Josephine's Pumping Adventure: Navigating Diabetes at the Office

Hello everyone,

I hope this message finds you all well!

I was wondering if I could kindly seek your invaluable advice for a little troubleshooting? You see, I have this 'case study' that's been on my mind, and I'd absolutely love to hear your expert insights and suggestions on the best way to handle it. Here's the scenario:

Imagine you're in the office, and you've already enjoyed your delicious lunch at around 12:00 hrs, expertly using your trusty insulin pump to bolus for your meal. Fast forward to 15:00 hrs (3 hours later), and your friendly line manager unexpectedly asks if you could 'pop out for just a minute' and grab a file from our friendly collaborating office. Now, 'popping out' in this case involves a little adventure: walking to the nearest train station, navigating some stairs, strolling to your destination, and then, of course, making your way back to the office. All in all, it's about 45 minutes of gentle exercise.

Your pump has been keeping you at a picture-perfect 5.3, and you still have some bolus on board. What's the secret to ensure you can fulfil your manager's request without risking any pesky hypoglycaemia?

I'm turning to my fellow diabetes squad for some much-needed wisdom and guidance! Please, dear friends, shower me with your answers and insights.

Warmest regards, Josephine

Juicyj said:

Hi Josephine, I would suspend insulin on the pump and also take 10g of glucose and re-instate suspend feature upon my return, I would prefer to start with extra glucose in my system and no threat of more incoming insulin too for the duration, but that's me personally, would depend on how you respond to exercise.

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Hello JuicyJ, thank you very much for your help.
Josephine

eventhorizon said:

You could say 'sorry I can't do that right now' suspend insulin delivery for 30 mins or so get things in order and off you go.

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Hello eventhorizon, thank you for your reply.
Josephine

In Response said:

i try to avoid the situation where my diabetes may stop me doing something at work. I would not like to it be seen as ”an excuse” by others.
I have certainly found myself in work situations which would be easier without diabetes but they are usually situations that no one likes so I do not want to be seen by my colleagues as not pulling my weight.
In @Bluemarinejosephine scenario, I may suggest the trip can wait for me to finish my current task (and suspend my pump as I do so). But that is reasonable for anyone - a boss should not expect an employee to drop what they are doing at a whim regardless of any medical conditions. A boss should be able to plan ahead unless it was an unexpected emergency.

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Dear In Response,

Thank you for your reply.

Relating to exercise, my diabetes nurse has recommended a protocol involving the use of a temporary basal rate set at a reduction of 50% approximately one hour prior to, during, and one hour following exercise, with a subsequent return to my regular basal rate. Her rationale for this approach is to minimize the risk of a blood glucose spike that may occur when insulin is suspended entirely during physical activity.

However, as I've delved into various discussions within the diabetes community and sought advice from friends and fellow individuals who manage diabetes in their daily lives, it has come to my attention that many people tend to prefer suspending their insulin altogether rather than adopting the temporary basal rate approach.

Personally, I have a tendency to place significant value on the guidance of those who navigate the complexities of this condition daily, as opposed to individuals who may have read about it in manuals.

I am keen to hear your perspective on this matter. Do you lean towards suspending your basal insulin before engaging in exercise, or do you find the temporary basal rate method more effective in managing your diabetes during physical activity?

Antje77 said:

I think your best guide is your meter, which will tell you how you react to exercise, it's not the same for all.
Do you use a CGM?

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Dear Antje77
Thank you for your response.
I use the Freestyle Libre 2

In Response said:

It depends
- some exercise will raise my BG so I increase my basal for that
- some exercise will lower my BG but it depends upon my starting BG. If my levels are higher than I want, I will use the exercise to lower it
- low impact exercise will have no impact so I don’t change my basal for an amble to the shops
- any bolus on board will lower my BG faster when exercising so I try to avoid intensive exercise for 3 hours after meals.
- I needed to adjust my basal longer before exercise when I used NovoRapid. Now I use Fiasp, I can change basal later.
- how long the exercise will be. I will adjust basal differently for less than an hour to I would with a 3 hour session
- as I did before pumping, I can adjust my BG with bolus and/or fast acting carbs.

Assuming my BG is in range and not changing, to I have not eaten for the last 4 hours (an hours extra just to be sure) and I am going to have a scheduled 45 minute long spin class, I will suspend my basal for 45 minutes from 30 minutes before my class starts.

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Thank you. This is very helpful.