- Do I need a flu shot?
- My child was just diagnosed with diabetes. What will we do with all of his candy at Halloween?
- I play on a summer soccer team and lately I have had to sit on the bench for almost half of practice because I am low. Please help!
- Are there any diabetes apps for smartphones that you recommend to help with diabetes care?
- When should my child start doing his/her own diabetes tasks?
- I'm going to an amusement park and I wear a pump. Anything I need to do?
- I will be traveling to Europe this sumer with my friends. What do I need to do?
- I use insulin pens and I like to leave them in the car instead of carrying them around. Is this okay?
- How do I figure out how many carbs are in my favorite recipe?
Yes! The CDC recommends that people with either type 1 or type 2 diabetes, who are 6 months and older, get a flu shot. (The nasal spray vaccine should not be given to people with diabetes.) People with diabetes (type 1 and 2), even when well-managed, are at increased risk of hospitalizations, severe flu, and complications, like pneumonia. This is because elevated glucose can make the immune system less able to fight the influenza virus. In addition, the flu and other illnesses can raise blood glucose levels, causing a need for more insulin. Sometimes people don’t feel like eating when they are sick, and this can cause blood glucose levels to rise and fall, so it is important to check glucose levels often and stay in contact with your health care team when ill. And always remember to wash your hands to prevent the flu!
-Katie Wentzell, RN, MSN, PNP
My child was just diagnosed with diabetes and I am worried about what we will do with all of his candy at Halloween. Can you tell me what other families do at Halloween? Do they let their children eat candy?
Children with diabetes can eat candy just like other children. While occasional treats are okay, it is important for all children, not just children with diabetes, to eat a balance of healthy foods with occasional less-healthy options. This is a great topic to discuss with your child’s diabetes health care team. Here are some ideas that have worked well for other families at Halloween: Discuss plans regarding Halloween candy with your child ahead of time. Have the same candy rules for all of your children. Ask your child to pick his/her favorite candies and give your child one piece each day for dessert. Work out an exchange plan where your child can trade in his/her candy for other special items, such as small toys or a family outing. Donate some of the candy to community groups. Plan Halloween activities that do not revolve around sweets. Some activities can include: playing Halloween games, doing Halloween related arts and crafts, and making healthier Halloween snacks.
-Debbie Butler, MSW, LICSW, CDE
I play on a summer soccer team and lately I have had to sit on the bench for almost half of practice because I am low. Please help!
Oh no! Lets talk about some ways to reduce those lows. Low blood glucose (hypoglycemia) can be caused by too much insulin, too little food, or too much exercise without sufficient planning. First, check your blood glucose before any activity. One way to reduce your risk of hypoglycemia is to reduce the amount of insulin before the activity. If you use an insulin pump, try running a temporary basal rate for 30-90 minutes before practice. If you use injections, consider cutting your insulin to carbohydrate ratio in half for meals or snacks 1-2 hours before exercising. Try having a snack before practice. Make sure you have an extra 15 grams of carbohydrate for every 30 minutes of exercise. Consider adding some fat and protein to the snack to help keep your blood glucose steady throughout the entire practice. Do you ever go low again a few hours after practice? That can happen too—it is called the “lag effect” of exercise and it happens because your muscles need to replenish their energy stores after exercise. Be sure to check your blood glucose frequently after activity and try to have a bedtime snack with carbohydrates, fat, and protein to reduce the risk of hypoglycemia overnight. You may want to reduce your insulin dose after practice by running a temporary basal rate or reducing your carbohydrate ratio. Consider using a pump basal rate (for pump users) at bedtime with a 20% decrease for 6 hours. Talk to your nurse or doctor if you have questions about how to adjust your plan for exercise and consider meeting with one of our exercise physiologists at Joslin.
