Insulin resistance is the name given to when cells of the body don’t respond properly to the hormone insulin.

Insulin resistance is the driving factor that leads to

type 2 diabetes, gestational diabetes and

prediabetes

Insulin resistance is closely associated with obesity; however, it is possible to be insulin resistant without being overweight or obese.

Modern research has shown that insulin resistance can be combatted by treatment methods that reduce how much

insulin
the body is producing or taking via insulin injections or insulin pumps.

Reducing insulin resistance can be achieved by following

low-carbohydrate
and

ketogenic
diets.

What is insulin resistance?

The role of insulin is to allow cells of the body to take in glucose to be used as fuel or stored as body fat.


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It also means that glucose is more likely to build up in the blood and this can lead to

too high blood sugar levels

When the body becomes resistant to insulin, it tries to cope by producing more insulin. People with insulin resistance are often producing too more insulin than healthy people.

Producing too much insulin is known as

hyperinsulinemia

Symptoms of insulin resistance

Initially, insulin resistance presents no symptoms. The symptoms only start to appear once it leads to secondary effects such as higher blood sugar levels. When this happens, the symptoms may include:

• Lethargy (tiredness)
• Hunger
• Difficulty concentrating (brain fog)

Other signs that often appear in people with insulin resistance include:

• Weight gain around the middle (belly fat)
• 
  High blood pressure
• High cholesterol levels

If insulin resistance develops into prediabetes or type 2 diabetes, the symptoms will include increased

blood glucose levels
and more of the classic

symptoms of type 2 diabetes

Causes of insulin resistance

Whilst the exact cause of insulin resistance is still not fully understood, it is well-known which factors can lead to insulin resistance developing.

Insulin resistance can commonly develop if one or more of the following factors apply:

• If you are overweight or
  
  obese
• Having a high-calorie diet, high-carbohydrate or high-sugar diet
• Sedentary lifestyle – taking little physical activity
• Taking high doses of steroids over an extended period of time
• Having
  
  chronic stress
• Having
  
  Cushing’s disease
  or
  
  polycystic ovary disease

In terms of what is happening inside the body that causes insulin resistance, researchers have observed that insulin resistance occurs in people that have:

• High levels of insulin circulating in their blood
• Excessive fat stored in the liver and pancreas
• High levels of inflammation

Can insulin resistance be reduced or reversed?

It is certainly possible to reduce the effects of insulin resistance and there are a number of effective ways to do this.

Effective methods include:

• 
  Low-carbohydrate
  and
  
  ketogenic
  diets
• Very-low-calorie diets
• Weight loss surgery
• Taking a lot of exercise in combination with a healthy diet

These methods share a similar way of working in that they all help to reduce the body’s need for insulin and help people to lose weight.

Read more on

reversing the effects of diabetes

Insulin is a hormone which plays a key role in the regulation of blood glucose levels. A lack of insulin, or an inability to adequately respond to insulin, can each lead to the development of the symptoms of diabetes.

In addition to its role in controlling blood sugar levels, insulin is also involved in the storage of fat.

The role of insulin in the body

Insulin is a hormone which plays a number of roles in the body’s metabolism.

Insulin regulates how the body uses and stores glucose and fat. Many of the body’s cells rely on insulin to take glucose from the blood for energy.

Insulin and blood glucose levels

Insulin helps control blood glucose levels by signaling the liver and muscle and fat cells to take in glucose from the blood. Insulin therefore helps cells to take in glucose to be used for energy.

If the body has sufficient energy, insulin signals the liver to take up glucose and store it as glycogen.

The liver can store up to around 5% of its mass as glycogen.

Some cells in the body can take glucose from the blood without insulin, but most cells do require insulin to be present.

Insulin and type 1 diabetes

In type 1 diabetes, the body produces insufficient insulin to regulate blood glucose levels.

Without the presence of insulin, many of the body’s cells cannot take glucose from the blood and therefore the body uses other sources of energy.

Ketones are produced by the liver as an alternative source of energy, however, high levels of the ketones can lead to a dangerous condition called ketoacidosis.

People with type 1 diabetes will need to inject insulin to compensate for their body’s lack of insulin.

Insulin and type 2 diabetes

Type 2 diabetes is characterised by the body not responding effectively to insulin. This is termed insulin resistance. As a result the body is less able to take up glucose from the blood. In the earlier stages of type 2 diabetes, the body responds by producing more insulin than it would normally need to.

If type 2 diabetes develops over a number of years, the extra demands on the pancreas to produce insulin can lead to a loss of insulin producing cells (known as pancreatic beta cells) as they wear out.

Depending on their level of insulin resistance, people with type 2 diabetes  may also need to take insulin injections to manage their blood sugar levels.

Insulin and fat storage

As well as being involved in the regulation of blood glucose, insulin is also involved in how fat is used by the body. When the liver is has taken up its capacity of glycoge, insulin signals fat cells to take up glucose to be stored as triglycerides.

An additional effect of insulin is in inhibiting the breakdown of fats.

Synthetic insulin

People with type 1 diabetes and a proportion of people with type 2 diabetes will need to take exogenous insulin (insulin that is not produced by one’s own body). Insulin is usually injected but can also be delivered by an insulin pump which continually infuses insulin through the day and night.

Synthetic insulin is made in laboratories and is the most commonly prescribed form of insulin for medication purposes. Non-synthetic animal insulin is also available in the UK if preferred.

Product:

EasyTouch Lancing Device

Manufacturer:

Abbott

Alternative site testing cap

You can also get and an

alternative site testing

cap to fit to the device to aid testing on forearms or other appropriate areas other than fingertips.

Abbot Thin Lancets

The EasyTouch Lancing Device uses Abbott Thin Lancets which are available from the Abbott site or from your local healthcare centre.

Product guide written by Diabetes Expert:

Sue Marshall

Product:

Microlet 2

Manufacturer:

Ascensia Diabetes Care

As well as its range of blood test meters including the Contour NEXT, Contour NEXT Link, and

Contour NEXT USB

, Ascensia Diabetes Care’s Microlet 2 lancing device is a neat way to get that little drop of blood needed to make those meters work.

The Microlet 2 has an ergonomic and compact design for simple, smooth testing and allows for easy one handed lancing with an easy to grip surface and large button.

Microlet lancets

It uses Microlet lancets, which are not only silicone coated (so they are virtually pain-free) but are coloured – which makes the whole lancet-changing thing just a little more fun!

Available on prescription

These are available on prescription in a pack of 200: PIP Code 280-0050, GMS Code 85055.

