I have a teenage son who is very active in football. He practices five days a week for three hours in the Arizona heat. He removes his pump for the entire three hours and checks his glucose every 60 to 90minutes. He is consistently HIGH and we are chasing those highs with an insulin pen using NovoLog. He has not been given any instruction on how to replace the three hour basal that he is not getting. Isn’t this important? What do you suggest? Also, since we are encountering such difficulty with highs, what are your thoughts on the “Un-Tethered regimen?” How many teenagers involved in sports use this regimen? How successful and widespread is it? Do you have to have some type of continuous insulin running through the pump or can a person give Lantus and then keep the pump connected for food boluses and corrections?

It is recommended to only keep the pump disconnected for an hour at a time. There are several techniques to accommodate the time off the pump. One is to replace the basal lost during the time off. Some athletes will only replace 50% of the lost basal if low blood sugars are a problem. Exercise can cause a “lag effect,” which is a delayed response to low blood sugars, so replacing all of the basal lost may add to this scenario. The longer an athlete is off the pump, the more important it becomes to replace the basal insulin lost.

Another technique is called The Un-Tethered Regimen introduced by an endocrinologist, Steve Edelman, who also has type 1 diabetes. It is not a common practice and, only recently, has anything been documented on it. Most endocrinologists do not even know about it let alone practice it with patients. Basically, it allows a person to be off the pump for more than an hour by replacing the basal rate delivered in the pump with a long acting insulin by injection not through the pump (i.e., Lantus). If this approach is going to be used, it is essential to discuss this with your healthcare team.

RP