Transcript SPORTS & PUMPING: FINDING THE RIGHT MIX The Pump Club Insulin Pump Rick Philbin, MBA, M.Ed., ATC.

SPORTS & PUMPING:
FINDING THE RIGHT MIX
The Pump Club
Insulin Pump
Rick Philbin, MBA, M.Ed., ATC
ADVANCED PUMP MANAGEMENT
 Insulin Action
 Basal Insulin Regulation
 Bolus Regulation
 Physical Activity Adjustment
 DKA Prevention
 Temporary Basal Rates
 Insulin - Prolonged Boluses
 Alternate Basal Patterns
The Pump Club
Insulin Pump
PROFILES OF HUMAN & ANALOG INSULINS
Humalog, Novolog, Apidra (up to 4hrs)
Regular (6–10 hours)
Plasma Insulin Levels
NPH (12–20 hours)
Detemir (Up to 24 hours)
Glargine (20–26 hours)
0
2
4
6
8
Adapted from American Diabetes Association. Diabetes in the Latino Population.
Available at: http://www.diabetes.org/uedocuments/LatinoSlidesAugust05.ppt .
10
12
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22
Hours
DIABETES CORE CURRICULUM WORKSHOP
24
BASAL INSULIN REGULATION
Basal Insulin’s One And Only Job Is To Hold
Blood Glucose Levels Steady In the Absence of
Confounding Influences*
* Food, Exercise, Bolus Insulin, Unusual Hormonal Conditions (illness,
rebounds, menstruation)
PHYSICAL ACTIVITY ADJUSTMENTS
Short Duration
(<90 Minutes)
Long Duration (>90
Minutes)
Activity Within 2 Hrs
After Meal
Activity Before or
Between Meals
 Mealtime Bolus
Snack Prior to Activity*
 Mealtime Bolus
 Basal Rate
Snack hourly
Basal Rate
Snack hourly
PHYSICAL ACTIVITY ADJUSTMENTS
Meal Bolus
Adjustment*
Basal
Adjustment**
 Low Intensity Cardio
 25%
  Basal rate 50%
 Mod. Intensity Cardio
 33%
 High Intensity Cardio
 50%
 Competitive/Anaerobic
???
* If activity is after meal
 Start basal reduction 1 hr
pre-activity
** For activities lasting > 90
Min.
PHYSICAL ACTIVITY ADJUSTMENTS
Snacking to prevent low (examples)
Carbohydrate Replacement Per 60 Minutes of Activity
50 lbs
100 lbs
150 lbs
200 lbs
250 lbs
Skating
7-10g
14-20g
20-30g
28-40g
35-50g
Gymnastics
8-12g
17-23g
25-35g
34-46g
42-57g
Soccer
13-17g
27-33g
40-50g
54-66g
67-82g
STAY CONNECTED OR NOT?
Where do you carry it
during exercise?
Can you play contact
sports?
How often do you
change the infusion
site?
Should you give yourself
a bolus of insulin for a
high glucose reading?
How can you adjust your
basal delivery of insulin
depending on your
glucose readings?
PHYSICAL ACTIVITY ADJUSTMENTS
Alternatives to Disconnection:
 Wear It! (Sport Pack, Bum Bag,
Backpack Harness)
 Re-Connect hourly & bolus
50% of missed basal rate
DKA PREVENTION
Causes of insulin deficiency in Pump Therapy
Malabsorption (site problems)
Insulin Spoilage
Tubing or infusion set clogs
Leaks where the cartridge connects to the tubing
“Tunneling”/Leakage at the infusion site
Air pockets in the tubing
Dislodgement of the canula from beneath the skin
Improper or insufficient priming
Extended pump suspension or disconnection
TEMPORARY BASAL RATES
High-Fat Food
Duration
Adjustment
Notes
8:00
+60%
Start After
Meal
TEMPORARY BASAL RATES
Illness
Duration
Adjustment
Notes
24:00
+80%
Repeat as
Needed
TEMPORARY BASAL RATES
Extended Inactivity
Duration
Adjustment
Notes
Varies (>3 hrs)
+40%
Great for
long trips!
TEMPORARY BASAL
Menstrual Cycles
Duration
Adjustment
Notes
12:00
+50% (pre)
Start at night
12:00
-30% (post)
Start at night
TEMPORARY BASAL RATES
Prolonged Activity
Duration
Adjustment
Notes
Minimum 2 hrs.
-50%
Start 1-2
hours prior
TEMPORARY BASAL RATES
Prevention of (Delayed-Onset Hypoglycemia)
Duration
Adjustment
Notes
6-10 hours
-50%
Base timing on
experience
TEMPORARY BASAL RATES
Alcohol
Duration
2 hrs per
drink
Adjustment
-50%
Notes
Begin
after
drinking
DEFINITION: INSULIN ON BOARD
(IOB OR BOB)
The amount of insulin still active
at a given time after a bolus
30% RULE IS WHERE IT STARTED
Pumping Insulin, Walsh J, Roberts R
BENEFITS OF IOB
Decreased risk of stacking insulin
Less chance of hypoglycemia
Decreased risk of intentionally running high
due to fear of hypoglycemia
May improve A1c
PROLONGED BOLUSES
Description:
Normal/Standard Boluses are delivered within a few
minutes; peak is approx. 1 hr, duration approx. 4 hours
Prolonged boluses are delivered over a period of a couple of
hours; peak is delayed/blunted and duration is extended.
DANGERS OF DEHYDRATION
*Fatigue *Loss of coordination *High Blood Sugar
*Increased risk of heat illness, heat stroke and even death
MONITOR FLUID LOSS
Two ways:
Weigh in before practice and after
practice
 3 cups of fluid per pound lost
Check the color of urine (lemonade v.
apple juice)
1 - 3 = Optimally Hydrated
4 - 6 = Slightly dehydrated should drink more
6 - 8 = Dehydrated, must drink more
FLUIDS AND EXERCISE
Hydration is very important
 Non-caffeinated beverages (non-diuretic)
 Cool water is best
 Consider using diluted sports drink if CHO supplementation is
needed
 Make sure fluids are available along planned route
Thirst mechanism may be unreliable
 Don’t wait until thirsty
High blood sugars can be worsened
quickly by dehydration
Fluid Guidelines
Before
 Drink 12 to 20 oz -- 2-3 hours before
During
 Drink 6 to 12 oz every 15-20 minutes
After
 Drink 150% of sweat losses
 Drink 3 cups (24 oz) for every 1 lb weight lost through sweat
 Two gulps are about 3 ounces
 Replace 70% of what you have lost before next practice
*Guidelines from American Dietetic Association & American College of Sports
Medicine , 2007
CASE STUDY…
WHAT CHANGES CAN BE MADE?
Female soccer player wearing an
insulin pump
Frequent weekend tournaments up to
three games a day
BG ok on Saturdays but struggles with
low BGs on Sunday
ATHLETES WITH TYPE 1 DIABETES
ATHLETES WITH TYPE 1 DIABETES
Adam Morrison, NBA basketball
Chris Dudley, NBA basketball
Jay Leeuwenburg, NFL football
Kris Freeman ,U.S. XC ski team
Gary Hall, Jr., Olympic Gold swimmer
Missy Foy, Ultra distance runner
Doug Burns, Bodybuilding
Travis Pesco, Olympic wrestler
Will Cross, Explorer
Phil Sutherland, Cyclist
Michelle McCann, LPGA Golfer
Bill King, Marathoner