[IPp] EASD: Exercise Okay On or Off Pump for T1D Kids

[Rachel A <email @ redacted>]

http://www.medpagetoday.com/MeetingCoverage/EASD/22293?utm_content=GroupCL&utm_medium=email&impressionId=1285053656807&utm_campaign=DailyHeadlines&utm_source=mSpoke&userid=261280

I personally reduce basal when my son excercises, depending on his before &
during BG... I generally reduce afterwards too but always depending on BG's.
I NEVER load him up on carbs (he is a bit overweight)... unless he has a BG
below 80, then I use a juice & reduce basal more :)

   EASD: Exercise Okay On or Off Pump for T1D Kids
    By Crystal Phend, Senior Staff Writer, MedPage Today
Published: September 20, 2010
Reviewed by Dori F. Zaleznik,
MD<http://www.medpagetoday.com/reviewer.cfm?reviewerid=512>;
Associate Clinical Professor of Medicine, Harvard Medical School, Boston and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner Earn CME/CE credit
for reading medical

news<http://www.medpagetoday.com/posttest.cfm?testpage=22293&TBID=22293&topicid=412>
  Action Points
------------------------------

   - Note that this study was published as an abstract and will be presented
   at a conference. These data and conclusions should be considered to be
   preliminary until published in a peer-reviewed journal.


   - Explain to interested patients that a study of insulin pump regimens
   during controlled exercise showed that leaving the pump on produced the best
   glycemic control.


   - Note that if an insulin pump is not allowed during sports, the next
   best regimen found in this study was turning the pump off with 20% to 30% of
   basal insulin added for the two to four hours after the exercise.

STOCKHOLM -- Children with type 1 diabetes who use an insulin pump should
leave it on during sports but don't appear to suffer from a well-managed
temporary break, researchers reported here.

In a randomized trial, active pump use during exercise yielded the best
glycemic control during and soon after exercise, Alessandra E. Gazzarri, MD,
of the University of Milan - Luigi Sacco Hospital in Milan, Italy, and
colleagues found.

However, with this regimen, blood glucose levels at three hours after
exercise fell to an average of 98 mg/dL with mild hypoglycemia in four of
the 15 patients in the trial, they warned in their study slated for
presentation at the European Association for the Study of Diabetes meeting
Wednesday.

Reducing the basal insulin rate by 20% for the two to four hours after
exercise might be warranted, they noted.

Given the limited evidence for what happens with pump therapy during
physical activity or how best to manage these kids during gym class, sports
participation, and other exercise, the researchers conducted a randomized
controlled trial to find out.

The trial included 15 children ages 10 to 18 who used an insulin pump.
Duration of diagnosis averaged 7.2 years, and they had relatively good
control (average hemoglobin A1c 7.66%, insulin requirement 0.85 U/kg per
day).

The participants were typically lean with an average body mass index of
20.05 kg/m2.

They performed the same exercise program under the supervision of a trainer
for two hours on each of four days under different insulin pump regimens
randomly assigned.

When the pump was kept active during exercise with no changes to dosing,
glucose levels rose from 117 mg/dL at baseline to a peak of 139 mg/dL at the
first hour but didn't change much thereafter during the exercise period.

By one hour post-exercise, glucose dropped back down to 121 mg/dL, but
reached the lowest average seen under any condition during the study at
three hours in this group (98 mg/dL).

Overall, Gazzarri's group called this an excellent glycemic profile.

Taking the opposite approach, suspending the insulin pump entirely, showed
"good" glycemic profiles as well, averaging 130 to 133 mg/dL during
exercise, although with a significant increase at 90 minutes post-exercise
(average 164 mg/dL at two hours).

The researchers also tried suspending the pump after a "correction" bolus --
equal to the basal insulin the patient would have otherwise injected during
the exercise period but reduced by 30%.

But the pre-exercise bolus didn't cut down on this post-exercise blood sugar
spike (185 mg/dL at two hours after exercise) and introduced a significant
lowering of glycemia -- to 100 mg/dL -- 90 minutes into the exercise period.

Further adding temporary basal insulin, reduced by 20%, two hours before and
four hours after exercise yielded even more variability with swings peaking
at 251 mg/dL by the end of the exercise period.

So, for sports that do not allow the use an insulin pump, the researchers
recommended suspending the pump with 20% to 30% temporary basal added for
the two to four hours after exercise as a good option.
.
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