sports & pumping: finding the right mix
DESCRIPTION
Sports & Pumping: Finding the Right Mix. 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. - PowerPoint PPT PresentationTRANSCRIPT
SPORTS & PUMPING: FINDING THE RIGHT MIX
Rick Philbin, MBA, M.Ed., ATC
The Pump Club Insulin Pump
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
D I A B E T E S C O R E C U R R I C U L U M W O R K S H O P
0 2 4 6 8 10 12 14 16 18 20 22 24
Plas
ma
Insu
lin L
evel
s
Regular (6–10 hours) NPH (12–20 hours)
Hours
Glargine (20–26 hours)
Humalog, Novolog, Apidra (up to 4hrs)
Detemir (Up to 24 hours)
Adapted from American Diabetes Association. Diabetes in the Latino Population.
Available at: http://www.diabetes.org/uedocuments/LatinoSlidesAugust05.ppt.
BASAL INSULIN REGULATIONBasal 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
Activity Within 2 Hrs After Meal
Activity Before or Between Meals
Short Duration(<90 Minutes)
Mealtime Bolus Snack Prior to Activity*
Long Duration (>90 Minutes)
Mealtime Bolus Basal RateSnack hourly
Basal RateSnack hourly
PHYSICAL ACTIVITY ADJUSTMENTSMeal Bolus Adjustment* Low Intensity Cardio
25% Mod. Intensity Cardio
33% High Intensity Cardio
50% Competitive/Anaerobic
???
* If activity is after meal
Basal Adjustment** Basal rate 50% Start basal reduction 1 hr
pre-activity
** For activities lasting > 90 Min.
PHYSICAL ACTIVITY ADJUSTMENTSSnacking 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 ADJUSTMENTSAlternatives to Disconnection:
Wear It! (Sport Pack, Bum Bag, Backpack Harness) Re-Connect hourly & bolus
50% of missed basal rate
DKA PREVENTIONCauses 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 RATESHigh-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 RATESProlonged 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 Adjustment Notes2 hrs per
drink-50% 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 hypoglycemiaDecreased risk of intentionally
running high due to fear of hypoglycemia
May improve A1c
PROLONGED BOLUSESDescription:
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 LOSSTwo ways:Weigh in before practice and after practice3 cups of fluid per pound lostCheck the color of urine (lemonade v. apple juice)
1 - 3 = Optimally Hydrated4 - 6 = Slightly dehydrated should drink more6 - 8 = Dehydrated, must drink more
FLUIDS AND EXERCISEHydration is very importantNon-caffeinated beverages (non-diuretic)Cool water is bestConsider using diluted sports drink if CHO supplementation is needed
Make sure fluids are available along planned routeThirst mechanism may be unreliableDon’t wait until thirstyHigh blood sugars can be worsened
quickly by dehydration
BeforeDrink 12 to 20 oz -- 2-3 hours beforeDuringDrink 6 to 12 oz every 15-20 minutesAfter 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
Fluid Guidelines
*Guidelines from American Dietetic Association & American College of Sports Medicine , 2007
CASE STUDY… WHAT CHANGES CAN BE MADE?
Female soccer player wearing an insulin pumpFrequent weekend tournaments up to three games a dayBG ok on Saturdays but struggles with low BGs on Sunday
ATHLETES WITH TYPE 1 DIABETES
ATHLETES WITH TYPE 1 DIABETESAdam Morrison, NBA basketballChris Dudley, NBA basketballJay Leeuwenburg, NFL footballKris Freeman ,U.S. XC ski teamGary Hall, Jr., Olympic Gold swimmerMissy Foy, Ultra distance runnerDoug Burns, BodybuildingTravis Pesco, Olympic wrestlerWill Cross, ExplorerPhil Sutherland, CyclistMichelle McCann, LPGA GolferBill King, Marathoner