Josephine's Pumping Adventure: Navigating Exercise with Omnipod Dash

Hello lovely people!

I hope this message finds you well and brings a smile to your face!

Yours truly is about to dive into the wild world of pump adventures with the Omnipod Dash. I need your wizard-like wisdom on how to handle this new rollercoaster ride, especially when it comes to my exercise routine.

1. My relationship with post exercise effect is like a complicated romance novel. It's not a 12-hour fling; it's a marathon! I understand from your discussions that most of you suspend or minimise your insulin intake approximately 1 hour before, during, and 1 hour after exercise. But what happens to me after that? The exercise effect lasts 12 hours or more. Any tips and tricks, to share?

2. Remember that DAFNE 15-gram rescue plan for low blood sugar? (we treat with 15 grams, we wait and check, and if necessary we treat with 15 grams again). Well, I've read discussions of people explaining that they needed 40 grams or more after a workout to get their levels back in line. Is this the case and is the rule different when we use a pump?

3. I'm basically a whirlwind of activity all day, every day. I love walking everywhere (for my grocery shopping, to work, for personal or window shopping), I take the stairs and never use elevators, I enjoy jogging in the morning after breakfast (when work schedule permits), I love yoga, reformative pilates, I dance on my own in the kitchen to swing jazz… What do I do in this case? I mean, when I keep moving all day…What's the game plan for someone who can't sit still?

4. And, what about those surprise, spontaneous exercise moments – the ones where you decide to run a marathon to catch the ice cream truck or dance the cha-cha when your favourite song plays on the radio or feel a little naughty and inclined to misbehave. What's the secret recipe for those unexpected sweat sessions?

My diabetes-fighting squad, share your wisdom with me!
Much love and gratitude, Josephine

Juicyj said:

Hello Josephine,

Great news on your pump.

Personally doing as much as you are doing, I would simply set up a different basal pattern for exercise days, so duplicating your current pattern and renaming it and then reducing basal by 20 or whatever percentage you feel comfortable doing, that's entirely up to you as anything new you do will need tweaking to suit your specific needs.

Then creating a basal profile for more sedentary days and switching between them. You will also need one for sick days too, although we may or may not need them, they can make life easy when the brain doesn't want to do the calculations !

That's where pumps do become very useful tools to navigate your ever changing needs.


Best wishes Juicy

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Dear Juicy,

I trust this message finds you well.

Firstly, I would like to express my heartfelt gratitude to you. Your willingness to not only respond to my inquiry but also generously share your advice and insights with others has not gone unnoticed. As I prepare to embark on the journey of transitioning to an insulin pump, I have diligently combed through various threads, and your contributions have proven to be an invaluable resource.

For the past 15 years, I have adhered to a basal/bolus schedule utilizing pens. The prospect of transitioning to an insulin pump is an entirely new chapter in my diabetes management journey, one that admittedly fills me with trepidation.

If I may impose upon your wisdom, I have come across discussions in which individuals reported an increased sensitivity to insulin following their switch to a pump, resulting in adjustments to their bolus ratios. I am curious to know whether you have encountered a similar experience.

Your insights would be immensely appreciated. Thank you in advance for your response.

Josephine

eventhorizon said:

Hi Josephine.

It'll be a steep learning curve but here's what I do.

1. Yep, I suspend basal insulin at least 1 hour before planned exercise and wait for a definite upward trend on the Libre. Once I start my climb, walk, swim etc I'll set the basal to 10%. I find if I'm doing a long session like hill walking for 6 plus hours I have to be very careful to catch a huge spike as soon as I stop because I have very little IOB. So I might start increasing a little the basal shortly before stopping. It's not perfect but the best I've worked out.

4. For immediate unplanned short exercise I'll have to eat something carby and reduce basal.

I'll deal with the after effects by running basal at 40 to 50% and add a few micro boluses as required for a few hours or until a large meal.

Hope that helps.

Glen.

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Dear Glen,

I hope this message finds you well.
I want to extend my gratitude for your prompt response to my previous email and for sharing your valuable advice.
To ensure that I have grasped your recommendations correctly, I would appreciate your confirmation on the following points:

• For brief exercise sessions, you suspend your insulin completely 1 hour before the exercise session.
• When your Libre sensor indicates an upward trend and you have ceased insulin administration from your insulin pump, you then initiate an insulin delivery at a rate of 10% of your basal rate before commencing your training session.

I would like to clarify the timing of resuming your normal basal rate after completing your exercise session. If we assume that your training session lasts for 45 minutes to an hour and you have maintained a basal rate of 10% insulin during this time, when do you transition back to your regular basal setting? Is it after waiting for 1-hour post-exercise?

So, to summarize the process:

• Suspend insulin 1 hour before exercise.
• Initiate a 10% basal mode when you observe the upward trend and then start your exercise.
• Upon finishing the exercise, continue with the 10% basal mode for 1 hour.
• After the 1-hour post-exercise period, return to your normal basal setting.

Is my understanding of this sequence, correct?
I greatly appreciate your guidance on this matter.

Thank you once again for your assistance.
Warm regards,
Josephine

eventhorizon said:

Hi Josephine.

I'll normally run the basal at 40 to 50% immediately post exercise for 2 to 3 hours unless I'm heading for a hypo.

