Omni Pod and Exercising

Been on the Omni Pod for almost three months. age 46. T1 for about 20 years. So far really like the Pod. The one issue i am having with it is when i exercise. I exercise a lot and even when i suspend the basal for a few hours i often go low when i exercise. Sometimes test before exercise and i will be 180 then after an hour of exercise i am at 50. This is with the suspended bolus. Then after i eat later in the night i seem to go high. Just curious if others that use the POD and do some strenuous exercising have this issue.

thanks

S

Also on the pod and loving it. I’m a 48 year old female, T1 for almost 40 years now and I do boot camp 4 times per week. When I am doing an evening class I count only half my carbs at supper and lower my basal by 60%, and this has been working well for me. But it took some time and trial and error to come up with these numbers. Good look with it.

100%

no matter what i try, i go low (i sometimes play basketball for 2-3 hours. but even for 1 hour. no matter what i eat prior doesn't help - it will only shoot up my sugars after i play!

then i have to bolus quite a bit to bring it down.

i try playing at 20% - but still encounter problems.

I exercise intermittently. When I do a lot of exercise for a day my insulin sensitivity goes up. A bolus for a given carb count which would otherwise be just fine will send me low for about 2 days after the exercise.

I also have no residual insulin production, so far as I can see. Some type 1 diabetics apparently do have residual production. If I cancel my basal, and don't do any boluses, my blood sugar will start going up after at most 2 hours.

The pod (and, I suspect, any insulin pump) is very different from MDI. It allows us to fine tune our insulin delivery to match our eating and exercise requirements. I have to swap back to MDI periodically and when I do I am continually frustrated by the lack of 1/2000 ml graduations on the syringe.

I've become far more aware of what my body needs in terms of insulin and far more critical. So far as I am concerned it is a good thing but it definitely means that I know that the insulin I need depends very much on activity, weather, stress and last and probably least what I actually eat.

I also see odd changes in BG from time to time for no reason or opposite of what I would have expected. There are SO MANY factors to take into account when adjusting, it's almost impossible to get them all. Things like stress, or the type of food you last ate, or the humidity (yes, the humidity, go figure!) It all affects us in ways that we would never imagine. For that reason, I can't wait to see where they go with work on combining the pumps with the CGM devices, so that the machine can monitor more closely and adjust faster to the changes.

Yes, I am in the same boat as you, BUT I recently started using a product that I was recommended a while ago and if things continue this well, it will be life changing for me! “Generation UCAN” was originally created for a diabetic and with the starch they’ve developed it allows for more fat burn and no sugar crash. I think it has around 34g of carbs in a scoop which you mix with 16 oz of water, 1/2 before exercise. A couple of times I drank it when my BGC was around 95, which is usually too low for me to start a 5 mile run. The rep was at the gym one day and told me not to take insulin for the total amount of carbs it lists on the package. I was skeptical, but figured I was low enough to see how it would play out during the run. I ended up going up to about 180, but but never higher. I finished the run and my BGC was in the 140s (and all with no bolus for this!). Usually I can’t lift weights after a run because I’m fending off a crash and need more fuel. They say the UCAN can sustain sugar levels from 3-4 hours and I was amazed to see my BGC was completely stable for that amount of time. I was upset I let the opportunity pass to lift weights without a crash, but I was skeptical. I am going to try to push this product further to really see how long I can run & workout without my usual crashes. Let’s just say I’m cautiously optimistic, and from what I’ve read I think I’m going to have a long relationship with this product! I really think it’s worth you looking into as well.
As I re-read this, I apologize if it sounds like a sales pitch, but this is really my experience with the product. Hope it helps. Good luck!

Hi S. I was diagnosed with type 1 diabetes about 33 years ago and have been using the OmniPod for about 6 years. In order to avoid a low if I want to exercise for an hour or more, I need to not bolus for my breakfast (~47g carbs). I don't like to adjust my basal because I find it leaves me with higher glucose levels in the afternoon. If the exercise is going to be strenuous, however, I make an exception and turn my basal off for 30 minutes at breakfast on top of not bolusing for the food.

Good luck!

