Endocrine Abstracts

In Northern Ireland the annual marching season starts around April/May and can last until the end of September. This is a time when those children and young people with Type 1 Diabetes Mellitus who are involved in parades, need advice from the diabetes team regarding the variations in their activity levels. This can be a very delicate subject within the cultural setting, revealing their allegiance for one side of the community or the other and can be very sensitive. As a result, patients or parents may ask veiled questions about these events but seek clear guidance about ‘long walks whilst carrying a drum’ to avoid swings in their blood glucose levels, allowing them to participate. The team must read between the lines and delve deeper in a sensitive way as the ‘long walks’ can be continuous or sporadic in nature and each patient may be participating for a different reason. This leads us to an explorative discussion about the effect of anaerobic and aerobic exercise on their blood glucose levels and how to manage this, especially using a basal bolus regimen. The recommendations need to be individually based, and often leave little time for testing the advice out before the event. In the midst of this vague discussion, variations in the weather, interpretation of the ‘long walk’ and change in diet can lead to a tricky conundrum. These enquiries need the advice of the whole multidisciplinary team. Often the family will ‘open up’ better to the nurses, especially if they feel the nurse has realised the reason for the ‘long walk’. The dietitian is invaluable in offering dietary advice for the different types of activity and the prescribers within the team advise on adjustment to the regimen pre, during and post the activity. We discuss one such case & the advice provided.