However it's all subject to the random and not so random effects of life and t1d. No 2 days are the same.

For example If I'm swimming in the sea I'll have a significantly higher BG safety margin than if I'm climbing indoors with help, harnesses and food available.

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Dear Eventhorizon,

I hope this message finds you well. I wanted to express my gratitude for your prompt response and for sharing your valuable insights. I greatly appreciate your willingness to assist me in understanding the preparation process for exercise and the management of basal insulin rates.

To further delve into this topic and gain a comprehensive understanding of the entire procedure, I was hoping you could provide some additional clarity. While I have gathered information from various discussions, I would like to ensure my assumptions align with your actual approach. Please accept my sincere thanks in advance for clarifying the following points:

• Pre-Exercise Preparation: My understanding is that you typically reduce your basal insulin rate to approximately 40% to 50% one hour before commencing exercise. Is this accurate?
• Exercise Engagement: During exercise, assuming a mild cardio session of 45 minutes to an hour, do you maintain your basal insulin rate at the reduced 40% to 50% level?
• Post-Exercise Maintenance: After completing your exercise routine, you continue to maintain the reduced basal rate for approximately 2-3 hours, unless your glucose levels indicate a hypoglycemic episode. If a hypoglycemic episode occurs, could you share your typical approach in terms of further basal rate reduction and treatment?
• Return to Normal Basal Rate: You then resume your normal basal rate after the 2-3 hour post-exercise period. Consequently, does this mean you operate at the reduced basal rate (40% to 50%) for an estimated total of 4-5 hours, encompassing the pre-exercise hour, the exercise duration, and the post-exercise period?
• Additionally, in cases of spontaneous or unplanned exercise, is it correct to assume that you employ a similar approach by reducing your basal rate by 40% to 50% and treating to prepare for the exercise?
  
  I acknowledge that individual handlings of exercise and insulin management can vary and are not an exact science. Nevertheless, having a general framework or guideline would be immensely valuable in navigating this process effectively.
  
  Your insights and guidance are highly appreciated, and I look forward to hearing from you. Thank you for your time and expertise.
  
  Warm regards,
  Josephine

CJa said:

Josephine,

Great question and it has been really interesting read with all the responses. I'm also very impressed with your diligence and efforts to manage your diabetes. It can be exhausting.

Personally I could never manage to remember all the rules successfully. In the end, I found that controlling short periods of hypo conditions significantly easier to manage than extended hyper conditions.

One opportunity that the pump will reveal is the ability to use a looping function. I recommend that once you get the hang of the pump, start researching the various looping algorithms. I use AAPS and it has totally transformed my life. My time in range is >80% and my HBA1c dropped to around 50. The biggest thing though is the improvement in my mental health. It's still a lot of effort but I now feel that I can actually succeed in controlling my diabetes. A feeling I never had prior to using AAPS.

My exercise routine is walking the dog and I simply tell the AAPS to adjust the target blood sugar level for a duration around the exercise. AAPS then adjusts my basal to correctly drive my blood glucose level, accounting for my extant bolus and food intake. The available support for looping is also amazing and there is so much information on the various forums and Facebook pages.

Best wishes and good luck with the new pump.

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Dear CJa,

I trust this message finds you well.

I recently had the looping system recommended to me by a fellow member during a thread discussion related to my upcoming insulin pump initiation. I must say, I was thoroughly impressed by the concept and its potential benefits.

In pursuit of further information, I conducted some research, primarily utilizing online resources such as Google and other search engines. Regrettably, my investigations led to a somewhat disappointing revelation: the insulin pump I have been offered, the Omnipod Dash, appears to be incompatible with a continuous glucose monitor for integration into a looping system. My understanding is that the Omnipod 5 is compatible with the Dexcom CGM; however, I currently find myself unable to access either of these devices.

During my research, I came across instances where people with diabetes had ingeniously devised their own looping systems—a testament to their resourcefulness and determination. While I greatly admire these efforts, I must confess that, at this juncture, I lack the confidence to embark on such a technical endeavour.

It seems that, for now, I may need to familiarize myself with the manual operation of my current diabetes management tools before considering a transition to a more automated system. I tend to think of it like learning to use a manual gearbox before switching to an automatic.

I sincerely appreciate your suggestions and insights in this matter. Your willingness to assist is truly commendable.

Warmest regards,

Josephine.

CJa said:

The below link is the documentation for the AAPS. My simple mind interpretation is that Omnipod Dash is compatible but Omnipod 5 isn't.
Regardless, moving to a loop system is a huge investment of time and confidence (and you need to be rich in both).
Best wishes.

AAPS Documentation

Android APS (AAPS) is an open source app for people living with insulin-dependent diabetes. It is an artificial pancreas system (APS) which runs on Android smartphones.

androidaps.readthedocs.io

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Dear CJa,
Greetings and salutations!

I wanted to extend a heartfelt thank you for gracing my thread with this glorious attachment.
I'm prepared to dive into it with the enthusiasm of a squirrel chasing acorns. I'll dissect every nook and cranny of this guide, and even if I find myself swimming in deep waters, I'm convinced that this noble pursuit will, at the very least, elevate my IQ by a smidgen.

Your generosity in sharing this knowledge is greatly appreciated,
With much gratitude, Josephine