Product:

OneTouch Delica

Manufacturer:

LifeScan

Lancing devices are an important part of testing and so it’s important to have a lancing device that is easy to use and minimises unnecessary pain.

The OneTouch Delica from LifeScan is designed to be kind to fingers, featuring seven depth settings to choose from and Advanced Glide® Control System, which guides the lancet in a straight motio, reduces vibration and allows more precise lancing.

Features of the OneTouch Delica

• Advanced Glide® Control System guides the lancet for smooth lancing
• Seven depth settings to choose from to minimise pain
• Ejection Control removes the lancet without needing to touch the lancet, reducing risk of accidental finger stick injuries
• Quiet and easy to use
• Small and easy to fit in blood glucose testing wallets
• Takes OneTouch Delica thin 30 gauge lancets
• Lancets have a cap to cover the used sharp tip

In a clinical study, 96% of patients found the Delica system easy to use and 76% thought it was quiet.

Product:

Vitrix Sterilance Press

Manufacturer:

Vitrix

Delphis Medical Limited specialise in blood lancets and have a range of

blood lancet products

in the UK. Vitrex Sterilance Press is the newest.

It comes pre-loaded, button operated and has high-speed penetratio, all of which ensure a good blood sample every time.

Sterilised using gamma radiation

There are a number of variations of Sterilance Press, including the Vitrex Sterilance Lite which has been sterilised using gamma radiation.

The

needle

is fully shielded before and after use (so it can’t be re-used and there are no accidental finger-pricks), and being extremely sharp it’s comfortable to use with minimum pain.

Vitrex Steriheel Baby is a blood safety lancet especially designed for neo-natal and premature babies.

However, it can also be recommended for other applications where short penetration depth and/or minimal compression of tissue is required.

Product guide written by Diabetes Expert:

Sue Marshall

This calculator helps people with diabetes to determine the correct initial insulin dose for

type 2 diabetes

patients.

This calculator has been discontinued.

How to use the Insulin Initiation Dose Calculator

To calculate the number of units required per day, simply input:

• Your weight
• Your height
• Your fasting blood glucose
• Your gender

You will then be presented with the initial dose in IU/day. This tool is meant for indicative purposes only. Please consult your GP or healthcare team to determine your insulin initiation dose.

Losing diabetes equipment such as your insulin dose or insulin pen can cause anxiety, particularly if you don’t have available spares.

This guides offers advice to help you replace your

insulin

or

insulin pen

whether at homen, away from home or abroad.

Have spares available

Before we tackle what to do when you have lost insulin or an insulin pe, it’s worth noting the importance of having spares available of insulin and insulin pens.

We recommend that people using insulin pens have a spare set of insulin pens in case such a loss occurs.

Replacing an insulin pen urgently

If you need replacement insulin or an insulin pen as a matter of urgency, follow these steps:

1. Check obvious places for your insulin or insulin pen
2. Call your out of hours service for an emergency prescription
3. Collect your insulin or insulin pen from a pharmacy – or if out of hours, from a hospital

Check obvious places

This tip may be obvious but in the panic of thinking we’ve lost something important, it can be all too easy to overlook an obvious check.

Take a few minutes to think whether the insulin pen may be recoverable. Was it put aside when travelling or at a restaurant? Have you checked all bags, cases and pockets?

A few extra minutes thinking or checking could save up to a few tense hours of sorting out and collecting an emergency prescription request.

Call your medical centre or out of hours service

If you’ve established that you will need to get a new insulin pen as a matter of urgency, contact your health centre and arrange to get an

emergency prescription

which will speed up how quickly you can get a new insulin pen and new insulin if needed.

If your medical centre is not open at the time, contact your out of hours service.

Collecting your insulin pen or insulin

If you are given an emergency prescription, you should be able to collect the insulin pen from any pharmacy that has it in stock.

You may need to call in advance to ask whether they have the insulin or insulin pen you require in stock.

If no pharmacies within travelling distance have your insulin or insulin pen in stock, you may need to accept a disposable insulin pen or a different type of insulin until your pharmacy can order and

receive the specific insulin or insulin pen you need

If you have to accept a different type of insulin, ask the pharmacist to explain whether you should expect any differences between the insulin you are given and your normal insulin.

You should be prepared to test more regularly than usual if you have to temporarily go onto a different type of insulin.

If the pharmacies are closed, you may need to arrange to collect an insulin pen from your hospital. Check with your out of hours service where they advise you collect the insulin pen from.

Losing insulin or an insulin pen away from home

If you have lost your insulin or insulin pen whilst away from home but in the UK, contact your own health centre or out of hours service and ask for their advice first.

Once you get hold of an emergency prescription, you should be able to take it any pharmacy or, if pharmacies are closed, to a nearby hospital.

Losing insulin or an insulin pen abroad

If your loss of insulin or an insulin pen occurs in a country within the European Economic Area and you have an EHIC card (European Health Insurance Card), the EHIC card should help you to get hold of insulin or an insulin pen either for free or for a reduced charge.

The

EHIC website

has full details covering usage of the card.

Note that names of insulin can vary from country to country. If your own insulin is not available, you may need to take a different type of insulin. If you need to go onto a different type of insulin, ask whether the insulin will effect you differently to your normal insulin and test more regularly than usual to

avoid high or low blood glucose levels occurring

Your own insulin pen may not be available and you may therefore need to

take injections by syringe

If you do not have an EHIC card or are in a country outside of the European Economic Area, you may need to buy your own insulin, insulin pen or syringes. If these are relatively expensive, you may wish to claim for the cost of these items on your

travel insurance

The Initial Insulin Pump Requirements calculator estimates the initial insulin requirements for when you first use your insulin pump.

Before starting to use an inulin pump, patients should be instructed on how best to operate a pump by their healthcare professional.

As well as pump operatio, patients need instruction in how to insert and care for their infusion set, and how to deal with any problems.

The
Insulin Pump Forum
on the Diabetes Forum is a great resource for helping with this.

Usually, the insulin pump will require around 80 per cent of the insulin requirement before beginning pump therapy. 50% of the insulin is given at the basal rate, whilst the other 50% if divided into three premeal boluses.

The initial insulin dose calculator will help patients to estimate their initial insulin requirements.

Basal Rate

The

basal rate
is adjusted following closely monitoring the blood glucose levels over a 24-hour period. To accurately calculate how much is needed,

blood sugar levels
are obtained before meals, one hour after meals, at bedtime, at 12.00 AM and at 3.00 AM.

The goal of adjusting the basal rate is to maintain the desired range of blood glucose levels.

