demanding physical work and type 1 diabetes

[kelvin]

My son is doing a very physical demanding job for the summer months and he has not decreased his insulin, but has increased his carbs. He is experiencing low blood sugars a couple of times in the day. What is the best way to deal with this? Also, does anyone have an opinion regarding heavy physical work and type 1 diabetes? Are they compatible? Is it normal for a type 1 diabetic to become fatigued more easily than someone without the disease.

[JDRF-Team-ES]

These are great questions with many possible answers, like most issues with diabetes.  I am not a physician, but have had Type I for 40 years and will try to do my best to respond to your questions from my personal perspective.  As always, these questions should be directed to your son's physician for a more educated medical response.

It is always a challenge to figure out the right mix of food and insulin when there is a change in activity or schedule. It sounds like your son has made a good start by increasing his carbs, but leaving the insulin as it is. He probably needs more food simply because he is burning more calories with the increased activity.  Because of the frequest lows, it may now be time to decrease the insulin dosage.  His physician can help him with the best way to do that. In the meantime, he may need to test more frequently and, as always, keep some juice or extra carbs close by at all times. It is also always a good idea to let co-workers know that you have diabetes and what they can do if you should get into trouble with  a sudden low.  

Regarding heavy work, I don't know how old your son is, how long he has had diabetes and if he has had any complications as a result of the diabetes.  All of these factors would impact the answers to your questions and should be asked of his physician.  My own philosophy is that if he has not had any complications and is in good control and in decent shape then he should be able to handle heavy physical work as well as anybody without diabetes.  He may be a little more tired initially just because he isn't used to the work.  That should change once he gets used to the physical labor and gets his food/insulin mix under control.  Having low blood sugars can also wear you out, especially if you are having them a couple times a day, so that may also be contributing to his fatigue.

The only time I would worry about heavy physical labor for a diabetic is if there have been retina complications, high blood pressure or heart disease which can be long term complications of diabetes.  He should also make sure to wear proper fitting sturdy shoes that are appropriate for his work.

I know that some people feel they have to limit themselves because of their diabetes. That has never been my philosophy. I have enjoyed a very active nad productive lifestyle, in part, because I made the decision very early on that Diabetes was going to exist as part of my life as opposed to my organizing my life around diabetes.   Obviously, there are many things I must do because I have diabetes..insulin, food, activity, etc..., but as far as my activities, I have never stopped myself from doing what I want to do because of diabetes.  I would encourage you to support your son in living the kind of lifestyle he would like, while always maintaining a healthy respect for the medical demands that diabetes requires.  It's not always an easy balance, but the rewards are worth it.  I wish him a great summer and I know by the end of it, he'll be in great shape!
Es

[JDRF Team SGG]

I must agree with the response written by ES. I have been a type 1 diabetic for 35 years, have played USTA tennis and was a white water rafting guide for several years. Physical activity requires that we compensate with extra carbohyrdates or decreased insulin, and it may take your son a few weeks to adjust to what is going to work for him during the summer. I have been told that for physically active people, the quickest-absorbed carbohydrate fix for a low glucose episode is Gatorade, for it not only replenishes the electrolytes that sweating makes the body lose, but it also is made to be at the perfect consistency for very quick digestion. He may do well to keep some Gatorade handy at all times, and sip it occasionally throughout the day if he feels a drop starting. He can forestall serious lows this way, and the "grazing" may help his body stay stable while doing the strenuous work. He may also need to take a quick break to do a finger ***** every 2-3 hours just to make sure he is OK. While this may seem like a pain to him, it is certainly the best way to know whether a sip of Gatorade is in order or not, and it is certainly preferable to having a severe low while on the job. His lows now may be happening just because his body is still adjusting to the new schedule and he has not quite figured out yet how much to lower insulin or increase carbohydrates. The Gatorade will see him through until he gets the routine down pat... just get him one of those water bottles with a nylon clip and have him clip it to his jeans and he will have it with him whenever he needs it.

[kneazlelady]

I am new here, and I am so grateful for this place! Disclaimer: I am not a trained nurse, social worker, psychologist, diabetes educator, nutritionist, or doctor--just a diabetic--and any advice from me should be checked with a qualified person to prevent any possible calamity.  I commend everything that has been said here so far, especially reading two posts from diabetics with 30+ years under their belts--YAY! I am a type 1 diabetic and have been for 23 years. I would also add a caveat that the person with the physically strenuous schedule not only has to be careful during his summer job but also when he ends the job and returns (perhaps) to a lesser level of activity. I always got more physically active during the summer and then had an adjustment period after getting back into the fray of the rest of the year. Times when I was not prepared for the decrease in physical activity were the hardest for me. Insulin usage went haywire, my eating habits had changed drastically, etc. Also, hypervigilance (the only person who can define what is 'hyper' is that person and no one else) can be draining to the spirit/emotional balance as well as low blood sugars. I can check and check and titrate and monitor myself into oblivion until I get burnt out from the effort. Another thing: I would recommend that extreme care be taken when confronting a person with a chronic illness on aspects of her/his self care routine. Is the advice welcome? How is the advice given--in a friendly, non-judgemental manner, etc.