August 26, 2001
Question from New York, New York, USA:
My 27 year old boyfriend has had type�1 diabetes since the age of 14 and is about to go on an insulin pump. I am a fairly well-educated partner, but I have several questions: I am very good at telling when he is going low, but not so much when he is going high. Is there a good list of symptoms to look for? I am confused about why he will have to test for ketones on the pump when his blood sugar is too high. How high is too high? What is he supposed to do if tests positive for ketones anyway? Wouldn't he just take more insulin? We are both very physically active people. Should he always disconnect his pump when exercising? What about "intimate moments?" Should he disconnect then as well? Will the tubing, etc. be in the way?
It is great that you are helping your boyfriend think through these things. I hope you will go with him when he actually starts on the pump, and ask these same questions. Each diabetes team has its own set of protocols for dealing with the situations you describe. For specific information you and your boyfriend will have to ask for their preferences, but I will offer some general advice:
The symptoms of high blood sugars are thesame as the symptoms of diabetes.
Whenever the blood sugar is greater than 250 mg/dl [13.9 mmol/L], he should test for ketones to avoid progression to DKA [diabetic ketoacidosis] which is very dangerous.
If his ketones are positive or his blood sugar is high, he needs to drink extra water and take a correction bolus according to his diabetes team’s protocol. However, if the blood sugar does not start to come within range in about an hour, he should stop the pump and take an injection of fast-acting insulin such as Humalog
There are several ways to handle the insulin pump during exercise. It can be disconnected for short periods or changes can be made in the basal rate. It is extremely important to do blood glucose monitoring before, during, and after exercise to know what the appropriate adjustments need to be. Again, your boyfriend should seek advice from his diabetes team about specific exercise protocols.
It is probably easiest for your boyfriend to disconnect during those intimate moments so you both do not get tangled up in the tubing. Just be sure that he remembers to reconnect!. We occasionally have had folks who just fall asleep, do not reconnect, and run into the problems above with a high blood glucose.