The basal rate is adjusted very slightly in 0.1-0.2 U/hr increments to keep premeal and overnight blood glucose within 1.7 mmol/L (30 mg/dl) of the desired range. In some instances, basal insulin requirements will be less at certain hours of the day.

Pre-meal Boluses

Boluses will be adjusted according to postmeal blood glucose levels.

The pre-breakfast bolus will normally be ~ 8 units. Pre-lunch and pre-dinner boluses are usually lower, at around ~ 4 units.

Correction of the bolus may be required if the premeal blood sugar is too high or low.

Covering Carbohydrate with insulin

A rule known as the 450 or 500 Rule can be used to calculate the amount of insulin used to cover a particular intake of

carbohydrates

Insulin/Carb ratio can be understood by using the calculation: 450/total insulin dose=grams of carbohydrate covered by 1 unit of insulin.

This calculator can help you to calculate the amount of insulin required to cover a certain amount of carbohydrate.

Correction Bolus

A premeal blood sugar reading can be alarming if it is elevated. The amount of insulin necessary to correct this level may be estimated using the 1500 rule (for regular insulin) or the 1800 rule (for Humalog).

Whilst many people are unsure of how they will sleep with an insulin pump, most people find that they soon get used to sleeping with their pump in close proximity.

Our guide on sleep and insulin pumps will look to answer some of the following common questions people have about how to sleep with an insulin pump attached.

• 
  What if I roll onto the pump?
  
• 
  Will I press any buttons as I sleep?
  
• 
  Will I pull out the infusion set?
  
• 
  Will I block the infusion set or tubing from delivery insulin
  
• 
  Will I get caught up in tubing
  
• 
  Where should I put my pump when I sleep?
  

What happens if I sleep or roll onto my pump?

It’s common for first time pump users to be anxious about what will happen if they roll onto their insulin pump.

The pump doesn’t get damaged if you roll onto it. If you roll onto the infusion site, it may be uncomfortable enough to notice it but your body will usually naturally turn again in response to the discomfort.

Will I accidentally press any buttons in my sleep?

The controls of a pump are designed so that buttons cannot easily be pressed accidentally and as setting a bolus involves more than one press of a butto, the chance of delivering a bolus in your sleep is highly improbable.

Some pumps will have a lock feature which prevents anything happening if a button is pressed with the lock mode on.

Will I pull out the infusion set?

It’s unlikely that the

infusion set

will get pulled out during sleep. In a rare case when the infusion does come out, some pumps will sound an alarm to wake you to reconnect it.

Nobody wants to reconnect their pump in the middle of the night but if you have a spare infusion set near to the bed it’ll make reconnecting your pump that little bit easier.

Will I block insulin from being delivered?

In most cases, tubing shouldn’t get blocked if roll over it because the mattress will usually be springy enough for this not to be an issue. If you roll onto your infusion site, it may cause insulin delivery to be blocked but this should rarely happen.

There are quite a few restless

sleepers with insulin pumps

who manage to sleep in all kinds of positions with their pump working fine.

Will I get tangled up in the pump’s tubing?

Many insulin pumpers will have nights in which they wake up with their tubing wrapped around them. This is not usually a problem and tends not to get in the way of a good night’s sleep. The tubing is thick enough not to get very tangled.

If tangling of the tubing bothers you, you can try using less tubing when you next change your infusion set and either have your pump in a pocket in your pyjamas or wear an insulin pump belt to keep it in a fixed position.

Where can I put my pump when I’m sleeping?

This one’s a common question. The following ideas are some common answers but you may find there are other solutions too.

Some people get quite creative with how they sleep with their pump –read more on the insulin pump forum:
Fergus

Clip your pump to your nightwear

Clipping your pump to your nightwear is a popular option. It is common for people to put their pump into pockets in their pyjama bottoms or to wear the pump fastened around their waist.

You may try to turn onto the pump at night but your body will most likely recognise and turn the other way. Over time, your body will tend to adjust to the position of your pump.

Let your pump lie beside you

If you sleep with little movement, you can sleep with the pump beside you. If you have a partner, particularly one that moves around at night, you may wish to position the pump on your side of the bed, although you may need to balance this against the chance of the pump sliding off the bed.

Supporting Your Partner

Put your pump next to your bed

If you have long enough tubing, you can put your pump on your bedside table or on the floor beside your bed. If you tend to roll around at night a lot, this could see you sometimes waking with the tubing wrapped around you which may not be ideal but needn’t necessarily be a problem.

When it comes to swimming, most

insulin pumps

will need to be disconnected whilst you are swimming. However, there are one or two which can be kept on whilst swimming.

We look at the considerations you’ll need to bear in mind if you’re on a pump and want to go swimming.

Which insulin pumps can be worn for swimming?

The OmniPod is well suited to swimming as there is no tubing involved. Be aware, however, that the adhesive that helps the

OmniPod

stick to your body may loosen in the water so you may need to take steps to ensure it doesn’t become loose.

The

Animas Vibe

can be worn in the water but to allow swimming, the tubing will need to be sufficiently well kept out of the way to prevent you or anyone else catching on the tubing.

If you are swimming with your pump o, it is advisable to reduce the rate of insulin delivery for swimming as the increased activity will

usually lower blood glucose levels

If you are unsure about how much to reduce your basal insulin by, or whether to take a carbohydrate based snack before swimming, speak to your diabetes health team.

It’s recommended to test before, after and, where possible, at a midpoint of a swimming session so you can see how the activity has affected your blood glucose levels.

Non-waterproof pumps and swimming

If you have a pump that is not waterproof, you will need to disconnect your pump prior to swimming.

An insulin pump can be disconnected for up to an hour but it’s important to be aware of any symptoms of

high or low sugar levels

or

ketones

and test your blood sugar if you are not feeling right.

Blood sugar levels would usually go higher as a result of not being connected to your pump but the activity could help to balance this out and some people may find their sugar levels drop despite being disconnected from their pump.

Swimming, pumps and blood glucose levels

Whether you’re swimming with a pump attached or not, it is important to see how your sugar levels respond to swimming. It’s well worth testing your blood glucose before and after swimming and it may be advisable to test after half an hour of swimming to see how your sugar levels are behaving.

If you are

testing your blood glucose levels before

, during or after a swimming session, it’s advisable to wash and fully dry your hands as having water on your hands could affect the accuracy of the test result.

Preventing the infusion set from washing off

If you’re spending a significant amount of time in the water, it is possible that the

adhesive of your infusion set

may become loose.

Pumps are designed to be able to deal with some moisture but not all pumps are intended to be immersed in water.

When it comes to bathing or showering there are two main options. The first is to

disconnect your insulin pump

whilst you are having your shower or bath.

