Athletes require intensive management of his or her diabetes to keep a balance of carbohydrates, insulin, and the effects that exercise causes during activity. The good news is an athlete on an insulin pump should already being practicing intensive management. Participating in sports on an insulin pump has many advantages over injection therapy but questions often come up on how to manage the pump during activity. The Sports Corner Column will feature different aspects of insulin pump therapy and sports participation. Through short concise articles one particular aspect of pump therapy will be discussed and its relationship to sports activity. This article will discuss the pros and cons to being connected to the pump or taking it off while participating in sports.
Insulin pump therapy has been around for many years. The first insulin pump, as shown in figure 1, was the size of a backpack. As you may guess, wearing this pump would be difficult to participate in sports with any success. Today's pumps, as seen in figure 2, are much smaller and can be worn in many places on the body. Individuals wearing insulin pumps often wonder whether it is better to wear the pump during sports or take it off. As with many aspects of diabetes, it is up to the individual and health care team as long as certain guidelines are followed.
The first insulin pumps were very large
Today's insulin pumps fit in the palm of your hand
Guidelines for Disconnecting
The health care team must be informed of any changes or ideas an athlete may have for disconnecting for sports. The general guidelines suggest to not having the pump off for more than an hour. The reason for this is the fast acting analogs used in pumps (Humalog, NovoLog, and soon to be Apidra) are processed more quickly which leave the body sooner as well causing the blood sugar to rise if more insulin is not given. Some athletes may be able to keep it off longer due to a prolonged honeymoon phase or because they are producing some insulin in the body.
Most athletes know that often times cardiovascular or aerobic exercise can lower blood sugars during activity and probably more often hours after the activity. In fact, studies have shown that significant drops in blood sugar are realized 24-36 hours after activity. In general, aerobic exercise can increase the sensitivity of insulin which may allow athletes to think they can keep it off longer but it may also cause a significantly high blood sugar hours after participating if not enough insulin is on board. Some athletes, with the health care team's knowledge, will need to compensate for lost basal insulin. As an example, an athlete keeping her pump off for an hour for a basketball game takes 0.8 units of basal insulin an hour may need to replace 0.4 or 50% after the activity. The reason for replacing only half the amount is due to the lowering affect exercise can have on blood sugars after activity.
Some athletes like to disconnect just prior to the activity, hook back up at half time and give a supplemental bolus if needed. The problem with this approach is the need for how much insulin for a high blood sugar knowing that the second half is coming and the exercise can make one more sensitive to the insulin. The key is to check blood sugars often and make small adjustments based on the health care team's recommendations.
Arguments for Staying Connected
Insulin pump therapy, often called Continuous Subcutaneous Insulin Infusion, has the advantage of continuous infusion of insulin. It is the closest thing to a normal pancreas secreting insulin so disrupting this process may not be as beneficial as keeping it connected. There are many ways to alter the delivery of insulin to compensate for exercise that will be discussed in future articles.
As mentioned above, size or weight can be a factor for individuals participating in sports. The weight of the first pump could have been a deterrent but today's pumps weighing less than 4 ounces should not be a factor in one's decision to wear it. Now that size/weight is not an issue, where can it be worn on the body? Again, this is up to the individual to feel comfortable and maintain good blood sugars during activity. There are accessories offered by most of the insulin pump companies or some independent web sites to protect the pump while participating. One such accessory is a neoprene sleeve the pump slips into that looks like "fanny pack" but is the size of the pump. One company calls it a Sport Pack that has a clip or a Velcro strap that fits around the waist. Some individuals will wear it on the abdomen, on the lower back, or even under the arm with the strap over the opposite shoulder. Many runners use the clip that comes with the pump and clip it to the shorts.
Contact sports such as football, soccer, field hockey or basketball can create challenges that other sports do not. If one chooses to wear the pump during these activities, it is advisable to protect the pump if possible. Consider using a protective padding similar to the type used when protecting a bruise on the thigh. A pad about 1/4 inch thick is cut a little bigger (~2 inches) than the bruise on the thigh. Cutting a hole in the middle of the padding to the size of the bruise then placing over the bruise for protection. Cut a second pad equal to the first but no hole is cut in the middle. Place the first pad (the one with the hole cut out) over the bruise. Place the second pad over the first pad and secure it with an ace bandage or hold in place with compression shorts. If the athlete is hit on the bruise, the upper pad disperses the force. When making the pad the only difference would be to cut the hole out of the first pad to the size of the insulin pump. If there are pads to protect knees and elbows, there are pads to protect insulin pumps. Wearing the protective padding with the pump in it is up to the individual.
Depending on the position, the athlete may decide to take the pump off due to the higher risk of getting it hit. For example, a running back in football may not feel the need to wear the pump and increase the chances of damaging the pump since he is tackled many times during a football game. If the pump is damaged, most pump companies will overnight another pump at no charge as long as it is in warranty (usually 4 years).
Whether or not an athlete decides to stay connected or not during sports, it is important to have a plan. The plan should consist of a back up if the pump is damaged during activity or is lost/stolen when disconnecting. An insulin pen or a syringe and insulin are mandatory for athletes on pumps.
Rick Philbin, MBA, M.Ed., ATC
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Last Updated: Friday September 07, 2012 11:16:17
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