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[IP] Determining insulin levels for exercise

I thought I would chip in with some suggestions for adjusting insulin
levels for exercise. There have been a number of questions on this lately.
This will most certainly end up as some type of FAQ, so we might as well
jump in and start discussing it.

These are offered as suggestions, not gospel. They are certainly open to
argument, and remember YMMV.

1)  Know your trends. If your basal rates are "solid" (they are set
properly), judging how your body will react to exercise is an easier task.
Rather than "guess" at a 50 % reduction for a specific exercise, for
example, try reducing your basal rate by 50 % for the period you would
exercise *but don't work out*. Check your BG every 15 minutes during this
period, and for the 2 hours or so after this time. This will give you a
"baseline" of sorts to determine how much exercise you can "apply" to bring
down or maintain your BG levels. These experiments may seem like you are
wasting valuable exercise time, but the information you gather is worth it
in the long run.

These rates will vary with different activity at different times of day,
etc. By developing this baseline of data a lot of adjustments will be made
easier. Developing this trend info is virtually impossible without some
careful record keeping, so work on some sort of log, and keep it complete.

2)  Know your exercise. Once you know how much your BGs will rise at
specific basal rate reductions, find out how certain activities will affect
your normal BG rates. If you know how much a particular activity will lower
your BG over a specific time interval, you can then use this info to fine
tune your basal rates (and possibly carbohydrate intake) for exercise. The
best reference I have seen on this is at:
<http://www.diabetesnet.com/excarbs.html>. This is actually an excerpt from
the book "Stop the Rollercoaster" by John Walsh, and offers some solid
advice. It's not as complicated as it may first appear to be ;-)

3)  Know your training "base". Exercise which you are not accustomed to
will usually require more energy than something that is very routine for
you. These variables need to be factored in to the overall equation, but if
you have taken care of steps 1 & 2, this should be an easier adjustment. If
you are starting on an "unknown" exercise, it is generally best to reduce
your basal a little more than you might otherwise. The thinking here is
that administering an adjusting bolus for a slightly high BG is preferable
to dealing with a low BG in the middle of your exercise routine.

4)  Be flexible. Your trends are just trends, not absolutes. Things may
change, life goes on. You still need to be ready for the unexpected, but
you will probably be better prepared than you were prior to pumping. The
math is generally simpler (ever try to calculate NPH and Regular insulin
requirements prior to the start of a 25 km cross country ski race? Good
luck. I can tell you it's no fun), and your ability to recover appears to
be greater.

5)  Remember points number 1 and 2. They make everything else work.

Bob Burnett

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