How do we figure out the amount of insulin to be given when removing the pump for football practice and games? My son removes the pump and after practice he is above 500 mg/dl [27.8 mmol/L].

The general rule is to not have the pump off for more than an hour at a time. If the blood sugar is high prior to the start of football, some insulin may be given but it usually not a normal correction due to the fact that exercise can lower blood sugar. Some athletes will reconnect and give a correction bolus if the blood sugar is high or replace 50% of the basal insulin lost during the time off the pump. As with most guidelines in pump therapy, many factors can influence whether to give more or less insulin. This is why it is imperative to keep the healthcare team in the decision process.

Football is generally an anaerobic sport which, in itself, can cause blood sugars to rise. If insulin is used to bring down a high blood sugar after competition, it is very important to check blood sugar levels rather quickly (i.e., within 30 minutes) to make sure it does not drop too far. As with any high blood sugar, drink a lot of water and check for ketones. Blood sugars between 250 mg/dl to 300 mg/dl [13.9 to 16.7 mmol/L] with ketones indicate exercise should be delayed. Levels above 300 mg/dl [16.7 mmol/L] with or without ketones should be delayed as well.

RP

[Editor’s comment: Please speak to your son’s diabetes team about having your son check his blood sugar at half time. At that time, he should consider a shot or reconnecting his pump to bolus a small amount of missed basal insulin.

BH]