Recommendations for outside labor


(HUNTER) #1

I do commercial and residential tree work. So I’m always outside sun up to sun down. I’m newly diagnosed with t1d and am curious on how I’m going to cope with having to change my omnipod every day if its above 98 so my insulin won’t go bad? My doctor told me if it can cause the insulin to stop working. I have a dexcom also. So do I use a pen on 98 plus degree days or use my pod since I can monitor my bg reading and see if the pod is actually giving my insulin.


(Bill) #2

Hi, Hunter.

I don’t have an Omnipod; I’m still using an older Medtronic device. I would encourage you to visit with the folks at Omnipod for their specific recommendations. Now, be aware, they are going to give you the “liability-attorney-approved” recommendations. They are not going to make any recommendations, or infer that what you plan to do is “okay,” unless your plan exactly matches the recommendations they have been told to provide. Nevertheless, it might be good to know what they have to say.

Now, to “real life.” I live in West Texas and have lived in other climates where temperatures in summer hover at or above 100°. And I often am outside working in the sun. At times I will be on my motorcycle on long trips (>3 hours) when the temperature is above 94° and, of course, I’m in the sun. All of the above was true even before I got my first pump (>12 years ago?).

Whether backpacking in a wilderness area, riding my motorcycle, or working outdoors this is what I do year round. I wear my pump on my belt and I make sure my pump (and infusion set) are covered. So, in the winter, they are covered by my coat. In the summer I pull out the tail of my tee shirt and allow it to drape over my pump/connecting tubing. When I’m on my motorcycle my armored riding jacket covers the pump. So, when outdoors/in the sun/in the cold my pump and connecting tubing are covered somehow.

I have seldom had issues with my blood glucose levels that I could relate to having my pump reservoir exposed to high temperatures/weather conditions. I can remember two times(?) in the past thirty years or so when heat “may” have been an issue. The more recent episode required me to slightly increase my meals boluses, and I had to bump my basals up just a bit. But this lasted for about a day and a half. But note - I had filled that reservoir with the last of the insulin from a vial. My next reservoir was from a newly-opened bottle of insulin.

To go off topic just a minute, the package insert in your bottles of insulin (and the PDR or “Physicians Desk Reference”) clearly indicate that bottles of insulin should be discarded after they have been open for 28 days. What? Yes, 28 days! I have never discussed “why” with a representative from Eli Lilly, but I wonder if their reason is that insulin “ages” and is rendered ineffective over time after the vial has been opened. It might be, too, that repeated draws from the vial has the potential to introduce contaminants that can begin to break down the insulin (I don’t know if this is true). Prior to the development of recombinant insulin we would sometimes see “stuff” grow in bottles of beef and pork insulin that had been opened; this was despite a healthy dose of camphor used in the diluent of the insulin (that’s why it used to smell like camphor). The “tradition” of “pitch it after 28 days” has been around for a long time (if I remember correctly). I will admit I use vials for longer than 28 days (is that the FBI knocking at my front door?).

I wrote the above paragraph to indicate that I don’t know if heat “caused” my insulin to become less effective, or if it was a matter of an “old bottle,” or a combination of the two. I kind of think it was both.

Now, let’s talk about climbing trees, er, riding a motorcycle. Before I get on my scooter I know what my blood glucose level is. I don’t get on it unless I know. And, after 60+ years of doing this, I know the pattern of my responses to glucose loads and insulin doses. So, when traveling (even in the car) I check my blood glucose level every hour; I make corrections (subtly when on the scooter) as needed. And I remain extremely vigilant of signs of developing hypoglycemia (low blood glucose). You don’t get “second chances” when climbing trees, er, riding a motorcycle. With diabetes and dangerous physical activity you have to stay vigilant! Period!

You are obviously new to this. And, it may be, that you are still in the “honeymoon period” where your body will not need larger amounts of insulin. Given your occupation, and given your unfamiliarity to the ins-and-outs of this rascal of a disorder, I would encourage you to stay in pretty close contact with your physician. Also, and this is most important, use your blood glucose meter in addition to your CGM so that you can begin to see how your pattern of activity and insulin affect your blood glucose levels. Keep a log in addition to the data stored from your CGM. Learn to “know” how your body reacts to insulin and activity. As you continue to keep your log you’ll see how being outdoors affects the effectiveness of your insulin. Once you “know,” you and your physician can make any necessary adjustments.

Remember, just like riding a motorcycle, there are no “do-overs” climbing trees.

Good luck to you!

Bill


(Dennis J. Dacey, PwD) #3

Hi Hunter @Hunter52, welcome to the world of diabetes and a warm welcome to TypeOneNation. Like @BillHavins I’ve been playing around learning life with insulin for 60+ years since the good old days when it took a couple of days to get the results of a simple blood sugar blood draw - so I’ll paraphrase what Bill says near the end, get to know YOUR body, get to know the feeling when your body glucose level is dropping and you will be fine.
As for insulin in warm / hot weather, from my experience I don’t see a need to be too concerned. I live in Florida where it is hot, flat and very little shade 10+ months of the year and I’m outside for hours every day - after retiring on the first day of my 70th year I’d be out on my bike 6+ hours every other day and on the other days I’d walk 4 to 6 miles a day. I never noticed insulin losing its potency. I use an older model MiniMed pump with tubing.
Enjoy your time in the trees - I miss managing mine since I left my ski-house on the NH mountains, and come home safely EVERY day to that wonderful looking baby.


(Kate) #4

@Hunter52 Hi Hunter! I’m not an outdoor worker but am an experienced pod user. First off, the pod will always work and deliver the insulin. The issue is that the insulin loses its efficacy at high temps. This may mean you need to take more. At most, it is only 3 days, so it should be fine in the pod. I would make sure your insulin vials are kept in the fridge so the whole vial doesn’t get ruined. The pods are good for 3 days, so you won’t have to change it everyday. I can also pretty much guarantee your insurance won’t let you get more than the average 30-90 day supply. For ways to keep the pod cooler, maybe try a sports sleeve that can go around it, to block the sun. Or a cold wet towel around it. I would check in with Omnipod, they are super helpful. You will also struggle with sweat causing the pod to not adhere to your skin, so a sleeve will probably help. Google omnipod sleeves, there are a ton of options!


(ginny) #5

Hello! I’ll also add I never had any issues with my omnipod for the ~8 years I worked outside in Texas. Temps in the summer often were over 100.

I was careful to not leave a backup pod or a vial of insulin in the sun or a car. Usually just tucked the backups in my lunch cooler.

I would also recommend working closely with your doctor as you adjust. High temps, dehydration, labor etc… can effect your blood sugars.

It’s great you got a cgm to keep track of trends that pop up, and can work with your doctor to address them.


(Ami-one) #6

Hi! Depending on your insulin you may notice differences in bg + heat. I change every two days in the summer months. Bgs are good day 1 & 2, day 3 they start to go up so I can increase amount of insulin or change pod.

Keep your insulin and backup pods in a cooler - I use room temp insulin to fill and I do cycle out my insulin every 28 (used to carry a backup insulin and found that there was a difference in my bgs using insulin that had been opened more than 28 days. Thought it wasn’t a biggie till I stopped carrying a back up. Now I take mine out of the fridge one day before I open it (got lots of failures with cold insulin).
All in all. Use your Dexcom to keep tabs on bgs. If they start going up increase basal or change pod depending on your situation. :sunglasses: