Insulin Pump Training

[lyndsayob]

How far in advance have you tried bolusing, what amount of carbs have you tried and normally have? Are you sure your basal levels are properly correct, and also bolus ratios? Do you get the same spike without going to the gym or having breakfast before the gym? but like novorapidboi26 has said it might be tricky

ok, so how would a pump help out?

(I did say I was going to be annoying )

No problem i appreciate the help! Ive tried bolusing up to half an hour before eating but my worry with that is that I might not finishing all my breakfast and depending on how intense the exercise was I can have a drop in glucose levels later on. I normally have a maximum of 30g carb after the gym for breakfast. I think my basal levels are OK as most often my glucose level comes back into an acceptable range before the next meal and if I have a carb free lunch or dinner my glucose levels stay fairly consistent. I go to the gym at 6am before work so don't have breakfast before this. However I find if I have a meal before the gym i need to cut my bolus back as the exercise can cause a hypo but then I I've had a spike in blood sugar level before I start exercising! I was hoping that the pump would give me more flexibility, e.g. maybe the opportunity to control the spikes associated around the exercise. Though I've got a lot to learn about this. Sorry for the information overload! My hospital are wanting me to have a chat with them about it over the next few weeks so hopefully that will give me a better idea around whether the pump is suitable for me

 

[lyndsayob]

You would expect to be more insulin sensitive post exercise....

but yeah, spikes as you know are a result of mis-timing of the insulin dose.....and you say you have experimented with the timing?

Yeah sometimes I find that if I go for a walk after eating post exercise have a hypo. Trying different timings for the injections to see what works best. It's all a bit of a balancing act I think!

 

[novorapidboi26]

What do you have for breakfast usually?

 

[novorapidboi26]

Yeah sometimes I find that if I go for a walk after eating post exercise have a hypo. Trying different timings for the injections to see what works best. It's all a bit of a balancing act I think!

I have seen myself dosing 45 minutes before a meal...

 

[lyndsayob]

What do you have for breakfast usually?

Usually low fat yogurt, small portion of oats, flaked almonds and berries. Or rice cakes with peanut butter or eggs of some sort. If I'm on the go sometimes have a protein shake straight after exercise but before breakfast which I give insulin for but with caution as although it causes a rise in sugar levels it doesn't cause a sustained rise.

 

[slip]

OK I'm going to stop being annoying now!

Thanks for all the info, sounds as though you have really looked into trying to over come the breakfast spike - TBH I'm not sure I can help any further (I'm not a Gym bunny) but I know @TorqPenderloin is a gym goer (he's USA based) he might be able to help or know of others here that might.

 

[azure]

Thanks for the reply! I'm pretty well controlled overall at the moment and have attended the DAFNE course so I do carb counting and dose adjustment. To be honest I'm just keen to find out if it would help with control during and after exercise and stop the crazy after breakfast spikes I get regardless of what I eat in the morning.

@lyndsayob There are loads of threads here about the pros and cons. Have a read round and it will help you get a feel for pumping

I agree with everyone above who has mentioned advance bolusing. Me plus cereal and no,using just before eating equals a post meal BS of 11, but with advance bolusing my post meal BS is around 6. It works fantastically and until people try it, they never get how good it is (which is why I go on about it all the time : D ).

If you're spiking in the morning, you need to do a basal test, rule out a waking rise (I get that), try advance bolusing and try changing your breakfast insulin to,carb ratio.

My waking rise plays a big part in my morning. I find delaying breakfast will make me go high, so I always eat asap. You mentioned exercise. Whe I exercised first thing, I did my usual pre-exercise stuff (taking glucose, etc) didn't bolus as I didn't eat breakfast - and ended up surprisingly high when normally I'd be topping up with glucose and be low. So another option is changing your exercise time or tweak your eating time/snacks/bolus.

I've had a pump 13 years and I love it, but it's no easy option as there's still work to do for control

 

[lyndsayob]

OK I'm going to stop being annoying now!

Thanks for all the info, sounds as though you have really looked into trying to over come the breakfast spike - TBH I'm not sure I can help any further (I'm not a Gym bunny) but I know @TorqPenderloin is a gym goer (he's USA based) he might be able to help or know of others here that might.

