Hot Insulin and Other Ways a Person With Diabetes Knows it’s Summer

How do you know that summer has arrived? Some may go by the calendar (June 21^st) and some may mark the last day of the school year as the beginning of summer, but I have my own signs that let me know it’s summer.  My signs are ones only a person with diabetes can understand. And I’ve come up with some solutions to my summer diabetes issues.  If you have other ones, please share.

1.  Sweaty hands make it hard to check blood sugar. For the past few days as it has become hotter and more humid, I’m sweating more during my morning runs. I have found myself looking for something to wipe my fingers on when I stop to check my blood sugar because there is simply too much sweat on them to get an accurate reading.  During the winter I just use my shirt if I need to wipe at all.  But when summer comes, my clothes are too soaked in sweat and I find myself wiping my finger on trees and walls, and then trying to test my blood sugar as quickly as possible before the sweat takes over again. I know some people carry a small microfiber cloth in their glucose meter kit but my running pack is already so stuffed. Any ideas?
2. I find myself trying to calculate the correct bolus for watermelon.  I love watermelon and I live in a place that grows spectacular watermelon.  It’s one of the few foods I find totally irresistible, and eating it almost always causes a blood sugar disaster. Why is it so tricky to bolus for watermelon?   Watermelon has only 8g of carb per 100 grams (8%) and a relatively low glycemic load because of the high water content.  However, it has a GI of 76 (way higher than orange juice), meaning it raises blood sugar very fast and without a pre-bolus it’s almost impossible to avoid high blood sugar.  But a large bolus which can keep up with the quick rise in blood sugar usually means eating much more watermelon or other carb a few hours later when my blood sugar comes crashing. My solution is to try and enjoy small amounts of watermelon or spread it out over time so the sugar rush doesn’t come all at once.  This requires self control.
3. Dehydration. A few weeks ago I had a headache so severe it frightened me.  It started at the base of my skull, radiated across my head, and throbbed over my eyebrow.  It lasted several days, and I could barely function.  When I moved my head suddenly, I felt shooting pains.  My wife told me to either drink more water or go to the ER.  She suspected dehydration, which made sense as the weather had become significantly hotter and I was continuing to run long distances without increasing my water intake.  Drinking more water worked.  My headache improved. Dehydration is dangerous to all people regardless of diabetes but those people with diabetes who have kidney complications need to be much more careful since dehydration can seriously affect damaged kidneys. So as it gets hotter it is imporatnt to drink plenty of caffeine-free beverages like water and sparkling water. It is also important to drink before you exercise and while you exercise.
4. I start to worry about my insulin overheating. Like many people with diabetes I like to stockpile diabetes supplies. I store most of my supplies in bathroom cabinets and drawers, and I keep my insulin in the refrigerator. This includes all insulin, except for the insulin in use. Before I started using an insulin pump this meant two insulin pens. Now that I’m on the pump it means the insulin in my pump (which is always with me) and the vial of insulin I’m using for refills. I used to keep the “in use” vial in the refrigerator too, but was told that to avoid air bubbles, it needs to warm up before filling the reservoir.  So I keep it out of the fridge in a shady place.  I’ve been told that as long as it doesn’t get too hot, it’s fine. Can anyone define too hot? And what about the insulin in my pump? I just came back from a three day sailing competition with my son. I spent most of each day on a small motorboat helping the coach and learning about sailing. I covered myself with sunscreen and UV protective clothing but my pump was exposed to the sun and the heat most of the time. I knew I needed to keep my pump dry, but didn’t know what to do about the sun and the heat. According to Joslin Diabetes Center, “The pump housing provides some insulation from the heat. If you are concerned about heat, you can use a protective pouch with a small, cold gel pack placed inside the pouch as a way to protect your insulin from the effects of heat. If you are spending an extended amount of time in the sun, cover the pump with a towel to protect it from prolonged direct sunlight. Disconnecting your pump for up to an hour is another option, but if it is disconnected for a longer time, you will need to adjust your insulin infusion rate accordingly to allow for the missed doses.”
5. My infusion set comes out when I exercise. Last Friday I  knew summer had really arrived. I went out early in the morning for a 13 mile run. As always, I reduced my basal rate to 30% before heading out. When I finished my run around 7:30 a.m., dripping in sweat, I grabbed my pump off my belt to cancel the temporary basal rate. When I did, I noticed it wasn’t connected to me.  The sweat had caused the infusion set to fall out.  Joslin Diabetes Center says, “If perspiration is a problem, try using a spray of antiperspirant on the insertion site after your usual skin-preparation routine. Others have success with skin-barrier preparations such as Mastisol, Skin-Tac H or a compound tincture of benzoin applied to the skin.”  I’m afraid that the no amount of antiperspirant or skin-barrier preparations is a match for my sweat, kind of like hoping a flimsy umbrella will keep you dry in a hurricane. Can anyone recommend a tape with very strong adhesive? Other solutions?

Happy Summer!

Michael Aviad

Michael Aviad is co-founder of ASweetLife.  He was diagnosed with type 1 diabetes in 2002.  Michael was born in Santa Barbara and grew up in Jerusalem.  He studied law and after passing his bar exam went on to get an MBA with a major in finance.  Michael worked for many years as an economist.  He and his wife Jess, also a type 1 diabetic, have three sons.  Michael loves to run and is always training for the next marathon. 

Michael Aviad

Michael Aviad is co-founder of ASweetLife. He was diagnosed with type 1 diabetes in 2002. Michael was born in Santa Barbara and grew up in Jerusalem. He studied law and after passing his bar exam went on to get an MBA with a major in finance. Michael worked for many years as an economist. He and his wife Jess, also a type 1 diabetic, have three sons. Michael loves to run and is always training for the next marathon.