It was only about 24 hours after the shock of my lifetime: My freshly-turned 6-year-old daughter was in the hospital, diagnosed with type 1 diabetes (T1D).
There was so much to learn. And yet, one thing kept floating to the top of my mind. As selfish as I felt, I had to let it out to the endocrinologist sitting there explaining to me how to handle a vial of NPH insulin.
“Never mind that,” I said, tears welling up in my eyes, “How are we ever going to ski again?”
That endo, who happened to be an avid skier himself, put down whatever he was showing me, took a breath, looked me in the eye and made this promise:
“You will ski, Moira, and so will your whole family. And you’ll do it the same way you did before this. I’ll guide you. You’ll see. Diabetes need not take away or even greatly alter the activities your family loves.”
Flash forward 6 weeks later, and I was in Vermont at Okemo Mountain Resort, dropping my newly diagnosed itty-bitty kid off at ski school for the day.
How did it go? I’ll save sharing a very telling outcome with you until the end of this story (you’ll want to hear it!). But in short: He was right.
With some planning, testing, tweaking and a whole lot of faith, we merged right back into our active ski lives, hitting up resorts all over America, savoring both powder and sun days and most of all: sharing the activity that was and still is for us a vital family bond.
It’s a lot to think about: sending your child (or anyone) with T1D off for a day of heart-pumping activity that’s sure to have an impact on blood sugars.
For us, since skiing was a family activity before T1D joined our lives (both my children started at around age 2. I like to tell people I only had kids so I could ski with them. It’s only kind of a joke), our goal was to return to how we did it before T1D.
That meant dropping my child at ski school for the day, heading off for my own high-level ski fun and then a post-ski-school late afternoon family ski session.
Fortunately, our endo felt it was important to show my daughter (and me) that diabetes didn’t control us; that rather, we could fit diabetes in around the things we love to do.
It was important to me because I wanted my child to learn from pros. Because I wanted my child to experience the friend-making and group-skiing vibe that is such a vital part of the skiing experience all your life. Because, frankly, I wanted to go do some grown-up skiing for at least part of our ski days.
And because I wanted my child to know and see that she could and would be safe and fine doing things without me hovering.
In other words: My reasons had more to do with growing an engaged skier than they did with diabetes. That’s how, our endo told me, it should be.
Natalie Bellini, diabetes care and education specialist (DCES) and endocrinology nurse practitioner at R & B Medical Group in the Buffalo New York region, told DiabetesMine that our decision was a solid one.
“I think all things with managing T1D is never saying no. It’s learning how to adjust so we can say yes,” she said.
Which brings me to my first tip: Do a “practice trip” with just you and your child with T1D to work out both your nerves and the kinks. By heading up with just my daughter for a weekend (and leaving my other child and husband behind) I was able to cut down what I had to worry about, pack, keep track of, and manage, freeing up my headspace to take this on.
My first step in setting up the practice trip is a must-do that Bellini suggests: a planning call or meeting with the endo or diabetes educator.
It’s important here to point out that no one can simply list out how to tweak insulin dosing for a ski trip in a general way. As we all know, diabetes is individual; everyone seems to have their own unique reaction to just about everything we do.
Some people go higher in cold weather sports. Some people have adrenaline spikes that self-correct later. Some people need much less insulin while skiing.
Most experts advise those going out for the first time to err on the side of needing less insulin. Our endo suggested I cut back my daughter’s long-acting insulin first by about 30 percent and then see. Today, for those on multiple daily injections (MDI), that would mean cutting the long-acting the night before. For those using an insulin pump, a “temp basal” program can be set that morning.
Your healthcare team will help you make that decision.
“We recommend to everyone cutting back basal by 30 to 50 percent, and then simply checking blood sugars every couple of hours,” Bellini said.
“The goal with new skiers, with or without diabetes, is to have an amazingly wonderful day skiing — It is not to have a perfect blood glucose day, but to learn from the glucose is so that the next time you go out it’s more predictable,” she advises families.
Next, it’s smart to call the ski school ahead of time.
“It is helpful for a parent to reach out so that we are aware of the dates and can be prepared to greet them,” Kurt Hammel, Children’s Programs assistant manager at Deer Valley Resort in Utah, told DiabetesMine.
Their goal in speaking with parents, he said, is both to understand the child’s needs ahead of time, give parents an outline of the day (as well as foods to be served at any snacks or meals while in ski school) and most of all, he said, “to also reassure them that we can provide a safe experience.”
Some parents consider asking for a private instructor so they can focus on their child’s diabetes needs. For us, since my goal was for my child to have a full ski life experience, sending her to group ski school worked best.
Ski resorts usually cannot promise which instructor you have ahead of time, since they usually build up the groups, the morning of the ski day or the night before. But I did have a time when my daughter was little that a ski resort decided to assign an instructor to her ahead of time and work the groups around that.
It was Killington Mountain Resort in Vermont and the reason was amazing: They had an instructor with T1D. It was very much serendipity, but you never know what you may get from speaking to them ahead of time.
