Q: Do I need to adjust my child’s type 1 diabetes care when there’s a time change?
A: When it’s that time of year to turn the clocks back or forward, be aware that a few details of your child’s diabetes management may need to be adjusted, especially if your child uses an insulin pump.
Every child with diabetes has different insulin needs. As a general rule, kids with T1D receive basal (background) insulin and mealtime (bolus) doses of insulin. If your child’s insulin is delivered via multiple daily injections, it’s up to you and/or other trained caregivers to calculate how much — and when — insulin is administered. When you know a time change is coming up, you can factor this into your calculations.
Insulin pumps are programmed to administer mealtime boluses and to trickle out small amounts of basal insulin at times set through the pump’s internal clock. For now, pump clocks do not auto-adjust for daylight saving time. (Nor do pumps have GPS-enabled tracking systems for automatic time changes when you cross geographical time zones.) It’s up to you or another trained caregiver to manually change the internal clock on the pump to match the new time. For the annual “fall back” and “spring ahead” time changes, consider changing the pump clock first thing when you wake up in the morning after the time change (which officially occurs at 2 a.m.), so that it will be easier for you to monitor any blood sugar changes.
What happens if you forget? The biggest clue that something is off with your child’s pump is out-of-range blood sugar numbers. For example, your child’s insulin pump may be set to adjust basal insulin delivery based on your child’s typical activity levels during the day. Your child may have gym class in the morning, or walk home from school every day at 3 p.m., and the pump may be set to deliver a smaller basal rate at those times.
If your child arrives at school on Monday with his or her pump unknowingly off by an hour, basal insulin rates will no longer match up with your child’s schedule — and you may notice mysteriously higher or lower numbers. Likewise, if your child is eating an hour earlier or later than the time recognized by the pump, bolus insulin won’t be as effective or precise and blood sugar numbers may end up out of range.
Your pump trainer probably showed you how to change the pump’s internal clock at one of your initial training sessions. If the details have become fuzzy, check in with your trainer for a quick review or call your pump manufacturer’s customer service number. Besides adjusting the hour, also make sure you know how to correctly set a.m/p.m. — another common pump clock issue that can interfere with insulin delivery.
It’s important to keep in mind that many other factors can impact a child’s blood sugar numbers whenever there is a time change. For example, when we turn the clocks back in the fall, it gets dark out earlier and kids start to spend more time indoors. If your child’s fall sports have come to an end around the same time, you might see blood sugar numbers start to creep higher and you’ll need to adjust. The opposite may happen in the spring when extra daylight helps kids stay active outdoors and their insulin needs may decrease.
Travel can also create a time change. If your family plans to fly or drive across multiple time zones on vacation, you may end up eating at different times or skipping meals. Your trip might involve a lot of sightseeing or swimming at the hotel. Your child might need a pump site change because a kink developed in the pump’s tubing. Be prepared for anything by carrying such essentials as extra snacks and low blood sugar supplies, extra pump supplies (including extra insulin), and injection supplies. Performing more frequent blood sugar checks when you travel can help you adjust and catch problems early.
That old expression “The only constant in life is change” is more than true when it comes to diabetes management. No matter what, time will change — so write yourself a note and remember to change that pump clock!
—Donna Naturale, D.N.P., R.N., A.P.N., C.D.E., is an assistant professor at Caldwell University School of Nursing and Public Health in Caldwell, New Jersey.
How Other Parents Deal
“One thing we didn’t expect flying between the East and West Coasts was the amount of jet lag our son experienced. He would be up — wide awake — at 4 a.m. Pacific, ready for his 7 a.m. Eastern breakfast. We were in Los Angeles for only three days, so I decided to stick with his East Coast eating schedule. I think it helped keep everything steady — and we made it to a lot of early-bird dinner specials!”
—Amy P., Scarsdale, N.Y., mom of 9-year-old Jonah
Disclaimer: The information in these articles is not intended as medical advice. Families should check with their healthcare professionals regarding individual care.