So this may not be your area of expertise, @Eric, but since you’ve been so helpful with @daisymae’s workout plan I thought I’d ask if you have any insight into how to bolus for my son’s gymnastics class.
It’s not really aerobic exercise and sometimes I question whether it is even exercise, with all the waiting around to use equipment, the dawdling and the times when he just isn’t into it. And yet it seems to have a dramatic impact on his blood sugar.
He’s 3, and right now his workout is anything but strenuous. It’s a lot of waiting in line, a few moments of jumping on a trampoline, swinging on a bar, balancing on a beam, and maybe a few forward rolls and obstacle courses. It lasts about 50 minutes. It’s definitely less activity than he gets typically running around on a playground.
The problem is that he both goes low in class and then spikes super high after.
Here are the basic details:
Breakfast typically at 8-8:30 am, sometimes as late as 9am
Breakfast I:C ratio: 1:16
total breakfast carbs: 40-50 g, typically pancake, waffle or french toast
Morning basal rate: 0.3 units/hr
Class is at 10am - 10:55 am.
By the time he starts class he is typically heading down --he could be in the 130s or 120s. We give him part of a cliff bar (10-20g) to prevent a low, unbolused, but it doesn’t usually stop the low. He may drift down to about 65 or even, as today, 55 (he didn’t eat all of his pancakes for breakfast). We have to give him a glucose tab during his water break at 10:30.
About 10:30 or 10:45 he does start drifting up. His pump is on during this time but his openAPS is typically giving him a 0 temp basal for most of the class, meaning that over the course of an hour or two it’s subtracted about 0.6 units from his total basal delivery for his breakfast bolus.
If we try to underbolus for breakfast he will go high and will stay high; he will not enjoy class. Same goes for situations where he’s low. Only about 1 in every 3 classes does he wind up in range for the whole class. It’s frustrating because he really enjoys class when he’s in range and clearly does NOT when he is out of range.
About 10 minutes after class ends, he starts a precipitous rise up to about 300 over the next 1.5 hours. If he’s already above 80 after class I will try to give him a bolus, but it’s tough because sometimes he’s still in the 70s when I start driving home and is already in the 150s by the time we park. Today for instance he’s currently at 280mg/DL + 13, but I bolused him when he was 149 with 1 unit.
His lunchtime I:C is typically 1:22 and his ISF around this time is usually about 230.
Sometimes at night he runs low about 12 hours after the class in the middle of the night, but not all the time.
Any ideas how to bolus him so he doesn’t go high or low during class? Unfortunately we can’t really avoid him starting class with food IOB because this is the only time slot for the class, and unless we serve him breakfast at 6am he’ll still have a lot of insulin left for his food.
I figure the first goal is to deal with the low during class first, then figure out how to avoid the after-class high. I also suspect I’d feel more comfortable bolusing aggressively after class if I didn’t have to wait for him to rise from a low.
Also, doing things with basal prior to the class has limited effect because he’s on an openAPS algorithm which essentially shuts off for the hour or two after the meal, turning his food bolus into a superbolus. WE could turn off the openAPS and put him on a manual temp basal but we try to avoid that because it mucks up the logic of the algorithm. At this point I’m not sure what kind of temp basal he’d even need.
Thanks so much – not sure if this is in your area of expertise but you probably have some ideas! My initial thought was to reduce the I:C a bit for breakfast, give him the extra carbs for class a little earlier, and maybe bolus him 1.2 units at the 45-minute mark during his class – but I’d really rather not interrupt him during class either. My goal is to help him enjoy class as much while drawing as little attention as possible to things that would take his attention away from it.