My 18 year old daughter, who is a college freshman and is running cross-country, began using an the insulin pump just a few weeks before starting college, and she is becoming frustrated trying to avert low blood sugar reactions while doing intense workouts. We have worked with her to make adjustments to try to fine-tune her basal rate as well as what she eats prior to running. She is experiencing very rapid drops in blood glucose levels and not sure what else she can possibly do. She has consulted the The Diabetic Athlete by Sheri Colberg, Edward Horton but has not found the information to be specific enough to help her. Her endocrinologist and diabetes educator are also somewhat stumped. Where do we go from here? She doesn’t want to stop running, but it is hard for her to participate when low blood glucoses force her to stop and treat before continuing the workout.

Wearing an insulin pump allows for various options in avoiding low blood sugar during exercise, including use of a lowered temporary basal rate; suspending the pump; or disconnecting the pump. The reduction in basal rate (via the temporary basal rate option) can be programmed to begin some time (perhaps even 30 minutes to two hours) before starting exercise. Generally, aerobic exercise requires at least a 50% reduction, and sometimes more, to avoid a drop in blood glucose levels.

If your daughter is experiencing low blood sugar during exercise training sessions, she may benefit from this advanced reduction option. Depending on which model of insulin pump she has, it may be possible to actually program a 0.0 basal rate, prior to and throughout exercise. She will need to experiment a bit with the duration and degree of the reduction, but this should allow her to begin exercise with a reduction in the amount of circulating insulin, and hopefully avoid some of the hypoglycemia she is experiencing. She should discuss these options with her diabetes team.

Even with the reduction in or suspension of basal rate insulin flow, she may need to ingest some carbohydrate prior to exercise. In addition, many distance runners with diabetes carry on them glucose gel, which is both easy to carry and simple to digest during exercise. Be aware that glucose ingestion during endurance exercise is not limited only to athletes with diabetes.

Here’s wishing your daughter the best of success throughout her cross-country season and freshman year.

DMW