the bottom of the run might work better than the top.
- Keep your pump and meter in an inside pocket, close to your body so they stay warm. If you keep your meter in an outside pocket or bag, it may be too cold to work properly.
- Exposed pump tubing may cause the insulin inside to get too cold. Keep it close to your body or inside layers of clothing to prevent problems with frozen insulin.
- Your backup pens and/or insulin also need to be protected from the cold environment. Frozen insulin won't bail you out from anything.
- If you are falling more than usual, stop and check your blood sugar. Lack of coordination might be a sign of a hypo that you haven't noticed!
- Think about cold temperature when choosing your low supplies. A juice box might freeze if it gets too cold. Find something that you can still eat if it gets very cold.
- Think about falling when choosing your low supplies. A juice box might burst open if you fall on it hard enough. Find something that will stand up to some abuse.
- Wear medical ID.
- Keep some low supplies within very easy reach rather than packed away somewhere. Imagine having a hypo while stuck on a broken chairlift...
- And now that you're worried about having a hypo while stuck on a broken chairlift, remember to have fun and stay safe!