The second option is to keep your pump on, but you may need to take precautions to prevent your pump either getting wet or getting too warm.

Warm baths and showers

If you are having a warm bath or shower, it is important to note that

your body may absorb insulin more quickly

than usual and you may need to take precautions to prevent a hypo from occurring.

Exposure of your insulin pump to hot temperatures for extended periods of time could spoil the insulin inside the pump. If you are using a hot tub or sauna, it is advisable to disconnect your insulin pump and leave it in a cooler and dry place. Check the owner manual for specific information on ideal operating temperatures for your pump.

Disconnecting your pump for a bath or shower

If you are disconnecting the pump, you will need to be aware of

how your blood glucose levels will respond

It is recommended that you do not keep your pump disconnected for over an hour to prevent your body from

developing higher levels of ketones

in the blood. If you are having a quick shower, this shouldn’t normally be a problem. If you are having a longer shower or a bath, then it is important to see how your blood sugar levels respond.

Your blood glucose levels may rise, and sometimes fall, at different rates depending on a number of factors including:

• How close to a meal you disconnect the pump
• 
  How much activity you have taken
  
  during the day
• How warm your bath or shower is.

Testing your blood sugar levels before and after disconnecting

your pump for a bath or shower will help you to see how your body responds to being disconnected from your pump.

Some people will deliver a bolus before disconnecting for bathing but it’s important to do this only if you know it’s safe to do so and

won’t raise the risk of a hypo.

As noted above, a warm bath or shower may speed up the rate at which your body absorbs insulin that is already in your body, so you will need to take this into account too.

Keeping your pump attached for a bath or shower

You can keep your pump attached when you are having a bath. There are a few options for what to with your pump if you are keeping it connected.

• Securely held on a shelf
• On the floor beside the bath
• On a pouch that can be hung

You can place your insulin pump on a shelf if it is held securely. You may wish to install a shower storage basket at a convenient height for bathing to hold your pump. If the pump could slip out, you may need to make some modifications before use.

Another option is simply to lay your pump on the floor beside the bath. It is a good idea to cover the pump with something like a towel in case there are any large splashes. You may also need to take care when getting out of the bath. Note that this option may require a longer set of tubing.

There are also waterproof pouches available which can be hung on a suitable rail or peg or hook, or can be worn around your neck when showering.

If wearing your pump for your bath or shower, you may need to check that the adhesive on the infusion set doesn’t wear away with the water. This isn’t usually a problem but is worth being aware of. It is also important to ensure that your pump does not get too warm when you’re in the bath or shower as this could affect the quality of the insulin.

Waterproof insulin pumps

There are some insulin pumps that have been designed to be waterproof. These pumps can be worn with less worry with regards to getting them wet.

However, it is still important not to expose these pumps to very warm water as this could have an impact on the effectiveness of the insulin.

Sport is certainly compatible for insulin pump users and a number of professional sports people, including

Steve Redgrave

, have used insulin pumps.

Insulin pumps offer some distinct benefits when it comes to sport as they offer the chance to increase or decrease the rate of insulin you receive before, during and after exercise.

Questions to consider when taking part in sport

There a number of factors that, as an insulin pump user, you’ll want to take into consideration when taking part in sport:

• 
  How long will the session of sport last?
  
• 
  How does the sport tend to affect your blood glucose levels?
  
• 
  How should I adjust my insulin dose?
  
• 
  Is there a risk of the tubing getting tugged?
  
• 
  How can I prevent my pump getting damaged?
  
• 
  Which sports should a pump not be worn for?
  
• 
  Will wearing the pump affect my performance?
  
• 
  Where can I wear my pump during sport?
  

How long are you exercising?

The length of time you are exercising for can be a factor in whether to wear your pump. It’s generally recommended not to disconnect your pump for more than 1 hour.

If you are taking part in a sport with a long duration, such as a long distance ru, swim or cycling event, you may need to either wear your pump through the sport or take another approach.

Longer durations of exercise will generally decrease blood glucose levels if you are delivering your normal background rate of insulin and have not taken carbohydrate prior to exercising.

If you choose to disconnect from your pump or suspend insulin delivery then whether your blood glucose levels rise or fall can depend on the intensity of the exercise you’re doing and how long you exercise for. The effect on your sugar levels can also vary from one person to another.

If you are taking part in a long period of exercise, it may be appropriate to switch to insulin injections on the day of the sport. Speak to your diabetes health team if this is an option you wish to consider.

How does the sport affect your sugar levels?

Different sports can affect different people in different ways and in some cases the effects can vary from one session to another. Some sports can raise blood glucose levels whereas other sports may lower sugar levels.

• Read more detail about the
  
  effect of different sports on blood glucose levels
  

Blood glucose testing before, after and, where possible, during sport can help you to spot trends in how your own sugar levels are affected by a particular sport or exercise.

If you are taking part in a sport that lowers blood glucose levels but doesn’t last more than an hour, it may be beneficial to disconnect your pump for that sport. Some people may decide to give a small bolus shortly before disconnecting their pump. It is recommended to discuss whether this would be appropriate with your doctor.

If, however, the sport tends to raise your blood glucose levels, you may need to stay connected to your pump to prevent your blood glucose levels going too high.

Your diabetes health team should be able to help you with making insulin dosing decisions and whether or not to disconnect your pump.

How should I change my insulin dose?

This answer will only be relevant if you’re choosing to keep your pump attached for exercise.

If the exercise you’re going to take is known to lower your blood glucose levels, you will either need to take carbohydrate before or during exercise to prevent your blood glucose levels going too low or you can choose to lower the rate of insulin delivery or the suspend the insulin delivery.

If the exercise you’re going to take is likely to raise your blood glucose levels, you may wish to increase your rate of insulin delivery. If increasing your rate of insulin for exercise, take care to avoid hypos.

Low blood glucose levels

are more likely to occur the longer amount of time you exercise for when you are delivering insulin to your body.

A key benefit of wearing your insulin pump for sport is that you have the opportunity to increase or decrease the delivery of insulin at the press of a few buttons if your blood glucose levels are going too high or low during exercise.

It is best not to risk having very low glucose levels. If you are unsure how best to adjust your rate of insulin, speak to your diabetes health team.

Should I adjust my basal rate after exercise?

Following a period of exercise, your

muscles

will take in glucose from your blood to replace the glycogen (a form of glucose) they will have used during exercise. This often means that people with type 1 diabetes have a higher tendency to experience hypos up to 48 hours after exercise.

