Let's talk about dealing with exercise and the pump

I am an active adult who exercises almost everyday. I have information on how to deal with prolonged exercise which I do about once a week. Does anyone have info for regular workouts. The chapter in “pumping Insulin” was not specific enough for my taste. Today I had a BG of 120 before going on a half hour walk. My BG was 66 when I got back and I did not wear my pump during the walk. I had .2 units of humulog on board. Half of that should have worked during the walk which is less then half of what would have basaled. Does anyone have a chart of when your BG is here before moderate or light exercise do this or eat this amount of carbs? Any good references?

i red think like a pancereas,it has a chapter,really good,about exercise
to perform well,and keep your bg in the right catogory,that’s our goal when exercising
i’t’s all about the insulin level
try reducing the basal before the training about 5 hours before,since thats the time the insulin needs to clear
i hope i have been useful

I have to turn my basal down at least 2.5 hours before strenous exercise. I fine tuned my basal rates rates over time by testing before starting exercise, (and if needed, have a carby snack), then testing every 20 minutes. Over time I figured out what I need for the kind of exercise I’m doing. Basal rates that work for me will be different for you. Did you read John Walsh’s section on “Ex-Carbs”? It is pretty good at explaining what you’ll need to do to fine tune your basal rate needs.

A chart would be great, but I suspect there are just too many variables to develop a precise guide. I take an approach similar to yours for a 30 min run. I don’t reduce my basals pre-run, but I ensure I don’t have any bolus-related insulin on board, and if my pre-exercise BG is less than 180 I eat a 20g carb snack. The problem with that approach is that I’ve got to accept a relatively high BG going into the exercise, but I’ve rarely been low right after I finish. Having said that, now that I’m using a CGMS and can see with more precision how by BG changes during exercise, I’m considering changing to something more similar to what Dave and others have posted here with respect to basals – reducing to 50% for 2 hrs prior to exercising. I’ll still probably pull the pump while I’m actually working out and just monitor how my BG looks for the 3 to 4 hrs post-exercise. By the way, how did you calculate your insulin on board (IOB)? The MM Paradigm pumps only show IOB for bolus doses, not for basals, and basal IOB can definitely cause you to go low. I haven’t come across any tools to help calculate a basal IOB.

well dave,i am just giving my opinion
thanks for correcting me
afteall,you’re the expert :slight_smile:
i havn’t touched a pump in my life,am a newbie :slight_smile:
sorry sarah,i hope i didn’t get you in trouble :frowning:

5 hours would be overdoing it but thank you. and thank you dave for your suggestions also.

I will have to read the section by John Walsh. I have been taking my pump off during exercise. I am planning on trying reducung my bolus at least an hour before exercise. This is UCLA’s General Adult Guidelines for Prolonged Exercise:
I don’t have any guidelines for a not prolinged session of exercise but your suggestions are helpful. It is beginning to look like both prolonged sessions of exercise and a normal session of exercise should be treated similarly.
Meal Bolus:
If you plan to exercise more than 30-45 minutes after your meal bolus, keep your usual meal bolus.
If you will be exercising within 30-45 minutes after taking a meal bolus, then lower the bolus by 1 to 2 units.
Before Exercising:
1 to 2 hours before exercise, you should lower your basal rate by 50% but not lower than 0.15 u/h.
10 to 15 minutes before exercise, check your blood sugar:
If the blood sugar is:++ have:
below 80 15 grams of simple sugar and 1/2 serving of starch
between 80 and 100, then EAT 1 serving of milk or 1/2 starch or 1/2 fruit
between 130 and 160 no snack if basal rate was lowered, otherwise 1/2 serving of milk or 1/2 serving of fruit
between 161 and 200 0.5 unit if basal was reduced, othersise no snack
between 201 and 250 1.0 unit if basal was reduced, otherwise 0.5 unit.
between 261 and 300 1.5 units if basal was reduced, otherwise 0.75 unit.( I would postpone exercise with a BG at this level but that is my personal opinion.)
if sugar is over 300 postpone exercise and test again in one hour.
The next section goes on to tell abut what to during prolonged exercise like eat 5 to 10 grams of simple sugar every 30 to 45 minutes if you redused your basal. Possibly the first part that I retyped applies to all exercise.

My IOB was probably the cause of my rapid blood sugar drop yesterday eventhough it was only about 0.25 units during a half hour brisk walk. Thanks Dave for all of your replies and thank you Dave S. for your reply.

I used to run and I noticed this particular exercise requires a high BG prior. Running is such a rewarding exercise. I used to try to be at around 180 before doing my 4 mile uphill then downhill then flat surface and then a little more uphill loop. I took off my pump to run and didn’t eat. I found it difficult to wear a pump while running. Dave’s reply for IOB is correct.

I think you are correct.

You might try “The Diabetic Athlete” by Sheri Colberg for more information on pumping and exercise.

I think it’s a BAD IDEA to turn off your pump for exercise. Non-diabetics don’t turn off their pancreas. (I borrowed that line from a CDE I know.)

Turning off your pump does not have an immediate effect, for one thing. Since most fast acting insulin has a peak in about 2 hours, turning off your pump now means you will have NO INSULIN two hours from now. That could be an hour after you’ve finished exercising, or more. The effect of no insulin is, of course, higher BGs and possibly DKA. It’s happened to me.

Better, then, to reduce your basal or bolus. You can adjust your bolus immediately, but build in some lag time if adjusting your basal. The UCLA guidelines seem quite reasonable in my experience, but as with all things diabetic, YMMV. Keep trying different things until you find what works. Be prepared to readjust every few months.

BTW, I think it’s a good idea to ALWAYS have your meter available during exercise (I carry a One-Touch Mini in a SPIBelt) and some glucose tabs or other fast acting carbs. For prolonged exercise carry a lot of carbs and remember that if your BG is lower than when you started it’s going to keep going lower for awhile and probably very quickly, so you may want to take some carbs proactively. For instance, I test every 30 minutes on a long run. I started the run yesterday at 167. 30 minutes later I was 103. Not low but clearly on a sharp downward trend. I took four glucose tabs and tested again in a mile. I felt good but my BG was 80 - still going down. I at a gel back and tested 15 minutes later - 87. Took another gel and tested 15 minutes later - 120. No more gels the rest of the run. But it’s essential to keep a close eye on the BGs.

Good luck,


Thanks Terry. I am going to order “The Diabetic Athlete” and a spibelt today. I think wearing a pump during my yoga and pilates classes is not possible. I have never seen anyone do it but maybe there are no type ones in the three yoga and one pilates class I attend. How can one attach it without it getting in the way? Does the SPIbelt help hold your pump while you run? The other problem I have had is with the pump kind of bouncing all over the place while running. Most running clothes have elastic wastebands which do not support the pump well.


The SPIBelt’s primary benefit is that it doesn’t bounce, mostly becasue of the snug but unobtrusive fit. I wear it low on my hips. I carry my carbs in the pouch and I clip my pump to the belt. If you clip it to the inside of the belt, the belt will hold the pump snugly against your skin with no bouncing. You can carry the meter in the pouch as well.

Wearing a pump in yoga or pilates is possible - I do it all the time. I attach it with a clip to my shorts. Yes, you have to move it around sometimes from the front to the side and back again, but that’s just the way it is. Maybe you can get away with clipping it inside your bra. If you’re concerned about it being seen - that’s another issue entirely. Wear a loose fitting top is my advice. Make sure the instructor knows about it, too. Even though it’s yoga, some of the instructors are amazingly uptight.

Good luck,