August 28, 2002
Exercise and Sports
Question from Sault Ste. Marie, Ontario, Canada:
When my eight year old daughter, who is on a pump, plays soccer her sugar remains good with very little fluctuation. She finishes soccer at 8:15 pm, and the game lasts an hour. However, her sugar drops at 12:00 midnight to 2-3 mmol/L [36-54 mg/dl], and after we treat with juice her sugar is still below 6 mmol/L [108 mg/dl]. So, we treat again, disconnect pump and wait for sugar to go up. What can I do to prevent low blood sugar after activity? This also happens after riding her bike, and I am very frustrated.
As you have observed in your daughter, increased activity can often result in a reduction in blood sugar hours later. This occurs in response to both increased metabolism and increased insulin sensitivity.
You seem to have identified a consistent and predictable pattern occurring after activity. Increasing the amount of snack (carbohydrate/protein/& fat) consumed after exercise might be one way to address this issue. Some people have had success with extended action carbohydrate products such as Extend Bar or Nite Bite.
As your daughter is managing her diabetes via an insulin pump, you also have the ability to utilize one of the options on the pump to better match the reduced insulin needs after exercise. Talk to your diabetes team about use of a lowered temporary basal rate during the hours after exercise. This option allows you to program the pump to deliver less insulin each hour. On most insulin pumps, the pump will automatically return to your daughter’s standard insulin delivery pattern after a set time. Exactly how much to reduce the basal rate by, and how long to extend the reduction will take a bit of trial, but it should allow avoidance of the hypoglycemia that you are currently observing. Generally a 50% reduction for three to six hours following exercise is a good start. Additional blood sugar monitoring will assist you in determining whether a further (or less of a) reduction is necessary.
Ask for the assistance of your daughter’s diabetes team with these determinations. Your daughter’s insulin pump company may be another good resource for further training in this area.