The advantage of being on an insulin pump is that you can switch to a lower basal rate than normal to reduce the chances of going hypo. Your health can help you to decide by how much and for how long to reduce your basal dose for. With experience, you can tailor changes to your basal rate following different exercises and different durations of exercise.

Will my insulin pump’s tubing get caught?

Depending on the sport you’re playing, keeping your pump under your sports wear may be enough to ensure the tubing doesn’t get caught.

Some sports which may involve contact with other competitors, such as football or netball, may require more planning to prevent the tubing get caught on anyone or anything.

Wearing shorter lengths of tubing can be helpful and some people may wish to secure the tubing out of the way by taping the tubing to your body. Another option is to wear tight sports wear, such as cycling shorts or a tight Lycra jersey over the pump and infusion site.

It may also be possible to buy or make your own specially adapted clothing to keep your pump and tubing secured where it needs to be.

Will my pump get damaged during sport?

The risks of a pump getting damaged vary from sport to sport. You’ll want to take care that the pump cannot be trodden on or hit by a stick or a hard ball, such as in cricket or hockey.

In sports such as cycling, skating or skateboarding, the biggest risk of damage may be if you take a particularly hard fall. Insulin pumps are fairly durable but if taking part in sports with a risk of suffering a strong impact, it may be advisable to either disconnect the pump or take another form of insulin delivery, such as an insulin pen or syringe just in case part of your pump gets damaged.

It’s a good idea to discuss whether to disconnect your pump and what contingency measures you can take with your diabetes health team.

Which sports shouldn’t I wear my pump for?

Some sports may make wearing a pump unsuitable. For contact sports, such as rugby, boxing or judo, it may not be appropriate to have an insulin pump attached as it may increase the risk of injury for you or others.

For swimming, there are some waterproof pumps available but it may still be appropriate to disconnect the pump. Read more about

insulin pumps and swimming

If you need to disconnect your pump for a particular sport, it may be worthwhile speaking to your health team about how you can best manage your blood glucose levels.

Will my pump affect my performance?

If you are taking part in sport competitively, you’ll need to consider whether your pump may affect your performance and what you can do to reduce this being the case.

Insulin pumps are quite small and compact so shouldn’t add too much extra weight to runners or cyclists.

In some cases wearing an insulin pump may affect your performance, particularly if you’re worried the tubing might get caught or about whether the infusion set may come loose.

Some of these worries can be reduced, such as by taking extra care to secure your pump and tubing or to apply an extra tough adhesive to your infusion site.

If your insulin pump gets in the way of your performance, it’s worth talking with your

diabetes health team

about other options, which may include disconnecting your pump during sport or switching to injections prior to a day of sport.

Where can I wear my pump during sport?

The type of sport you’re taking part in may make a difference to where you wear your insulin pump. You will want to wear your pump in a place where it is not likely to be knocked on you or another competitor and where the tubing won’t get snagged.

Depending on the sport you choose, thigh and arm bands can be a good option. A popular option for women is to wear the pump in a bra pouch or within a sports bra. A further option is an insulin pump harness which can hold your insulin pump on your back and may present a good option for jogging.

It is also worth considering where your place your infusion site for a particular sport. For example, having the infusion site on your legs when doing running will likely increase the speed at which the insulin is absorbed and may increase the chance of a hypo.

An insulinoma is a rare tumour of the beta cells in the pancreas that results in an excessive amount of insulin being produced.

As insulinomas produce insulin, they can cause

hypoglycemia

and lead to dangerously low blood sugar levels. They generally occur in people between the ages of 40 and 60.

Insulinomas can be a cause of diabetes if the treatment of insulinoma requires a significant amount of the pancreas to be removed.

90 per cent of insulinomas are benign (non-cancerous), but most of the time these tumours will need to be removed by surgery. 10 per cent of people will have more than one tumour, while in one out of 10 cases, the tumour will spread to another body part.

How is insulinoma related to diabetes?

Secondary diabetes

can be caused by insulinomas if the whole or significant amount of the pancreas is removed as insulin is no longer produced.

Insulinomas lead to hypoglycemia, which people with diabetes face who are susceptible to hypoglycemia due to medication such as

insulin

, sulfonylureas and glinides.However, research generally suggests that insulinomas in people with pre-existing diabetes is rare.

J. Svartberg et al assessed that the relationship between diabetes mellitus and insulinomas of the pancreas is not clear.

They concluded, however, that when an insulin-using patient with diabetes experiences markedly reduced insulin requirements, insulinomas should be considered as a possible cause.

E

Ademoğlu et al claimed clinicians should bear in mind insulinomas could exist together with diabetes mellitus, but Muhammad Fuad Hameed et al report that this incidence is rare.

Symptoms of insulinoma

The symptoms of insulinoma are largely similar to the

symptoms of hypoglycemia

, which include:

• Blurred vision
• Anxiety
• Sweating
• Trouble concentration and
• Weakness

These are all typically mild symptoms caused by changes in insulin levels that cause low blood sugar levels. However, more serious symptoms can include convulsions and loss of consciousness.

These symptoms normally disappear after the consumption of glucose to raise blood sugar levels.

Causes of insulinoma

Insulinomas that develop in the pancreas are uncommon and only affect between one to five people out of one million each year. It is unclear what causes an insulinoma in most cases, but people with multiple endocrine neplasia type 1 (MEN-1 syndrome) – a genetic syndrome that enlarges hormonal glands – are more at risk.

The median age of diagnosis is 47-years-old, and while cases have been identified of insulinomas in young children and people as old as 70, these are extremely rare.

Diagnosis of insulinoma

A blood test will be administered to measure your blood glucose and insulin levels – a low blood sugar with high level of insulin will confirm diagnosis of insulinoma.

Additional tests may include computerised tomography (CT) or magnetic resonance imaging (MRI) scans to help detect the location of an insulinoma in the pancreas, and assess whether it is cancerous.

However, insulinomas can be problematic to locate due to their small size. An endoscopic ultrasound may be used if standard scans cannot locate the tumour.

Treatment of insulinoma

Surgical removal of an insulinoma is often recommended when there is a single tumour, with over 90 per cent of patients not requiring further treatment following surgery.

In rare cases, part of the pancreas may be removed if there are many tumours, while the entire pancreas could be removed if several insulinomas continue to reappear.

The removal of the entire pancreas, known as a pancreatectomy, leads to diabetes as no insulin is produced anymore in the body – insulin injections would be then be required.

Glucose responsive insulin (GRI), known as ‘smart’ insulin, is a promising treatment option for people with diabetes that, if successful, could result in blood glucose levels remaining within range during the day, and no more worrying about low or high blood sugar.