-Katie Wentzell, MSN, PNP
There are many apps available, such as:
- Log for Life: free 30 day trial, $9 monthly subscription
- Go meals: Free food log
- CalorieKing Calorie Counter: Free
- Track3 - $4.99
- Diabetes Personal Calculator: $0.99
- Diabetes Personal Manager: $4.99
- Drag ‘n Cook: meal planning app by Joslin's Asian American Diabetes Initiative
- Diabetes Log: $8.11 (demo in “lite” version is free)
- QuantiaCare for Diabetes: Free access to nutrition information for over 8,000 foods
- Insulin Bolus Calculator: $3.60
- Glucose Meter: $2.84
That is a great question to ask your child’s healthcare team, because the answer is different for each child. While some children may be physically able to handle some diabetes tasks at a very young age, we still prefer that the parents help with these tasks. We encourage family involvement for diabetes tasks during childhood and even during adolescence. We recommend parents check in with their child and ask how they can help. By sharing the responsibilities, you ease the burden of diabetes on the child and hopefully help reach glycemic control targets. Diabetes is hard work, and no one should be expected to do it all alone. When you go to your clinic visits, talk with your health care team about what are realistic expectations for your child. You can also consider meeting with one of our family support specialists, Debbie Butler, LICSW or Dr. Jessica Markowitz, PhD.
-Debbie Butler, MSW, LICSW, CDE
It is important to take precautions to be sure that your pump is protected during your trip. "Free-fall" amusement park rides sometimes use very powerful electromagnets. Pumps should be removed and not taken on these "free-fall" types of rides. High gravity forces can be experienced when riding on some roller-coasters. It is recommended that you disconnect (NOT just suspend) your pump while on roller-coaster rides or at water parks. You may want to use a basal bolus program, consisting of a long-acting insulin analog (detemir (Levemir) or glargine (Lantus)) and a rapid-acting insulin analog (lispro (Humalog), aspart (Novolog), or glulisine (Apidra)) instead of a pump for a day at the park. Contact your healthcare provider for further recommendations regarding possible changes to your insulin needs at amusement parks.
The Transportation Security Association (TSA) specifically states that passengers are permitted to board airplanes with insulin, syringes, insulin pumps, liquids “including water, juice, or liquid nutrition,” and “all diabetes related medication, equipment and supplies.” Tips for traveling are as follows:
- Arrive at the airport early to allow enough time to get through security
- Bring a travel letter from your diabetes health care team
- Bring prescriptions for your supplies (not required but it is advisable to have backups in case you need additional supplies while away)
- Pack all your diabetes supplies in clear plastic bags so they can be inspected easily and always place in your carry-on luggage
- All supplies should be clearly labeled
- Bring extra supplies to make sure you do not run out
- Carry some quick-acting glucose or small juice boxes to treat lows and carry some snacks
- Wear medical identification and carry contact information for your diabetes team
- Review the TSA website http://www.tsa.gov/
- You can continue to wear your insulin pump or continuous glucose monitor (CGM) while going through common security systems such as an airport metal detector as it will not harm the device or trigger an alarm. DO NOT send the devices through the x-ray machine.
- You will need to remove your insulin pump and CGM (sensor and transmitter) while going through the newer airport body scanners. If you do not wish to remove your devices, you may request an alternative pat-down screening process.
- With any of the security systems, notify the security officer if you are wearing a pump (or CGM device) and you intend to walk through the security sensor with it. Do not be surprised if you receive a “pat down,” this is for your safety!
- If you are traveling and want to be able to call your diabetes team, make sure you know how to make an international call. You will need to enable your cell phone to make international calls or you can get an international calling card. To place a call to another country, dial the destination country’s code before the phone number (USA is +01).
I use insulin pens and I like to leave them in the car instead of carrying them around. Is this okay?
A: It is recommended that you do not leave insulin pens or insulin vials in the car because insulin is sensitive to cold and heat. Extreme temperatures will cause the insulin not to work as well, which could result in higher blood sugars.
It is also important not to leave test strips or blood glucose meters in your car either as these are temperature sensitive as well. If you must, there are insulated bags available that can help you protect the insulin against these temperature variations.
A: Look up the carbs of all the ingredients in your recipe, add them up, then divide by the number of servings. This will give you the number of carbs in one serving. So for example, if your favorite fruit smoothie recipe is:
½ cup skim milk 6 grams carb
½ cup frozen blueberries 10 grams carb
½ cup vanilla ice cream 15 grams carb
The total carbohydrate in the recipe is 31 grams for the entire smoothie (1-1/2 cups) or 15 for ½ the recipe.
Page last updated: October 04, 2015