Mar 31

Exercise without the Pump (and thinking about another pump)

By Cary MDI, diabetes, exercise, lifestyle, pumping 4 Comments »

In all reality, not much has changed in preparation of exercising. COB, IOB are still the two items I am always conscious of – just how they get to me changes. While on the pump, I always disconnected before working out for 1.5 hours or less. This would tend to leave me in a basal deficit when I got out of the shower and reconnected and I would be forced to bolus immediately to both fill the cannula and get some insulin on board. However, now using Lantus, I do not have that insulin deficit when disconnecting. On the other hand, I do not start working out with a BG <180, Carbs-on-board and limited Insulin-on-board. I have purchased fun-sized candy that are 10 grams each – one or two candies are usually enough to get a BG <150 into my acceptable pre-workout range (also ensuring limited IOB). On the flip side, using the pump, I could be at any BG, and as long as I lowered my basal far enough in advance, I could raise my BG manually without additional carbs (however, I would end up going into further insulin deficit during the period of disconnect from the pump).

Not having to worry about the insulin deficit from disconnecting is a huge benefit for me during exercise – one reason why I am currently considering the OmniPod for my next pump.

As for the OmniPod in particular, I used a demo Pod for a few days over the weekend and I was somewhat impressed. Although the device is significantly large, it stays in place and has a smooth surface all around, unlike some of the MiniMed infusion sets I have used over the years. However, the inside information is calling for a 40-50% smaller Pod late 2010 or early 2011 (awaiting FDA approval). From the investor relations slides, it appears to retain its distinctive shape in a smaller package.

Mar 31

Insulin Leakage

By Cary MDI, diabetes, lifestyle No Comments »

Since I went on a pump “vacation” back in February, I have been using Lantus/Novolog with decent results. However, one of the downsides has been leakage from the injection site. This tends to happen if you pull the pen away from the skin too early (the pen is still releasing insulin for several seconds after it clicks done).

However, for some reason I feel like I am getting a little more leakage than what is normal and my precision boluses that I used on the pump are getting bumped up 10-15% to cover leakage (this is true to both my Lantus and Novolog).

Experienced leakage woes?  Just another part of living life as a diabetic and playing with the numbers.

Feb 09

The Basic Workout

By Cary MDI, diabetes, exercise, pumping 1 Comment »

Because New York winters are cold, rainy, and sometimes snowy, working out in a gym is almost a necessity. Not to mention sunrise near 8am and sunset at 4:40pm is debilitating to the mental game of getting outside before and after work.  However, going from 8+ hours at the office sitting at a computer, talking on the phone and eating – changing gears to workout mode can through you out of wack.

For the diabetic athlete the working out poses an interesting challenge.

  • Carbs on Board: Carbs consumed before, during and after the workout
  • Insulin on-board: Insulin used before, during, and after the workout

For the insulin pump user there are a handful of key issues to think through:

  • Temp basal pre-workout, during workout, post workout (timing and percentages for three distinct stages)
  • Optional disconnect during workout

All of these types decisions rest on a few key decisions: your personal insulin resistance, Insulin on Board, Carbs on Board and the type of activity you intend to take on.

The diabetic using Lantus actually might have it a little easier — since the basal adjustments are not a factor until an injection takes place – and you can feed your basal carbs as needed.

For an easy example, let’s say I have no carbs or insulin on board and have a BG of 120. Potentially a perfect way to start a workout, but it still requires a little more work. If I plan to do 30 minutes of reasonable cardio (say 10/min mile pace on the treadmill) and lift for another 30 minutes, I will have a low BG if nothing is done. One option would be to eat carbs prior to the exercise in an amount and time that would counter act the exercise to. A second option would be to run modify the basal 30 minutes prior to the exercise (to artificially increase the BG) and during exercise either disconnect or run another lower basal during exercise. Neither is a foolproof system nor you will find that most pumpers will utilize a combination of the above, since even in our simple example it becomes complex rather quickly.  Especially with disconnecting a pump, because a lack of basal can be debilitating when you reconnect (and somewhat scary if you bolus immediately after reconnecting after a workout to “replace” the basal).

Feb 07

Changing Time Zones

By Cary MDI, diabetes, lifestyle, pumping No Comments »

One of the more interesting aspects of life and sport is travel. Regardless if you are a pumper or MDI, planning ahead can make life easier when changing time zones (especially if you plan on actually living in your new time zone for more than a few days). Obviously the direction and number of time zones are the most basic principals.

For a simple example, take East Coast to West Coast of the US, a three time zone change – not the most drastic change in this globalizing world. On a pump, this could be a very simple task of changing the time in the pump right before take off. However, if you are taking off around midnight and will be flying through the night, temporary basal may be necessary – since many pumpers will utilize greater basal overnight to compensate for sleeping and dawn phenomenon.

On Lantus, I have two theories – one for once a day users and the other for twice a day users. For once a day, I always kept the time of injection the same on my “home clock” – which works well if the time is still easily working in the destination time zone. For twice daily Lantus users, giving the injection 12 hours apart may become a bit of an issue for some time zone changes because one of those injections will likely be at a time that does not correlate well with your schedule – you may be sleeping! Starting with the dose 12 hours prior to travel – I always try and delay or advance giving that injection somewhat (depending upon which direction I am traveling). So that 12 hours later, I will be more on-target with the time zone in my destination.  For once a day, if my daily injection does not align well with my destination time zone, over the course of 2-3 days before leaving, I will migrate the injection to the destination time (by a few hours forward or back every day) and compensate with shorter acting insulin.

Traveling can be a wonderful experience and with a small amount of foresight and planning, it can be a truly pleasant experience. And if you are lying by the beach, or going to ride 100 miles in a distant location – changing time zones should not hold you back. Let some gnarly hill climb be the most difficult part of your trip.

Feb 05

Going Analog / The Pump Vacation

By Cary MDI, diabetes, pumping No Comments »

Pump to MDI and Maybe back?

After pumping insulin for the past six years, I decided to take a break from my Deltec Cozmo and go back to multiple daily injections (MDI via Lantus/Novolog). There were a few reasons for this decision:

  1. Getting lazy with my day to day care (this was actually a reason for going on the pump in the first place)
  2. Changing infusion sets infrequently, taking advantage of advanced boluses & possibly over eating
  3. Infusion sets becoming irritated, itchy, etc. (partly due to changing sets infrequently, but also a general scar tissue issue developing after 6 years)
  4. Exercising less due to uncomfortable sites and wanting to run without the pump attached/no basal being delivered during exercise

Now for the technical aspect of doing the switch – from my prior experience with Lantus, it does not last a full 24 hours (tapers off in my body around hour 22). Therefore, I’m using a split 12u every 12 hours, for a total 24u/day an approximate 1:1.1 relation to my overall basal in the pump (in my experience, I usually need a little more Lantus than Novolog for pumping a basal).  With this setup, I can also change my “basal” Lantus dose in substantial 12-hour increments for say all day exercise.

Sunday at 6pm I had dinner, followed by a bolus for that meal on the pump. At 7pm I simultaneously took my first 12u Lantus injection and dropped my basal rate to 50% permanently. A few hours later I checked my BG and it looked great – no strange BGs. All clear.

Monday 6:30pm, breakfast, bloused, took another 12u of Lantus and removed the pump. I’m free from the pump and have a full dose of Lantus on board.  This is a fairly scary point – since there is no going back – even though I know I already have 12-hours of good BG under my belt with half-Lantus.

A BG test at 10:30am proves the Lantus is working as expected.

At 3pm I am running a little high from lunch that I originally thought was likely a combination of under-dosing for the meal and not enough pre-lunch correction.

However, upon second thought, I remembered seeing insulin “leaking out” of the injection site. Here is one thing I just needed to re-teach myself.  Since I am using an insulin pen, we don’t get instant gratification from the injection. I need to hold the needle in for about 5-10 seconds after fully depressing the injection, before can remove the needle to ensure a proper dose.

6pm – Gym Time.  Ensure IOB and Carbs on Board match my BG, but I ended up adding 30g of carbs because my BG was slightly low for starting an hour or longer cardio set.  No problems with the workout — and post BG numbers looked great too.

Five days into this experiment everything is going rather smoothly.  The only changes I foresee is if I do any long weekend morning exercise, I will probably use a lower AM dose of Lantus.  This would basically result in running a “temp basal” on the pump.  In the event that I oversleep past 7am (it rarely happens), I still have a 12u for another 12 hours—what I consider my backup.

Some good things I noticed is that because of the change I am paying more attention to my diabetes. Shaking up my routine has had the desired affect so far of motivating me to be a little less lazy about my diabetes.  And the great feeling of being able to go for a run without my insulin pump and still have a “basal” on board.

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