Scientists worldwide are working on administering smart insulin in different forms, such as capsules and patches. But the research is in its infancy – in many cases, human testing of smart insulin is not scheduled for several years.

GRI works in the body by automatically reacting to blood sugar fluctuations, essentially the same as normal insulin-producing cells in people without diabetes. GRI would therefore take the hassle out of consistently

managing blood sugar levels

and also enable tighter blood glucose control.

If smart insulin ultimately proves successful, it could be revolutionary for treating diabetes.

What is smart insulin?

Smart insulin is a next-generation

insulin

that automatically responds to changing blood glucose levels. The lower or higher blood sugar levels are, less or more insulin is released, respectively.

The insulin, whether taken as an injection or pill, keeps blood glucose levels normal throughout the day. This eliminates not just

hypoglycemia

and

hyperglycemia

but also

multiple daily injections

and


carb counting.

All smart insulin projects are at a very early stage and, in some cases, the drug is still being tested in animal studies.

Smart insulin cells

One of the earliest smart insulin projects began back in 2003 when Todd Zio, an MIT researcher, founded a company called SmartCells Inc, which soon gained backing from JDRF as it sought to develop GRI.

In 2011 US pharmaceutical company Merck acquired SmartCells. Their MK-2640 insulin is the first smart insulin to be tested on humans, with results still pending following completion of phase I of III in July 2016.


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Most smart insulin molecules are designed to circulate longer in the bloodstream than existing insulin, and increased funding in recent years means that more projects are experimenting with how these molecules are administered.

In 2017 an Ohio-based university was awarded a $2.5 million research grant to design a

novel class of GRI molecules

that would stick to the inside of the skin until high blood sugars are detected. These molecules are designed to be more responsive to blood sugar levels, for example, by preventing too much insulin from being absorbed when blood sugars are low.

Smart insulin patch

The University of North Carolina has been working on a

smart insulin patch

for several years.

In 2015 NC researchers reported that their patch, which rests on the outside of the body, will use a system of micro-needles to automatically detect high blood glucose levels and administer insulin appropriately.

One year later they


upgraded the patch to contain live beta cells which can control rising blood glucose levels for roughly 10 hours at a time. Because these beta cells are kept within the patch on the outside of the body, there is no danger of them being rejected by the immune systems of people with type 1 diabetes.

As of 2016 animal trials are continuing, with human clinical trials not expected for a number of years.

Smart insulin capsule

In the UK, progress is being made on a

smart insulin capsule

that rests inside the body and releases insulin when blood sugars are too high.

The University of Birmingham’s capsule contains molecules that bind to glucose, and when glucose levels are high, the capsule melts away, releasing the insulin.

While JDRF has called this a “life-changing treatment”, it is not expected to be tested in animal trials until 2022.

Other smart insulin projects

Will smart insulin prove worthy of the hype?

Currently, the “best case scenario” of smart insulin is extremely promising for people with type 1 diabetes and insulin-treated type 2 diabetes.

But with the first generation of these drugs still in very early development, it remains to be seen whether smart insulin can deliver somen, let alone all, of the anticipated benefits in humans.

JDRF has drawn up a draft set of characteristics for the “ideal” GRI compared to “first generation” GRI:

There’s a large range of accessories available for insulin pumps these days catering for a number of different uses and sometimes available in a number of different colours and styles.

This guide gives you an idea of which accessories are available for insulin pumps as well as some alternative suggestions if an exact product is not available for your pump.

We start with a range of, clips, pouches and cases and then go into other accessories such as skins and accessories designed for children.

Clips and holsters

Clips and holsters usually help to secure your pump to a belt, waistband, pocket or another part of clothing. You may be able to get holsters designed specifically for your type of pump or you may be able to use a holster designed for holding a phone or similar electronic item.

Bum bags

Bum bags and insulin pumps have been good friends for many years and a number of waist held pump bags closely resemble the appearance of a bum bag.

Bum bags can usually be adjusted and some may be worn over one shoulder across the chest or back, in addition to around the waist.

Bra pouches

These pouches generally clip onto the middle of the bra between the cups and the pump hangs down.

Depending on which top you choose, bra pouches can make accessing your pump relatively easy and fuss free and helps keep your pump secure and out of the way.

Thigh pouches

Thigh pouches offer extra flexibility and can be a good if you’re looking to conceal your pump say when wearing dresses and skirts.

Specific thigh pouches for insulin pumps are available from some manufacturers.

Arm pouches

Arm pouches give another option and place on your body to hold a pump. As with thigh pouches, arm pouches specifically for insulin pumps may be available from some manufacturers, whereas some people make use of arm bands designed to work with phones and MP3 players such as iPods.

Insulin pump harnesses

If you want to keep your insulin pump right out of the way, an insulin pump harness can allow you to wear your pump in the middle of your back.

This can be useful for some sports including jogging.

Insulin pump carry cases

Insulin pumps involve a bit more kit than insulin pens and so having a good kit bag or carrying case for your pump and consumables is often a good idea.

A carry case needn’t be specifically designed to be used with insulin pumps but having a specifically designed case may help to save space and/or keep your kit well organised.

• Carry cases can be particularly useful when travelling.

Waterproof insulin pump cases

It is possible to get waterproof cases for storing an insulin pump in places likely to get wet. Note that most waterproof cases won’t have been tested for waterproof functionality with the insulin pump in use.

For specific advice on

keeping your insulin pump protected from water

, it’s best to contact the manufacturer who will be able to give you advice with consideration to your insulin pump’s warranty, which could come into play should your insulin pump suffer water damage.

Skins

Skins allow you to personalise your insulin pump so that precious little box (your pump) reflects your personality.

Many insulin pump manufacturers offer the chance to choose from a range of skins to match your personality and style.

Accessories for children

It’s important for children to feel comfortable with their pump and there are a number of options to

make pumping that little bit more friendly for children

A number of companies have designed some really bright and wacky insulin pump carry cases and pouches, many of which will appeal to children. Have a look around on the internet and you should be able to find a design your child will love.

Insulin pumps are designed to be fairly durable and so most of the maintenance is to do with keeping the pump’s insulin reservoir topped up with insulin and ensuring batteries are changed when necessary.

The maintenance required with an insulin pump is more involved than is the case with using an

insulin pen

, however, maintenance procedures are only usually needed once every 2 or 3 days.

Re-filling insulin

Most insulin pumps can hold

around 200 to 300 units of insulin

Most people will find that this is enough insulin for around 3 to 5 days or so.

When the pump reservoir starts to run low on insulin, it will sound a warning, alerting you to refill the pump with insulin at the next opportunity.

