My 13 year daughter, who has type 1 diabetes and uses a Cozmo pump, will be attending several basketball camps this summer. Two of them are a two hour drive from home. What is the best way to use the pump in a situation when she will be physically active for eight hours of the day? For her other activities and games, she just disconnects for the hour or so. There will be medical people at these camps (RNs), but I seriously doubt they have pump knowledge. Is it best to leave the pump on and reduce the basals? How do you experiment with this to make sure it’s accurate before I let her go two hours away and try it? What percentage would be a good place to start? I also was thinking about the un-tethered approach. Has anyone tried this? How did it work ? I plan on asking her pediatric endocrinologist, but I wanted to run it by here also.

There are several ways to deal with extended exercise while wearing a pump. If she wants to keep the pump off, she can break it down into hour segments. Checking each hour to see where her blood sugar is and making adjustments that way. At some point, she is going to have to give some insulin since the camp is eight hours long. One way is to give 50% of the basal lost during her time off the pump. So, if for one hour her basal rate is 0.6 units she can replace 0.3 units after she hooks back up. Of course, this may not apply if she has a high or a low blood sugar when she checks her blood sugar.

Another way, and probably a better way, is to reduce the basal rate during the camp. A good starting point is to reduce the rate by 50% and check frequently to see if it is on target. It is better to error on less insulin (high blood sugar) rather than more insulin (low blood sugar). A lot depends on how much activity she is doing and how much instruction she has during the eight hours.

It is very important to keep your healthcare team informed of any changes in diabetes management.

RP

[Editor’s comment: For information on The Un-Tethered Regimen, see a previous question on our web site.

BH]