I like to do competitive road biking and also am on the pod and cgm. I too find that no matter how long I suspend my insulin, or no matter how many glucose tabs I eat before or during the ride, my bgs will drop low. The only difference is, if I suspend insulin for a long time or eat a lot before/during, the rebound immediately after I stop exercising is so dramatic I usually end up going high. Ive never gone dangerously low yet, so I have accepted the fact that I may go a bit low when I exercise and the only way to prevent is to not bike, which isn't going to happen!

I am an avid cyclist and triathlete. Competing since 2006. T1 for just over 18 years, pumping for just over 10 years, podding for just over 5.

Remember that any basal change you make will not really be "active" in your body for an hour or so. Meaning if you plan to exercise at 4pm and you change your basal at 4pm, you won't really have that basal as "active" until 5 pm. Well if you stop exercising by 5pm, you've totally missed your reduced basal and now you'll be chasing a high BG b/c the basal is not doing its job. This is perhaps what you are experiencing later in the evening?
SO, you need to make adjustments an hour or so prior to the exercise. Everyone is different, so saying to reduce your basal by "x %" for a certain activity is not necessarily going to work. However, a good starting point is maybe a 50% reduction for aerobic activity (which is what most people are likely doing). You may need a larger or smaller adjustment, but you won't know until you start somewhere.
If your exercise is for 1 hour, then perhaps make that adjustment for 1 hour. So exercising at 4pm you'd make your basal adjustment at 3pm, for a duration of 1 hour. At 4pm your basal profile goes back to normal as you start exercising...but remember that this insulin will not really be "on board" until after you finish your exercise. This should help prevent some of the high BG later.
Additionally, sometimes your muscles and liver realize that you are exercising (you're aerobic so you're burning muscle glycogen) and when you stop exercising, they--the muscles and liver--may not get the memo, so they continue releasing that glycogen for a short time...which causes a quick/dramatic rise in BG. You may be experiencing high BG later b/c of this issue as well.
Are you eating anything during your exercise? If not, then the 180 to 50 drop is probably a good indication that you need to be consuming something. It could be as little as some G2 gatorade, but you may need something more substantial (perhaps 30g of carbs for every hour of moderate activity?...that's just a starting point and may need adjusted on a case by case basis).
Lastly I would mention that you should WRITE IT DOWN. When you start making adjustments, look for patterns. Write down your last meal time and how many carbs, any active insulin still on board, your basal adjustments, how many grams of carbs you're consuming during exercise, what that exercise is, how intense that exercise is, the duration of your exercise, etc. Once you have a few weeks' worth of data, you can likely see that there is a pattern of "when I adjust by this much and I eat x amount of carbs, my numbers are more in the zone I want them to be". If you are still having highs/lows, then you would make adjustments from there.

Great Info

Thanks!

Great post. I agree with a few additions

-I always wait 2-3 hours after a bolus to exercise this way there is less insulin onboard which is very important since a bolus 2hours before exercise makes your change in basal useless (the basal is flooded by bolus). Note: the half life of insulin is different for everyone so you might have to wait longer…

-After exercise I always eat and give a bolus of at least 4 units (4 units the the amount I need to deliver a high enough concentration of insulin to my liver to turn the liver's ability to make glucose off) The food helps start recovery. (Note: Muscles can not release glucose to circulation as alluded to above ;) )

-For exercise lasting greater than 1 hour I usual have 20-30g of carbs/hr. During a high intensity race 45-70g/hr.

Lastly, I will echo "write it down." and search for loose patterns. Life is an experiment.

*Have fun exercising!

I'm a runner & to deal with lows I carry glucose gels with me & will suck one down every two miles of running. They contain between 22-24 grams of carbs. It keeps me pretty stable. I also reduce my basal before running.

I don't think this would be any different if you were on MDI or another pump. I think it is just a fact of being on insulin. I know for myself cutting off insulin for even an hour causes my BG to spike even if I exercise. For me a much better way to handle is to deliver insulin like always but take a slow acting carb before excising. In college I rowed crew which is just about the most energy you can exert in 4 minutes. I ate a candy bar before each race and did not have any problem.

Andy

T1 59 years

Real good daily schedule from an endurance athlete should give you some ideas:

http://www.slowtwitch.com/Features/A_Type_1_diabetes_triathlon_day_661.html

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