It is advisable to allow insulin to reach room temperature before using it to refill your pump as this helps to prevent bubbles forming in the reservoir. If insulin is used straight from the fridge, to refill your pump, bubbles may form in the reservoir as the insulin warms up to room temperature.

Replacing batteries

Battery life can vary from one pump to another but you can expect to need to change the battery anywhere between a few times a year to once every two or three weeks, depending on usage demands of the pump and the type of battery it uses.

The procedure for replacing batteries is usually relatively simple and the insulin pump manual will guide you through the process.

Your pump should alert you of when its battery is getting low to give you a number of hours notice within which to change the battery.

It is important to have spares of the batteries available so that you can change the battery within a few hours or so of the low battery warning.

Changing infusion sets

It is commonly advised to change your infusion set for a new set every 2 to 3 days. Changing infusion sets usually takes a few minutes and is best carried out at a time and place where you can get your infusion site clean and get your new infusion set organised.

• Read more about
  
  changing infusion sets
  

Temperatures for your pump

Ideally, it is best to keep your insulin pump in temperatures close to that of normal room temperature (around 20 degress celcius), so that the insulin is kept in top condition and to

help prevent bubbles occurring in the pump in response to temperature change

Inevitably, there will be times when your pump will be exposed to colder or warmer temperatures. This shouldn’t usually be a problem if the pump is not exposed to very warm or cold temperatures for lengthy periods of time.

If the weather is either very cold or very warm, it’s advisable to take measures, where possible, to protect the pump from getting either too hot or too cold for too long. Measures could include

keeping your pump well covered in very cold weather

or

spending time in the shade during warm days

Whilst insulin pumps give us more power to bring our blood glucose levels under control, there are a number of common problems which can occur from time to time.

Some of the problems can be prevented to some degree and insulin pumpers) are always looking for ways to better cope with life on an insulin pump.

Bubbles in insulin pumps

Bubbles can form in the reservoir or tubing of occur for a number of reasons

• not priming air out of the reservoir when refilling the reservoir/using an new cartridge
• not priming all the air out of the tubing when changing to a new infusion set
• having a loose connection at either of the tubing
• using insulin straight from the fridge – this can cause bubble to form as the insulin warms up to room temperature

If your insulin pump delivers bubbles, it means you won’t be getting the full insulin dose you intended which can lead to higher than normal blood glucose levels and

could lead to a rise in ketone levels

How you deal with bubbles may vary from pump to pump. Taking care to prime out air from the reservoir and tubing, ensuring all connections are tight and using insulin that is at room temperature before using in

your insulin pump can help to reduce the likelihood of high blood sugar levels

as a result of bubbles.

Occlusions

An occlusion is the name for any blockage that prevents your pump from delivering insulin properly. Some pumps may signal an alarm if it notices an occlusion has occurred.

Occlusions may occur for any of the following reasons:

• If pressure is being applied to the tubing or the infusion site
• If the cannula has been bent during insertion – which may be more common with Teflon cannulas
• Kinked insulin pump tubing
• Crystals forming in the insulin and causing blockages at the cannula

Check for any noticeable causes of blockages, such as kinked tubing or pressure on your infusion site. Changing your infusion site may be necessary, such as if the cannula has become kinked. Call your

health team

for help if you are unable to resolve the issue or you are getting occlusions occurring too frequently.

Leaking pump reservoir

It is possible for the insulin pump reservoir to leak

insulin

This can happen if the rubber seals, called o-rings, around the plunger become weak or damaged. The rubber o-rings can sometimes get damaged if they are not properly lubricated during the manufacturing.

If the reservoirs are leaking you may need to try a new reservoir and if the problem repeats itself, you may need to order a different set of reservoirs or contact the manufacturer.

Infusion sets coming loose

Infusion sets coming loose is a relatively common problem that can occur if sweat is able to gather at your infusion site. This can cause the adhesive to break contact with the skin and could result in the cannula coming free.

If you’re having your infusion set coming loose, you may wish to try using a more durable adhesive.

Bleeding and ‘gushers’

Occasionally, you may experience bleeding at your infusion site. It may be difficult to completely avoid bleeding but if you are regularly experiencing bleeding you may wish to change to a different type of infusion set.

Sometimes when you insert the cannula,

it can break a blood vessel

Occasionally the bleeding may be quite dramatic and insulin pumpers tend to refer to these occurrences as ‘gushers’.

Skin infections

Skin infections are more likely to occur when using insulin pumps than with injections. If bacteria gets onto the cannula before or during being inserted,

the body’s immune system will act to try and remove it

An infection may present itself as a lump under the skin which may look red, feel unusually warm and uncomfortable and may leak pus. It’s important to call your health team if you suspect you may have an infection.

Taking care to clean the skin of your infusion site and your hands when changing a set will help to reduce the likelihood of having a skin infection.

Pump bumps and scarring

Pump bumps are

raised areas of harder than normal skin (lipohypertrophy) which can develop at your infusion site

Pump bumps may occur if your skin gets irritated by the catheter.

Pump bumps are not as serious as an infection but can look and feel undesirable and may also lead to inconsistent insulin delivery.

Rotating your infusion sites, (making sure you don’t re-use the same infusion site too often) can help to reduce the chance of pump bumps. If pump bumps continue, you may want to consider changing to a different infusion set to see if that helps.

Some scarring can also occur at infusion sites. These should normally heal over a few days. Contact your health team if pump bumps or scarring becomes problematic.

Insulin pumps come in a variety of forms. Tethered and patch pumps are the options currently available on the NHS or to buy privately.

At the moment, a new breed of extra intelligent insulin pumps (closed loop insulin pumps) are being tested under

supervised conditions for research

and could start to become available if the trials are successful.

Tethered pump

Tethered insulin pumps are those that have a length of flexible tubing between the pump itself and the cannula (the short, thin tube which goes through the skin).

The pump itself, which usually feature controls, is free to be tucked into pockets or carried in pump pouches which can be worn under or outside of clothing.

Some tethered pumps may also have controls on a separate handset which may also

double up as a blood glucose monitor

Commonly available examples of tethered pumps include:

• 
  Accu-Chek Spirit Combo
  
• 
  Animas Vibe
  
• 
  Medtronic MiniMed Paradigm Veo
  

Patch pump

A patch pump is where the pump is attached to the surface of the skin. To allow the pump to be as small as possible, the controls for the pump are located on remote control.

The remote control may also serve as a blood glucose meter.

One of the benefits of a patch pump is that there’s no tubing to catch on handles and other such objects but you may still need to be wary of where your pump is to prevent knocking or dislodging the pump.

