Goinig from MDI to a pump for better exercise BG control

Hi,

I am looking at going form MDI to a pump for better exercise BG control. Just a little background. I was diagnosed just over a year ago at age 49. I have been a cyclist for 30 years and went from 3-4 hour 50+ mile rides to struggling to get in a solid hour. My Dr. suggested that a pump will help since I can suspend my basal before riding. As of now I need almost 80 grams of carbs for an hour ride.

Since I am on the Dexcom G6 I am looking at the t:slim X2. But the Omnipod is appealing since it’s tubeless. If there are any clyclists out there that use a pump (espically a t:slim X2) and are able to get in long rides I would love to here some thoughts on if a pump does in fact help with BG control.

Cheers,
Jeff

Hello @everlook Jeff, it does for me! The main reason is you can’t “untake” a shot of long acting insulin. When you pump you can turn down your normal basal rate for exercise such as riding a bicycle. It’s been great for exercising and for when I am less active than my typical. Please consider getting a book “Pumping Insulin” for pump basics. Good luck

Hi Jeff @everlook, the move to a pump sounds sound. And as @Joe says, you can not “undo” a shot of long-lasting insulin.

I no longer go off on my bike for several hours like you enjoy, but I do put together three hours of fairly strenuous [for a guy in late 70’s] and continuous bike-riding and gym workout on most days. I’ve learned NOT to suspend my pump for extended periods but rather instead use “reduced basal” rates beginning several hours before I plan to begin exercise; also a lesser meal bolus ratio.
The Tandem t-Slim [I switched in January from MiniMed] and Dexcom G5 are great tools. During my exercise period I alternate my basal rate hourly changing between 0.0 and 0.1 or 0.15 units per hour rates. I add this insulin knowing my body needs insulin to feed my mussel cells. On high intensity days I make a significant increase in basal rate [to 0.5 uph] to offset the anaerobic effect.

The only times I have hypoglycemic events is about six hours after my workout so beginning about two house before that I reduce slightly my basal rates. JDRF recently posted some good exercise information. It is available here: https://www.jdrf.org/t1d-resources/living-with-t1d/exercise/?utm_source=newsletter&utm_medium=email&utm_campaign=20190416_springtraining_email&utm_content=standard_exercise_2ndtextlink&s_src=bsd_newsletter_email&s_subsrc=20190416_springtraining_email_standard_exercise_2ndtextlink&mkt_tok=eyJpIjoiTm1Sa1lUQmhObVV6TTJWaCIsInQiOiJjVlhoRWVCaTFod0lQZjAzRHI2QTRjdmJDcHpNNVoxU3RQTFBWYzBUNXVBbFJRbjhQM3hLVTJYUFlkMUUwV1ozWHRiTTZpNnJpekxVRkU3bDJYM2NrVWUyRUpTNzZ0Y3kwVFdselwvcGMxY1wvQnRYNDRJNDIrRnNFSThHdzJCVlwvWSJ9

If you can adjust to the tubing, the T:Slim will give you the most help today. Basal IQ with the G6 will work to suspend/reduce your basal rate as it sees you are predicted to go low (lower than 80). So, you could set a reduced basal rate, like @Dennis mentioned, it will automatically switch to suspend (0.0) until your BG goes back up. This could happen many times during your ride automatically.

The new omnipod DASH will have some “brains” like this and integrate with Dexcom next year. The old/current omnipods are now integrated with Loop (Intro to Loop https://www.youtube.com/watch?v=qw_u1lqboCs&t=9s). This is a more automated system that you can build.

Thanks to all for the info.

@Dennis - thanks for the exercise link. I noticed that the athletes seem to using only pens. I also looked at cycling Team Novo Nordisk and all the rider profiles I read are using insulin pen therapy. Which leads me to think that I don’t need a pump and just need to do some more experimenting with basal/bolus dosage on ride days.

@Nightfox - yeah I have been agonizing over which pump. I agree that the t:slim is the best choice today but I don’t think I can get used to the tubes. I am leaning towards the Omnipod. However, after reading and Youtubing everything I can about the t:slim and Omnipod and seeing all the pod failures, infusion site failures, etc maybe the pump is not for me just yet.

Cheers to all,

There will always be trade offs to using technology, as its not bullet-proof.

If you just want to try it out, wait a few weeks and wait for Omnipod DASH to come out in full release. They will be available via pharmacy, so there is no 4-year lock-in. Its just a prescription. Then you can try it before committing to any pump. Or, ask your endo team if they have a Tandem you can test out with saline for a while and then see how cumbersome it is. Granted, you won’t be able to weigh the benefits, just the potential cons.

You can make anything work with enough effort. Good luck and keep checking back in

Hi Ken @Nightfox, I’m just curious - why do you say “test out with saline”?
For me, if I’m going to punch in an insertion cannula, fill a cartridge and wear a pump for several days/weeks, I’d want to use that time to see if the pump and its accessories actually work for me.

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@Dennis, I know people test them out this way. Maybe more often its kids. I am not familiar with the return policy on pumps. We are still waiting for our first one for my daughter.
Check w/ your endo.

@Nightfox Ken, Please get all information directly from the manufacturer on “returns” because it could be several thousand dollars worth of frustration if you don’t know the policy.

They put saline in pumps to get you used to the button pushing and pretend basal suspends and pretend boluses. The use saline so you can learn how to fill the reservoir, tubing, and priming. I however see no benefit other than allowing you to push buttons and not commit to a real insulin infusion.

My first pump trainer insisted on saline but since I was a 27 year insulin veteran I fired her and got a new trainer. My philosophy is simple, if I am going to make a hole I am darn well use it for all it’s worth.

It takes many weeks to tune a pump (basal rates) so be prepared to see some poor control and ups and downs before you see any benefit. Understanding pumping or even insulin use is important to success. My favorite book recommendations are “Pumping Insulin “ and “Think like a Pancreas “. Cheers good luck

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I too love to cycle long distances and have ridden from Niagara Falls to Portsmith NH in a week, averaging 80 miles a day. And the Death Valley cycling trip was even better. I have been using a pump for 28 years. Reducing your basal is key, as well as consuming carbs before taking off with a reduced meal bolus. I find I need to consume more carbs about every 45 minutes. it is trial and error. You must bring your glucometer and I carry with me at least twice the carbs I think I will need. I like Fiber One bars or Cliff bars. And of course, always have glucose tabs handy. And remember Gator Aid has sugar. One of the brands offers a sugar free version.

Hi all,

Just thought I would give an update on my transition to a pump. I ended up going with the Omnipod Dash. The transition was pretty smooth and I have not had any issues. I seem to need a 60% decrease in basal for my rides. The first ride I got right and stayed around 150 the entire time was amazing. I couldn’t beleieve it. What’s even better is I don’t have to eat a ton of carbs every hour. I’m up to a solid 90 minutes and working towards a 3 hour ride.

I’m still tweaking things but the pump sure has helped me during exercise.

Cheers,

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That’s great news about your pump and riding. Pumping, though, it has its challenges, surely helped me with my control too. You’ve inspired me to return to my exercise program.