Insulin Strategies for Cardiac Fun
Basal insulin rates are unique to every diabetic, especially when needed for activities like hiking, running, or mountain biking. Through more than 31 years of type I diabetes management, I’ve tried countless basal approaches; some have worked well, while others haven’t.
I’ve created basal ratios for heat and humidity and others for colder conditions. The type of activity, duration, and terrain makes a difference. Carrying a 40lb pack? Your standard hiking basal strategy may need further adjustment to account for the additional effort.
I learn from each experience and make slight adjustments each time I go out on an adventure.
Thanks to help from my endocrinologist, my latest approach has enabled me to reduce the amount of food required to avoid lows and has made adventures of three or more hours more enjoyable. It’s relatively straightforward and maybe that’s why it’s so effective.
Pre-event: On my Tandem pump, I remain in sleep mode: if you are doing a pre-dawn start, this should be easy. For afternoon or evening events, I turn sleep mode on two hours before my planned start
The benefit to this in sleep mode only your basal will be adjusted, so you will not receive a large bolus and potentially drop fast once your activity starts and you have active insulin on board
At the Start: I stop Control IQ and set a temp basal
Trail running: 15% of standard basal
Hiking: 25% of standard basal
Mountain Biking / Gravel Riding: 50% of standard basal
Adjustments: The weather, terrain, and how much gear I’m carrying all factor in to how long I remain in my starting basal rate
My target blood sugar during exercise is 130-170
For me, I try to avoid a bolus unless my blood sugar is running 250+ and is not responding to basal adjustments
If I’m trending higher than 170, I’ll raise my temp basal rate, or go back to sleep mode until I return to my target range
If I’m trending lower, I’ll reduce my basal rate further and if that doesn’t work, I’ll suspend my pump for 30 minutes and readjust at that point
I’ve learned over the years that basal adjustments should be made in small increments. I’ve made countless mistakes trying to speed the process up, which often results in low blood sugar and more frustration compared to sticking to my plan and giving my body the time needed to adapt to my basal adjustments.
