Last week the kids and I had our first holiday in quite a while! I was very nervous about this trip - because not only was it our first holiday, but it was a ski holiday - so we were mixing very cold temperatures with high levels of activity!
First came the packing! Our biggest bag was the Diabetes Supplies bag! The old rule of "think of what you will need then double it" - with a ski trip was more like "double it then triple it" - I had to be prepared for multiple site changes each day depending on the weather and any number of things that could happen to insulin pumps on the ski slopes! Add to that the dozens of juice boxes, snack-size chocolate bars to keep in pockets of ski jackets and plenty of other food to have on hand if needed.
Of course there was also contacting the Diabetes Nurse beforehand to check on insulin doses while we were away - reducing basal rates - and watching out for post activity hypos in the middle of the night.
Soooooooooooooooo much more planning has to go into preparing for any kind of trip when D is involved - and even more so for a ski trip. Skiing had always been a big part of our lives before T1D joined our family - so I was determined to make sure that T1D did not take this away from us.
I do have to say though that I spent a lot of time with my heart in my throat whenever my son was out of my sight! My daughter was with me all the time, but my son is 14 and is a snowboarder, he didn't want to hang around his Mum and little sister the whole time - but how do you let a T1D kid go off on his own on a snowboard??? It's not easy - but I had to give him a little slack.
We had one big scare - I had arranged for a photographer to take some family shots up the top of the mountain one morning. The weather was bad, very poor visibility and there had been a huge dump of snow overnight. We got off the chairlift and the photographer went off to scout for the "perfect" spot for our photos. She put her snowboard (which actually belonged to a friend of hers) at the edge of the run - dug into the snow. A gust of wind came up and blew her snowboard over the edge of the run. My son decided to go after it! WHAT??? He didn't really know his way around the mountain - and had NO idea what was down that side of the run - it was off piste! Not only that - but he only had one foot strapped into his snowboard - he hadn't strapped the other one in yet after getting off the chairlift because we were going to be taking skis and snowboards off for the photos! We called out to him to stop - but he kept going - could not hear us. We lost sight of him. I was terrified. We made our way back up to the the chairlift and waited - hoping that he had made it down the bottom okay and would somehow find his way back to where we were. I had a vague idea of roughly how long that would take - so we sat up on a bench at the top of the run and waited.... and waited.... and waited.... and waited.... and waited.... Finally the sick feeling in my stomach was too much to ignore so I went into the Ski Patrol hut and notified them that we had a missing T1D teenager somewhere down the side of the mountain! The thing that made it even more worrying was the fact that despite reducing his insulin doses during the ski trip to next to nothing he was constantly dropping low - with BGL's rarely above 3mmol/L while snowboarding! Ski Patrol got onto the radio and notified all lift operators to look out for him - and one of them was heading out the door to do a ground search when I saw my son's fluorescent yellow helmet come up the chairlift! He had made it back!
Wow - I could breathe again!
Turned out that the runaway snowboard had gone over a ledge that my son could not see because of reduced visibility - but he also could not stop because it was too steep. He too went over the ledge and landed in waist deep fresh powder! So, he had to dig himself out before he could make his way down to the bottom, then up one chairlift, down one slope, up a T-bar, down another slope then back up the main chair to where we were waiting for him!
As for his BGL while this was going on - in this instance adrenaline was our friend! He was just a tiny bit stressed - so the adrenaline kicked in and gave him a glucose boost! It was enough to get him back safely to us! Of course it then took 2 Boost bars and a full strength 600ml Coke to stop him from having a huge hypo a bit later!
So - other than that little adventure, we got through a week on the slopes without any major problems.
Tips for managing T1D in the snow:
1. If you're using an insulin pump check with your Endo or Diabetes nurse about reduced basal rates and be prepared to make lots of adjustments.
2. If you've reduced basal rates and your child is running a bit high make sure you check for ketones and if there are any present at all then you need to increase the basal rates a little - but just in gradual increments.
3. Wear your pump in a belt - either a Spi-Belt or something like the Diabete-Ezy belts - to keep it nice and close to your body to prevent the insulin from freezing. Wind the tubing around the pump also so that it can't get caught on anything - and make sure everything is tucked away inside several layers of clothing.
4. If you have a cover for your BGL meter - use it! If not - keep it in a warm pouch in an inside pocket of your jacket so that the meter and your test strips or test cassettes stay warm and dry.
5. Do BGL's after every 3-4 runs - or at least once every hour. We found that doing "half-corrections" worked reasonably well if they were a little high - gave them enough glucose in reserve to burn during skiing and in the cold temperatures.
6. Fill your pockets with snack-sized chocolate bars.
7. Wear identification on your person or on your clothing (or both).
8. Never hesitate to contact Ski Patrol if your T1D child has been out of sight for a little longer than you have expected. They are more than happy to help out.
9. If your child is having ski lessons - either with ski-school or private lessons, make sure the instructor knows that your child has T1D and give instructions for how often they need to test and what to do if they are low - also make sure they are able to contact you at all times.
We had the most fantastic time and it was wonderful to see the smiles on my kids faces!
Of course T1D usually has to interfere in some way - and since it pretty much behaved itself while we were away it decided to make up for it when we got home!
My daughter's pump failed while we were having dinner an hour after we got home from our trip! And not just that - she was high at the time (19.9mmol/L) - and needed to correct, but also, she was having pasta for dinner which always requires a square bolus since the carbs don't go in right away!
So, since it was Saturday night, my call to the pump manufacturer was diverted to the US - who are passing on the pump failure details to the local office who obviously can't do anything about it until Monday - so we're back to MDI's until a replacement pump arrives!
Ahhhh the joys!