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March 22, 2003

Exercise and Sports, Insulin Pumps

Question from Grand Rapids, Michigan, USA:

I am now 30 years old, have had type 1 diabetes for 17 years, and I have worn an insulin pump for the last three years. I am a professional modern dancer and still struggle with finding the proper balance of exercise, carbs, and disconnecting my pump. My method until a few weeks ago was always to eat a soy protein bar and drink a juice box for "insurance" before rehearsals. It seemed I'd always be chasing highs and lows throughout the four hour rehearsal. I've experimented with disconnecting and with cutting my basal in half. I've recently started replacing the soy bars and juice with string cheese and almonds. This seems to keep me on an even keel, but I'm worried about the fat content of these foods. The difference with dancing, as opposed to other sports and activities, is the lack of predictability of the intensity. Some days we rehearse less aerobic dances, other days more aerobic dances. There is also a great deal of starting and stopping, directing and discussing. We dancers are an odd breed. I guess I'm looking for help from someone who's maybe treated a dancer. I am currently baffling my doctors, and I'm wondering about the fat-loaded "insurance" snacks.

Answer:

Since my daughter dances six days a week, I am at least very empathetic. I have several suggestions. Some may be redundant but deserve being mentioned.

Make sure your insertion sites are into the abdomen.
Cutting the basal rate does not really do much in terms of cutting the total dose you receive, especially in someone like you who is active physically.
I would concentrate on making sure you are tanked up enough prior to dancing. Snacks with fat allow for slow absorption of the rest of the foodstuff, including the carbohydrate. You can also do the same with carbohydrate that is not absorbed as rapidly. The might include the use of the undigested corn starch snack products available now which were originally designed to protect from nocturnal hypoglycemia. There is not a big problem with the fat if you are not gaining weight or have elevated lipids. However, I would think that calories from fat should not go above 30-35% of your total daily calories. If this happens, there is some concern that the high fat content could preferentially decrease carbohydrate metabolism.
In the end, this is trial and error. There is no way to have a contingency plan for all the activity combinations you will have. The disconnect from the insulin pump can be a problem if it is over two hours. I would try to prevent this, if possible.

I would suggest sharing your experience with us. This is a major problem and one that others also battle. Your experience may really help others. Keep dancing.

JTL