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Adjusting for exercise, was: Re: [IP] Skiing
Some thoughts on adjusting for exercise when pumping:
I've been pumping for almost 3 years, and initially found it a bit
confusing to adjust for exercise. I had a lot of experience with exercise
on a regimen of NPH and Regular, so at least I had some notes to work with,
and often referred to them for some baseline data.
The best approach for me is to adjust my basal rates a little lower, a
little farther in advance of the activity. I use Regular in my pump, so
I'll often start a temporary basal decrease approximately 2 hours in
advance of my planned activity (I play with this timing, depending on BGs
in general, overall fitness level, type of activity). I would rather be a
"bit" higher than my optimal target BG level when I begin exercise, rather
than at, or below my target. I find it much easier to bring my BG down,
rather than have to deal with a low while I'm halfway home on a cross
country ski trail, floating down a river or some other inconvenient spot.
It's easy to ski harder - it's very difficult to plod homeward a bit
slower, suffering from low BG.
If I'm eating a meal prior to exercise, I try to time it so my meal bolus
is not peaking at the same time my activity level is increasing or peaking
(this timing is easier with Humalog than it is with Velosulin or Regular,
but can be managed quite well). I change my pre meal ratio for my bolus,
taking slightly less insulin than normal. The actual amount of decrease
will vary, depending on my overall conditioning, type and duration of activity.
I'll also sometimes ingest some carbs *without a bolus* when exercising
(this is not a crime ;-)), since the activity will offset the extra carbs.
I don't really need to decrease my basals after my activities, but others
do. If I'm a bit low, I might snack - hey I earned it <vbg> I do watch my
BGs carefully the day after strenuous activity, since the effects of the
activity can have a lingering effect. This is certainly a YMMV area.
If you keep good records of your activity levels, CHO intake, basals and
boluses, these adjustments will become much easier over time.
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