My nine year old daughter, diagnosed eight months ago, is very interested in going on the pump, and her endocrinologist’s only concern is the fact that she does dance and gymnastics four to five days a week. Her team is worried that she would have a hard time with lows and they told us we can’t take it off for more than an hour at a time. Any suggestions?

You would want to consider that the insulin pump uses only short-acting insulin so there is no intermediate insulin in the body (injected hours before) which may have a variable onset or a variable peak time. Most pump users will check on their blood glucose before exercise, during exercise if longer than one hour, and after exercise. By repeating the glucose testing two more times for this particular type of exercise a picture of the action of the insulin during that form of exercise will emerge. The safety feature of pump use during exercise is the ability to set the basal rate lower than the normal basal rate at that time of day.

Talk with your daughter’s team about how much to lower the basal rate shortly before, during and possibly after exercise. This is the only insulin delivery system that will allow a change in the insulin level during exercise in a similar manner of which the body would decrease the delivery of insulin.

MG