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Re: [IP] Exercise gymnastics and insulin

Dear Diane,

Exercise and Humalog can be tricky. When I changed from Regular I had to
redo my therapy quite a bit because of the action of the insulin. But this
is good. Humalog is so much more exercise 'friendly'! The lingering effect
of NPH and R used to dish up some unpleasant and unpredictable lows for me.
Also, if I'd lowered my R in anticipation of exerting myself, and then
didn't have that activity, I ended up too high.

I find I can remove the pump for one hour with no ill effect (for
aerobics). But I always check after one hour. If I bolus at that point (to
correct any rising BG or replace next hour's basal) I can keep the pump
off, go back to exercising or go take a shower or sauna (be off the pump a
little longer), which is what I usually do. If you are continuing high
levels of activity after the hourly check, bolus with caution! I assume a
competition is tricky because Lauren may be standing around or may suddenly
be exercising heavily, depending on the pace.

Also, in my corresponding with some athletes who have had very high BGs
after exercising, it's not necessarily always a 'rebound' effect, meaning
Lauren went low and then rebounded high. Sometimes, unpredictably, intense
exercise drives BGs up, not down. (Something about the muscles releasing
their stores of glucose.) Whatever the cause, the hourly checks can keep
you on top of this. It's happened to me and I cannot trace it to
doing/eating something different beforehand.

Re your statement "Normally, after exercise we have to temporarily lower
her basal for a couple of hours." - I'd also use caution here, and not
necessarily lower her basal to any great extent, unless she has put out an
extra-ordinary effort that day. If she is at a fitness level for her chosen
activity, and she probably is, her metabolic rate will quickly go back to
her normal state. That is, people who are already fit are usually not
building muscle and using up glucose. It is only when you challenge your
muscles by either increasing the workout or going to a different sport that
you will notice more of the delayed effect of exercise on BGs. This happens
much more frequently to people who are sedentary and then take up exercise
that their body is not used to.

I am not an exercise physiologist -- not even close! All of the above is
strictly my experience, but you may want to correspond with a person who is
currently writing a book on this subject:

Sheri Colberg, Ph.D.
"The Diabetic Athlete's Guide to Blood Sugar Control During Exercise"
Old Dominion University, Norfolk VA 23529
757-683-3356 work
email @ redacted

Also, the IDAA - International Diabetic Athletes Association
-www.diabetes-exercise.org/1-800-898-IDAA offers lots of help for anyone
pursuing athletics -- all sports.

So taking all this into account, be careful! A lot of writing is coming out
about managing exercise, but one always has to tailor it to the individual.

Tina Farrell
Writing, Editing, Design
email @ redacted

Insulin-Pumpers website http://www.insulin-pumpers.org/