Exercising with an Insulin Pump: Guidelines

How someone exercises when using an insulin pump depends on their sport of choice and insulin needs, but there are general guidelines to follow.

If you are new to wearing a pump and/or exercising, consult with your doctor and begin with gentle workouts. Learn what works best for you by starting slow and making small adjustments as you gain experience.

Before Exercising

Before starting any physical activity, it is important to check your blood sugar:

• if it is low, you will need to consume 15 to 20 grams of carbohydrate (or what your doctor recommends) and wait about 20 minutes before working out.
• if the glucose is high, check for ketones; if ketones are present, exercise should be postponed until levels are back within your target range.

Your diabetes team may recommend lowering your basal rate one to two hours before prolonged activities (more than 90 minutes). Insulin pumps provide an option for adjusting the basal rate for a specific time.

How much the basal rate is lowered depends on your physical condition and the duration of the exercise—longer activities require lower rates.

During & After Exercising

Always have a quick carbohydrate source with you. If you notice symptoms of hypoglycemia (low blood sugar) while exercising, stop and take steps to raise your blood sugar. Wait 15 minutes and check your glucose level.

Test your glucose after working out and make necessary adjustments for low blood sugar. For elevated glucose wait since your depleted muscles are being replenished with glycogen—if your diabetes team has different advice, follow that.

After prolonged exercise, it may be wise to retain a lower insulin basal rate for a while. Experience, monitoring, and doctor’s recommendations are your best guides.

Exercising Disconnected

People engaging in contact sports or swimming may choose to remove the insulin pump while working out. Read the pump manufacturer recommendations and consult your doctor.

Disconnecting from the pump for fewer than 90 minutes is generally safe. The missed basal insulin is usually not replaced.

If disconnection from the pump will exceed 90 minutes, your doctor may instruct hourly reconnection to administer a bolus dose of insulin. If hourly reconnection is not possible, an “untethered” program - involving a morning dose of long-acting insulin and a reduced basal delivery system - might be feasible.

The best tips for safely enjoying intense or prolonged sports while using a pump are found on the blogs or websites of experienced pump-using athletes.

Pump Considerations

You will also want to protect your pump and insulin from extreme temperatures while exercising, since that can lead to insulin breakdown.

• When the pump is worn close to the body, cold weather is usually not a problem.
• If you are exercising in temps over 86 degrees fahrenheit, it is best to shield your pump and tubing from direct sunlight.
• Pump reservoirs and tubing exposed to prolonged high temperatures may need to be changed more often.

Those participating in high-impact sports are typically recommended to use a flexible plastic cannula. This helps prevent infusion site discomfort or injury.

Athletes who have lean bodies generally prefer angled infusion sets since they are less likely to irritate the underlying muscle wall. Angled sets also have longer cannulas that are less likely to pull away from the skin than short ones.

Source: Integrated Diabetes; Diabetes Care
Photo credit: Zach Dischner