Our endo helped us hone in on what we expected from a ski school. We expected the instructor to be willing to carry glucose tabs in their pocket (even though our daughter had some in her pocket too). We expected them to keep an eye on her, knowing just the basics. We instructed them that if she said she felt low not to stop and check and assess, but rather to encourage her to just eat fast-acting carbs.
When she was little, we did ask them to always have her ride the lifts with an instructor.
Most of all, we expected them to teach her how to ski in a professional and positive way.
First, we had to figure out what she needed to carry and what could be left in the base lodge. For a ski program that returns to the same base area, it’s easy enough to put most of the diabetes gear in a locker or storage basket (most ski areas have such options).
In her pocket always was fast-acting glucose that’s easy to handle, something Bellini says is a must.
Whether pumping or on MDI, our endo suggested we leave the backup insulin, syringes, sites, and all that in the locker at the base, since none are ever as immediate a need as rapid-acting glucose.
If lunch was going to be in another spot, we would tuck an insulin pen into her jacket when she was on MDI. Pro tip: The closer to the skin the insulin is, the less chance of it getting too cold (freezing and become ineffective). But most closing pockets in a good ski jacket work. Think about it: If your body is warm, your jacket is keeping all things warm.
When pumping, we made sure to keep the tubing as close to the skin as possible, while also leaving the pump accessible.
If you use a meter, it’s not a bad idea to have that in a pocket, and in that case, any pocket will do. Pro tip: When your meter tells you it is too cold to work (and it will), simply tuck it into your underarm for about 30 seconds and *poof!* it’s back to working again.
If you are relying on a continuous glucose monitor (CGM) and reading results off a phone, make sure you keep both in an inside pocket and have someone carry a backup charger. We love the new Clutch backup charger, as it’s super thin and carries a good charge in case your phone runs down.
As for emergency glucagon, whatever kind you keep on hand, either tuck it in your child’s coat and let the instructor know where it is, or ask the instructor to carry it. Most ski patrol folks are familiar with treating a severe low, but ask the ski school ahead of time to be sure. Instructors have the ability to get ski patrol to a spot quickly.
And what about following numbers and reacting to them? Your medical team can help you decide that. For us, the first few times out were about not reacting to any numbers unless it was necessary. In other words, if our daughter ran a bit high, they wanted me to let it sit, so we could see what happens over the entire day and use that data to come up with a long-term plan.
Had I tried those first few times to keep her in a tight range with lots of corrections, her medical team explained, they’d not be able to see how the activity impacted things over hours and hours.
I did try to swing by at ski school lunch time to see how she was doing when she was younger — something that was easy to do since the resorts usually have a pretty tight daily plan around that.
And you probably will be guided to check extra often during the first overnights after skiing, both to see what happens and to make corrections if needed at night.
For those on hybrid closed loop systems like the Tandem Control-IQ, Bellini said the best plan to speak to your medical team about setting exercise mode throughout the day while skiing and leave that target on overnight. That reduces the risk of hypoglycemia all by itself, she said.
This is going to surprise parents newer to diabetes, but my top advice centers more on skiing and riding than on diabetes: Make sure that the instructors teaching your child are certified by the PSIA (Professional Ski Instructors of America).
I’d assert that this is more important than having expertise in diabetes.
While the notion of someone who understands T1D being your child’s instructor is of course soothing and may be inspiring to your child, the baseline is that you want to send your child out there to become a strong, smart, and well-trained skier.
Learning to ski and ride is a complicated and detailed process. Learning from someone not well-trained to teach skiing could draw the wrong lines on the ski blueprint in your child’s mind. So, opt for a trained instructor — and it’s OK to ask that question when exploring options.
I also suggest parents not assume their child can only ski with a chaperone. I love skiing as a family. But I also love that my kids grew up knowing that, when age appropriate, it’s a sport they can head off and savor on their own.
There are some don’ts though, and most of them follow don’ts for anyone who does not have diabetes as well.
Do not ski off-piste (off-trail) alone. Tell your children that, when skiing without ski school or you, they are not ever allowed to go off trail and into the woods alone. It’s just not smart. Mishaps can happen to anyone, like getting lost or injured, breaking gear, etc.
I actually did not allow my children to go off-piste without me or their dad. Ever.
Also, do not expect the ski school to watch a CGM and react to that information. Actually, neither you nor the ski school needs to know trends all day. A few check-ins planned with your medical team should work well.
Back to where I started.
That first day of trying it all out at Okemo resort was nerve-wracking for me, but I soldiered through. After our late-day family ski time, my daughter and I were at the base, talking about heading to swim in the outdoor slope side pool.
A fluffy, movie-set-like snow began to fall and as we stood there, out of nowhere, my then-tiny little skier raised both hands toward the sky, looked up at that snow and yelled with joy: “Kids with diabetes DO still have fun!”
And that, my fellow D-parent, is the telling outcome. Her joy. Her satisfaction. Her seeing first-hand that this would not stop her.
To me, that’s the most vital outcome of all.