Every year, in October, I usually go to a fair, or carnival, that is only once a year, My question is about hypoglycemia. In Florida, it’s still pretty stuffy in the heat and I know insulin is used faster in the heat and the carnival is outside, obviously. What should I do to prevent any episodes of hypoglycemia while I am out in the heat since it is pretty intense in excitement and I guess some form excise? I don’t want to be testing every single hour and eating snacks, and worrying half the night. Should I drink Gatorade or other juice continuously to keep my sugar up? Or, will that cased high blood sugars? Or, will my sugars hit sky high due to stress and excitement and should I watch it? Usually, my blood sugars go up a little when I get excited such as going to the doctors. I don’t go on any upside down rides or anything, mostly just the kid rides with my little niece, but a couple of moderately fast ride. Is it safe for any type 1 diabetic to go on fast rides? Or, is it dangerous due to the release of the adrenal hormone that could cause a nasty low or even cause me to pass out? Is it possible that everything will be fine? Should I check at 4:00 a.m. and 6:00 a.m. in case of any lows since muscles are stressed out from walking miles and on rides? Will I mess myself up for the next three days?

My routine is four snacks a day and four meals a day because I also have cystic fibrosis (CF) and I need more food in order to keep up my weight. In the morning, at 11:00 a.m., I take 18 units of NovoLog for breakfast and 12 units of NPH, 90 minutes later (for lunch). I snack during the day. At dinner, I take 13 units of NovoLog and seven units of Lantus. I have an evening snack two hours after dinner and another snack two hours later. Then, finally, I have my last meal around midnight, when I take 10 units of NovoLog and snack two hours later.Then, I go to bed at 2:00 a.m. I was diagnosed three months ago, in June. My A1c was 19% when I was in the hospital. My most recent A1c was 8.1%, which is very good since it only been three months. My sugars are always very good, from 100 to 120 mg/dl [5.6 to 6.7 mmol/L] before meals and 150 to 170 mg/dl [8.3 to 9.4 mmol/L] two hours after eating. I have no lows, unless I have a delayed meal or snack, and almost no highs. Could this be the honeymoon possibly?

These are good questions and really best should be asked to the pediatric endocrinologist or Diabetes Team that you knows you best. You are correct about the insulin and the exercise.

First, be certain that you keep your diabetes supplies with you, perhaps in a small backpack. You should have a smaller fanny pack into which you can place a chemical cooler bag/block and your insulin and needles. Take your Glucagon Emergency Kit. In your backpack, put in some glucose gel or cake frosting or something else that you have found brings your glucose levels up quickly. There are LOTS of fun and sugary items to eat at a fair but you may not get to them fast enough, given long lines, etc.

You should walk around with someone who knows you and that you have diabetes.

Please wear your medical identification bracelet/necklace that indicates you have diabetes and CF.

So, you should check your glucose often. I don’t think every hour is necessary, but perhaps every two hours if you are more active. Your letter doesn’t indicate that you really dose NovoLog based on your actual carbohydrate intake (“carbohydrate counting”), but that would be even more helpful, especially when you check your sugar before a snack so you know how much to dose.

I do not recommend that you drink Gatorade or juice to keep your blood sugars up since that will probably cause highs. The excitement and stress, plus the food and the heat will all contribute to higher blood sugars. However, the walking will lead to low blood sugars, although, with intense exercise, blood glucose will often rise temporarily.

As for fast rides, I think you will do fine on them as long as you don’t feel low. I recommend that you check your blood sugar just before the faster rides. Typically, the rides don’t last long enough for you to worry about a sudden drop. With a doctor’s note that you have diabetes, you MIGHT be able to be moved to the front of the line!

With respect to the release of the adrenal hormone, you are a bit confused. Release of the various adrenal hormones of stress (adrenalin and cortisol) cause glucose levels to rise, not drop.

Testing at 4 a.m. or 6 a.m. is not a bad idea, depending on when you get home and what your blood sugar is at that time. You are unlikely to “mess up” your schedule for the next three days.

Cystic fibrosis related diabetes is an interesting form of diabetes. Is it a “honeymoon?” Well,…kind of. Compared to the “run-of-the-mill” type 1 diabetic, you still make a fair amount of insulin, probably. You likely do not have so little insulin that you become ketotic routinely, for instance. The medicines that you take for CF quite possibly include medicines like Albuterol and/or inhaled/oral steroid medications, which all increase your glucose. And, depending upon the advice of your diabetes team, you probably have many fewer food restrictions compared to the other type 1 folks you know, as your CF team really WANTS you to gain weight.

DS