PHYSICAL EXERCISES WITH THE INSULIN PUMP
“Will an insulin pump limit my ability to exercise?” is one of the most common questions I get asked as a clinical diabetes manager. The MiniMed insulin pump allows you to adjust your insulin dose for short training times and for longer periods of time. Enlite- or Sof -sensors, which are used for continuous glucose monitoring (CGM), show sensor glucose (SG) data so you can see your glucose trends before, during, and after your workout. To find out how different types of physical activity affect your body, use the LMWH to monitor your sensor glucose levels and check your blood glucose (BG) levels with a glucometer before, during, and after exercise.
PREVENTION OF HYPOGLYCEMIA
The risk of developing hypoglycemia associated with physical activity depends on the type, duration and intensity of exercise, and measures to manage this risk should be taken during and after exercise. Some people may need to prepare an hour or two before class to ensure that their glucose levels are at a safe level. It all depends on the characteristics of the organism. Talk to your healthcare provider about the type of exercise you will be doing and how best to manage your insulin regimen before making any adjustments yourself.
If you are using a MiniMed pump paradigm Veo , the Threshold Stop feature will automatically stop insulin delivery when sensory glucose values reach a pre-set low threshold.
If you are planning to exercise, it is best to always have 15 grams of fast carbohydrates (eg 120 ml of orange juice or 3-4 glucose tablets) with you and keep them in an easily accessible place. If you are exercising between meals, check your blood glucose before you start exercising. If your BG is below your desired level, you can adjust your basal insulin with a temp basal setting (but follow your healthcare provider’s instructions) or have a small snack containing 15 grams of carbs, such as crackers, an apple, or whole wheat toast. If your glucocorticoid level is below 50 mg/ dL (2.8 mmol/L) try to get 20 grams of carbs.
TIME AND DURATION ACCOUNT FOR INSULIN ADJUSTMENT
Consider time and duration when adjusting insulin and always follow your healthcare professional’s advice. Your need for insulin can be affected by the time of day you exercise. For example, in the morning, glucocorticoid levels tend to drop less during exercise due to the presence of hormones that help maintain glucocorticoid levels at this time, so you can exercise at your doctor’s recommended insulin settings. In the afternoon, hormone levels drop, so you may need to temporarily lower your basal insulin supply to prevent hypoglycemia.
Prolonged physical activity (90 minutes or more), such as moderate jogging or swimming, can lower your blood glucose. In this case, a temporary basal insulin adjustment may be necessary. According to the Management of Insulin Therapy During Exercise in Patients with Type 1 Diabetes study , the recommended starting point is to set a temporary basal rate at 50% of normal or standard basal rate for one to two hours prior to physical activity (1). At the same time, short-term exercise (such as sprinting or lifting heavy weights) can increase blood glucose by causing the release of hormones, particularly adrenaline, which releases the glucose reserve from the liver. Thus, short-term exercise may not require basal insulin adjustments. It is important to check with your healthcare provider before making any changes to determine which option is best for you.
ADJUSTING BOLUS INSULIN WITH A MEAL
According to the ADA and Robert Walsh, author of Pumping Insulin , if you eat up to 90 minutes before you start physical activity, you may need to reduce your mealtime bolus insulin to maintain optimal blood glucose levels. Below are a few examples of adjustments based on exercise intensity and duration that have been effective in some patients (2,3). Remember that you need to constantly consult with your doctor. As with insulin to carb ratios, there is no one size fits all solution when it comes to insulin and exercise. Balance can only be found by trial and error.
- Low intensity, less than 60 minutes: Reduce bolus by 10% – 20%
- Moderate intensity, over 60 minutes: Reduce bolus by 50%
- High intensity, less than 60 minutes: 50% bolus reduction
- High intensity exercise, over 60 minutes: Bolus reduction of 70% or more
DISCONNECTING THE PUMP
The need to disconnect your insulin pump depends on your body’s response to physical activity and the type of activity. In some cases, the pump must be disconnected, for example, when swimming, surfing or other types of water exercises. There are times when close physical contact is expected and turning off the pump can help prevent damage to the pump. If you are considering disconnecting your pump, consider time, duration of disconnection, and exercise intensity. This will help determine the parameters and the need to adjust insulin. If you disconnect your pump for less than 60 minutes, you usually don’t need to change your basal insulin, disconnect your pump for more than 60 minutes, consider reconnecting after 60 minutes and delivering 50% of your normal basal insulin rate as a bolus. As always, you should discuss with your healthcare provider the plan to replace insulin that you did not receive when your pump was turned off.
CORRECTION OF HIGH BLOOD GLUCOSE
What to do if you go to a workout but your BG is high? If BG is significantly outside the target range of 14 mmol/L) and above, a ketone body test should be performed. Activity in hyperglycemia can be somewhat impaired, but if ketone bodies are absent, it is generally safe to exercise. Be sure to talk to your healthcare provider before you start exercising to determine a course of action. Remember to drink plenty of fluids, and Robert Walsh, author of Pumping Insulin, recommends considering administering 50% of the Bolus Wizard’s recommended pre-workout correction(3).
USE OF BINDING TECHNIQUES DURING TRAINING
There is a wide variety of infusion sets and attachment methods available on the market today for pump users. If you have difficulty turning off the infusion set during exercise, place it in a place where the skin will not sweat or stretch excessively (for example, on the arms or buttocks). Additional dressings (such as Tegaderm or IV 3000) may be used, and tight-fitting clothing may be worn over the infusion set to prevent it from shifting.
We look forward to your advice and comments, and do not forget to discuss any problems with your doctor! Whatever your plans – increase physical activity, go hiking or train for a marathon – take care of your health!