Currently, the

mylife OmniPod is the only patch pump approved

for use in the UK.

Implanted insulin pump (IIP)

An implanted insulin pump is a pump which remains inside the body at all times. An implanted insulin pump is

able to deliver insulin

into the peritoneal cavity which has a rich supply of blood vessels and can therefore absorb insulin very efficiently.

Users of implanted insulin pumps have reported an improved sense of well being but there are a number practical disadvantages including the need for users to travel to Montepellier, France several times a year to have their pumps refilled.

Implanted insulin pumps are rare and only a small number of patients worldwide use this kind of insulin pump.

Closed loop insulin pump (artificial pancreas)

Closed loop insulin pumps, also commonly referred to as an ‘

artificial pancreas

’, are insulin pumps which are linked up to respond automatically to readings given by a

continuous glucose monitor

which also needs to be worn by the user through each day.

A comprehensive set of rules and algorithms are required to respond to changes in blood glucose levels and ensure blood glucose levels stay within safe levels and to date these pumps are still in the research stage of development.

It is likely to be a few years, if not more, before closed loop insulin pumps become available to a significant number of people with diabetes in the UK.

Insulin pumps give more control of blood glucose levels over night and so they can help to reduce the chances of having an overnight hypo. However, a number of factors can mean night time hypos can still happen.

Read on to see how you can help to beat night time hypos with the help of blood glucose testing and your pump.

Insulin pumps and background insulin

One key advantage of insulin pumps is that you can change the rate of

background insulin (basal insulin)

that the pump delivers at any point.

This is advantage over injections. With injections, once you have given your background insulin dose you are stuck with having that dose being gradually absorbed over the day.

As well as allowing you to change the rate of your background insulin at any point, you can also program in different rates of insulin delivery at different times of day.

This can be helpful in

preventing hypos

Read on to find out what to take into account when setting over night basal insulin rates.

Overnight testing

It is quite common for people with diabetes to have periods of the night where sugar levels go lower than normal. If you know which point of the night you are tending to go low, you can program your insulin pump to deliver less insulin around that part of the night.

Unless you have access to a

continuous glucose monitor

, carrying out some blood glucose testing over night may be your best chance of finding out whether or when you are going low over night.

None of us like getting up to test blood glucose levels over night but it can be a very useful way to prevent lows over night.

Testing needn’t be done each night but a few tests at different times of night on different days may help to give you an idea of

how your sugar levels are behaving when you’re sleeping

Programming basal rates to prevent hypos

If you are experiencing hypos over night, or blood glucose testing during the night is showing that your sugar levels are getting too close for comfort to hypo range, you can set your insulin pump to deliver a lower rate of background insulin.

Some people may find that setting a lower rate over night may lead to higher than ideal results in the morning. This can sometimes be caused by what’s often called the

dawn phenomenon

, whereby the liver prepares the body for waking by releasing extra glucose into the blood.

To get around the problem of preventing low blood sugar levels over night but high blood glucose levels in the morning, you can program your pump so that it delivers a smaller rate of background insulin through the night and a higher rate just before waking.

Fine tuning your background insulin can be a bit of an art. Blood glucose testing and experience helps and your health team can also offer advice on how best to set up your background insulin over night.

Factors which can increase the risk of over night hypos

There are a few factors which can significantly raise the risk of hypos over night. It’s useful to be aware of these factors and it can also help to understand why they raise the risk of hypos.

Exercise

If you have a more active day than normal, your muscles may still be refuelling when you go to sleep.

When we exercise

, our muscles take in glucose from the blood but will also make use of stored glucose from our muscles and liver.

After a good session of exercise, our muscles will replenish their glycogen (a stored form of glucose) stores. They will do this by taking in glucose from the blood, thus gradually lowering blood glucose levels.

This can be a problem over night as it can raise the risk of hypos. To prevent hypos from occurring over night, you may wish to decrease your rate of background insulin over night following a significant period of exercise in the day.

Alcohol

Alcohol can also affect blood glucose levels

quite dramatically. Many of know that alcohol has an effect on the liver but its knock on effect on blood sugar levels is slightly less well known.

The liver helps to release a steady drip of glucose into our blood. This is one reason why we need to take background insulin through the day. However, when we have alcohol, the alcohol can prevent the liver from releasing glucose into the blood and this can mean that we have an imbalance of too much insulin and this raises the risk of hypos happening.

After having alcohol, you may need to decrease your basal insulin to prevent hypos occurring.

Following a period of illness

When we are ill, the body’s immune system steps up a gear and this often results in a decreased sensitivity to insulin. What this means is that

often during illness, our blood glucose levels become higher through the day

This can mean needing to take higher doses of insulin than normal. You may find that the rise in blood glucose sometimes occurs before the symptoms of illness have appeared.

Setting your over night basal insulin at an appropriate rate can sometimes be a challenge. Your health team should be able to advise you on picking a safe rate.

Once your immune system starts to beat the infection, your blood glucose levels can come back to normal. If you have been on a higher dose of insulin over night, the improved sensitivity to insulin can raise the risk of hypos occurring.

To minimise the risk of hypos, you may allow your blood glucose levels to be a bit higher than usual over night during the time of illness so that when your insulin sensitivity returns, the risk of having a hypo will be lower.

Another way to reduce the likelihood of a hypo over night is to wake up in the middle of the night to test your blood glucose. It’s not an ideal situation but may be preferable to risking going too low over night.

Change in weather

A number of people find that their blood glucose levels experience changes when a period of warmer or

cooler weather

begins.

For some people,

blood glucose levels get lower during warmer weather

whereas for others the opposite may apply. You will likely need to rely on experience to find out how your own body responds to changes in climate.

Predicting a change in blood glucose levels can be as difficult as predicting a change in weather itself so often the best we can do is to react quickly enough.

If you experience a trend of lower blood glucose levels in the morning or over night for no other reason, it could be related to a change in climate. As with any trend of low blood glucose levels over night, it’s recommended to either lower your basal insulin over night or to take a snack before bed.

Should I adjust my basal rate after exercise?

Following a period of exercise, your

muscles

will take in glucose from your blood to replace the glycogen (a form of glucose) they will have used during exercise. This often means that people with type 1 diabetes have a higher tendency to experience hypos up to 48 hours after exercise.

The advantage of being on an insulin pump is that you can switch to a lower basal rate than normal to reduce the chances of going hypo.

Your health can help you to decide by how much and for how long to reduce your basal dose for. With experience, you can tailor changes to your basal rate following different exercises and different durations of exercise.