My son started his pump Tuesday - so far, so good. Right now, his basal rate is the same all the time & we’re testing frequently & will be making adjustments as patterns emerge. He’s running within the normal range but just a smidge higher (10 points or so) than he was on MDI. He hasn’t had any lows so far. There could also be a difference, because he switched to the meter that came with his pump. We haven’t compared old & new to see how close they are.
He has his first basketball practice this weekend and wants to disconnect for it, because they get pretty physical. I told him that was fine as long as he tests every hour & reconnects if need be. He tends to go low during basketball and after, so we usually have to fuel him up before he plays & watch for lows after. Questions: If he’s going to disconnect for 2 hours or so while he plays, should we set a reduced temp basal about 2 hours before practice so he has less insulin circulating while he plays? When we reconnect, should we set another temp basal since he normally goes a little low after practice, or, since he won’t be getting insulin while disconnected, should that “no insulin” period actually hit him after practice and prevent the low? I know everyone reacts differently, but we need a good starting place from which to start experimenting.
Thanks - you guys are always so helpful!
p.s. - My son is loving his pump & all his anxiety about the change is gone!
I’d consider a “whiff” of insulin, like a fraction of the hourly basal beforehand? If his regular basal= like .8U/ hour, maybe .1 or .2 or a bit more if gatorade is readily available? That might prevent spiking as I suspect if they are “physical” there’s probably quite a bit of adrenaline, etc. pumping around? I am not sure it might not be a bad idea to just go for unplugging and testing as a test too but that might be because while I run regularly, i don’t crash the boards these days!!
Gatorade is frowned upon at the gym where he practices, so he usually sticks with water. His hourly is pretty low - .325/hr. So you’d suggest backing that way down, like 80% or so? That would truly be just a “whiff” of insulin. Or just disconnect at practice time & see what happens?
Adrenaline would probably keep him up some if we just unplug & don’t reduce beforehand. Interestingly, when he practices with his team or plays games, he doesn’t tend to fall until practice is over, but if you get him out back playing with dad (& they play hard) he almost always tanks unless he really boosts ahead of time & drinks Gatorade during. Maybe playing with dad doesn’t get his adrenaline going so much?
Thanks for the suggestions.
I usually figure .1-.2 is a pretty negligible amount but w/ .325/ hour, that might even be overdoing it? Maybe a 50% basal rate increase beforehand or something? If crashing w/ dad doesn’t produce the same results, maybe there’s a relaxation or adrenaline thing going on? I had a huge BG nightmare @ my black belt test as my BG spiked through the roof, likely nerves as we also were in the middle of a sudden move and it was a super stressful time. The test went ok and my BG eventually recovered but it was perhaps my worst BG day of just about all time, or at least that I can remember? If that sort of thing is going on, one other way to get one’s BG up quickly can be to do sprinting or pushups or some type of anaerobic thing? I hit 39 2 miles into an 8 mile run one day and had sugar and sprinted and I think the sprinting helps. I try to avoid that but, in an emergency situation it’s not to be overlooked, although the coaches probably would frown upon doing pushups or might make you do them until your arms fall off?
He needs fuel and insulin while he exercises and you’re right that by removing the pump he’ll be operating without insulin two hours later. One way to address both issues is to consume carbs an hour or so before practice but take a reduced bolus. That way he’ll have food and insulin on board for practice and to cover in part for the lost basal insulin. Obviously keep close track of bg during practice. Afterwards, reconnect right away, eat something with carbs and protein and bolus for the carbs if bg is normal or high. But don’t correct a high yet. I would wait and see.
It’s important to make up for the lost insulin when disconnecting. I avoid it.
Also, get a copy of the book The Diabetic Athlete by Sherri Colberg.
Good luck.
Terry
This chart (sorry I couldn’t figure out how to copy the pic link but just took a pic, the chart is in Pumping Insulin and Think Like a Pancreas, basically suggesting the duration and intensity. If there’s any "standing around being lectured or whatever, it might be considered “moderate” but if it’s really intense, it would probably work. As always testing and data should give you the best clue but it’s probably inconvenient to test during breaks or whatever?
We have the Diabetic Athlete, and it’s a great resource. We had everything pretty well figured out for MDI, but the pump is a different ballgame. I don’t like the idea of him being without insulin, but, we were told to disconnect for contact sports. Thanks for your suggestions.
We ended up doing -20% for an hour and a half prior to basketball practice. He started practice at 144; tested after the first hour & was 104; finished an hour later at 100 & reconnected. I guess we should have reduced his basal a bit afterward, but we didn’t. He wasn’t hungry & dinner was going to be about an hour later, so he didn’t have a snack. He was 64 when he tested before dinner. So, I guess next time, if his number is good after practice, we’ll reduce his basal for a bit after he reconnects, or,if he’s hungry, have him eat a light snack to ward off the coming low.
Thanks again for the suggestions.
I thought about this more and, by “pretty good”, while 64 is a bit on the low side, it’s not out of hand and a slight reduction in basal or small snack would likely get him right where he’d want to be? Or maybe some type of anaerobic activity, “great practice, now do 100 pushups” groan LOL…one of my martial arts instructors would often have a set of “celebration pushups” at the end of class, which I thought was a great idea, to move it away from being sort of punishment to a positive thing. I don’t recall what it did for my BG but I have used sprinting to raise it while I 'm running.
One thing I wonder about is how precise pumps really are, if you are only pumping .325U/ hour and cut it to 80% vs. 70%, does the pump really put out the exact amounts in question or does it wing it? There probably is some medically determined “margin of error” that would figure into this. I suspect that a pump would likely err on the side of caution but it’s hard to tell for sure?
My son chooses to disconnect his pump for basketball practice as well. If his practice is after dinner (usually it is) then we do 25% less bolus insulin for his meal. We disconnect the pump for the 2 hour practice, check sugar inbetween the 2 hours, reconnect and check bs. We put him on a 30% temp basal for 3 - 4 hours after practice.
At our last visit, his dr told him to give a % of his basal before disconnecting like maybe 30% and see how it goes. She did not like that we just disconnnected his pancreas without giving him at least some of his basal for the hour. We have not yet tried this. Glad to hear your son is enjoying his pump.
