My 10 year old daughter was diagnosed with type 1 diabetes a little over two years ago. She has maintained an A1c of 5.8 to 6.1 and is doing well control-wise. During exercise, such as school physical education classes, we reduce her morning bolus dose as exercise brings down her sugars significantly. She’s 66 pounds, takes 11 or 12 units of Lantus at bedtime and boluses pre-meals, as required.

We are doing well, so far, but the little one is going on her first ski trip next week! Whilst she is the only child where the mother is accompanying, that doesn’t rest well in my mind as they would still be sleeping in different rooms. How is skiing activity generally thought of from an exercise perspective? We have been discussing lowering her insulin dose to compensate for the activity, as well as keeping her sugar level on the high side, but have no experience with “skiing.” We would appreciate any advice or experience.

I applaud your daughter on her A1cs. My first thought is when you reduce her Lantus for physical education class, how much do you decrease it? A good starting point is 50%, but make sure she checks a lot to see if that is the right amount. You should not reduce her insulin by more than 50% of the total daily dose. If so, she will probably be running high later on. Have her check her blood glucose an hour before and a one half hour prior to skiing to compare the two numbers. This will give her enough time to eat or give a little insulin depending on what her number is prior to skiing. I personally shoot for about 150 mg/dl [8.3 mmol/L] prior to activity, but everyone is different. The guidelines recommended by the American Diabetes Association and American College of Sports Medicine are to not exercise if your blood glucose is less than 100 mg/dl [5.6 mmol/L] or 240 to 300 mg/dl [13.3 to 16.7 mmol/L] with ketones or over 300 mg/dl [16.7 mmol/L], (it does not matter whether there are ketones or not).

As always check with your health care team prior to making any changes in her diabetes management.

RP