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October 22, 2009

Exercise and Sports, Hyperglycemia and DKA

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Question from Toronto, Ontario, Canada:

My 13-year-old daughter is a competitive athlete — soccer and running. We have found your suggestions concerning blood sugar maintenance during running competitions invaluable, but I have a question about soccer matches. Typically, my daughter will disconnect her pump during a match. She plays 45 minute halves and is on the field for most of the game. She plays midfield, which involves a lot of running. She always checks at half time and she is often a bit low, so she will correct with a bit of juice or sports drink. Often she will go high after the game. I’m assuming that this is because she has been disconnected from her pump for more than an hour. It seems counter intuitive to reconnect at half time and bolus, even a small amount, if she is low. What do you recommend?

Answer:

From: DTeam Staff

I’m really glad you’ve found some of the previous suggestions beneficial; I hope I can do it again.

I think you’re right, your daughter may be high after playing soccer because of the lack of insulin. And, you’re also correct that giving insulin when she’s low and seems to go against the grain. But there might be a way to try and resolve both issues….

Rapid acting insulin (Humalog, NovoLog, or Apidra), the kind that’s used in insulin pumps, begins to work in 10 to 15 minutes, peak in about an hour and a half, and taper off within about four hours (and these will vary greatly person to person). So, the low she’s experiencing during the game is the result of the exercise, but is also due to the insulin she has in her body from being on the pump hours prior to the game.

One suggestion to try is lowering the basal rate before her game and then leave the pump on. The recommendation I’ve seen in literature is to begin with a 50% basal reduction one hour prior to the start of exercise. As you try this, you’ll begin to tweak the percentage and time to start it. She will still need to check her blood sugar often to confirm and make changes, but the hope is this will reduce the chance of a low blood sugar during the activity, and provide insulin when she does not have any and ward off the high blood sugar she has after her game.

Soccer can be physical at times, so if you’re daughter is worried about the pump getting banged she could look into wearing the pump underneath her clothing. Pump Wear’s Pump Bands can be worn on your thigh or waist and should hold the pump in place.

BF