Don't worry you weren't annoying at all! I have no diabetic family members so pretty isolated from others in that sense so I appreciate your help. Thanks for the suggestion I'll take a look

 

[lyndsayob]

I have seen myself dosing 45 minutes before a meal...

Never tried that far in advance but I might give it a go depending on my blood glucose level at the time. Thanks

 

[lyndsayob]

@lyndsayob There are loads of threads here about the pros and cons. Have a read round and it will help you get a feel for pumping

I agree with everyone above who has mentioned advance bolusing. Me plus cereal and no,using just before eating equals a post meal BS of 11, but with advance bolusing my post meal BS is around 6. It works fantastically and until people try it, they never get how good it is (which is why I go on about it all the time : D ).

If you're spiking in the morning, you need to do a basal test, rule out a waking rise (I get that), try advance bolusing and try changing your breakfast insulin to,carb ratio.

My waking rise plays a big part in my morning. I find delaying breakfast will make me go high, so I always eat asap. You mentioned exercise. Whe I exercised first thing, I did my usual pre-exercise stuff (taking glucose, etc) didn't bolus as I didn't eat breakfast - and ended up surprisingly high when normally I'd be topping up with glucose and be low. So another option is changing your exercise time or tweak your eating time/snacks/bolus.

I've had a pump 13 years and I love it, but it's no easy option as there's still work to do for control

Thanks for the advice! I find that breakfast is the most difficult meal to control blood sugars around and most days I feel sick up until lunch time. I previously moved my basal injection to a later time in the day as I was thinking that the basal dose was running out at around breakfast time maybe resulting in the blood sugar spikes. I think I'll try bolusing further in advance than what I currently do. Will just need to make sure I finish the full breakfast haha! Thanks again

 

[slip]

Don't worry you weren't annoying at all!

I must try harder then next time!

 

[novorapidboi26]

Also, with active folk and gym goers a split basal dose usually suits better due to the increased flexibility....

 

[lyndsayob]

Also, with active folk and gym goers a split basal dose usually suits better due to the increased flexibility....

Thanks that could be worth a shout. I'm on a very low quantity of basal but I don't think that would be a problem!

 

[slip]

Did you mention trying splitting your breakfast bolus?

 

[novorapidboi26]

Thanks that could be worth a shout. I'm on a very low quantity of basal but I don't think that would be a problem!

Whats the amount....?

Its very likely you need different amounts overnight than you do in the day time and it may allow you to tweak it slightly to help with the post gym spikes...but it also allows you to reduce said basal dose in the morning if you needed to stop lows from happening....

it all depends on the duration and type of activity...

 

[lyndsayob]

Whats the amount....?

Its very likely you need different amounts overnight than you do in the day time and it may allow you to tweak it slightly to help with the post gym spikes...but it also allows you to reduce said basal dose in the morning if you needed to stop lows from happening....

it all depends on the duration and type of activity...

I take 13 units of Lantus at 1330 each day.. Very little. I do weight training at the gym for 30 mins to 1 hour.

 

[novorapidboi26]

You could consider splitting it, maybe take a dose in the morning and in the evening.....

you should probably get some feedback from your diabetes pros before making any changes though....

 

[lyndsayob]

You could consider splitting it, maybe take a dose in the morning and in the evening.....

you should probably get some feedback from your diabetes pros before making any changes though....

Yeah I'll have a chat with them about it Thanks very much for the advice!

 

[TorqPenderloin]

I have to completely alter my basal/bolus approach in situations where I don't exercise for more than 2 days in a row and eat a high carb diet. If you're just starting to workout, you're going to have the opposite problem.

The key for me is consistency. I can take an occasional day off from the gym, but two in a row is a night-and-day difference in my blood sugar levels.

I wake up, drink a cup of coffee and head to the gym. I rarely workout if I've bolus less than 2 hrs before. In fact, it's probably been months since I've done that. It's too hard and not worth the frustration.

When I was first dialing in my insulin doses I did 10% adjustments at a time until I had several days of consistent success (1 day isn't enough if you ask me). I'm very fortunate to be on a CGM which makes it 100x easier.

Happy to answer specific questions if you have any. Note: I'm on MDI (tresiba and novolog/novorapid) and have zero desire to go to a pump since my current approach works fantastic.