I know everybody does it differently. How do you normally calculate your very first bolus, immediately after exercise, right as you stop exercising (if you turned down your basal or stopped it)?
Depends on the size of the bolus and the intensity of the exercise and the current BG level and the direction (up or down) as well as how many carbs were eaten during the exercise.
But ballpark maybe 60% normal dosage?
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Do you inject anything to replace what basal you did not inject while you were exercising?
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Calculate is a strong word. I think looking to “replace” missed bolus is a misnomer. For instance my son is running cross country. The race takes less than 25 minutes. Because it is mostly anaerobic exercise my son skyrockets without a prebolus. Following the race they replace a few carbs because their coach says they should.
So before he starts running he takes a little more than a unit, then hands his pump to a coach. Following the exercise (23 minutes) he routinely takes 2 units plus a little more depending on how many carbs he will eat/drink.
If he was calculating he would take far less than 2 units post-race. I think you need to experiment and see what you need based on the exercise, and the CGM track, etc.
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Do you correct for post-exercise highs? That’s a Q for anyone! Curious how everyone handles it.
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I take a bunch of insulin after exercise. The longer the amount of exercise, the more I take.
This is totally counter to what a lot of people would tell you to do. After finishing a lengthy period of exercise, dumping in a bunch of insulin seems like a bad idea.
But the reason I do it this way is so I can replace the carbs immediately. Replacing carbs right away allows your muscle glycogen to be restored much quicker than if you wait. The only way your body can use the carbs to replace muscle glycogen is if you have enough insulin.
So my process is a bunch of insulin and a bunch of carbs, right away. The extra insulin that starts to bring me low about an hour later is met with a big dinner.
So for me the insulin I take after exercise is a combination of:
- replaced basal
- bolusing for the important post-exercise carbs
- pre-bolus for dinner
The idea of replacing lost basal is important because even if you don’t eat after exercise, if you have been using zero basal for a number of hours, that will kind of catch up to you.
And these things vary for everyone based on their circumstances. If you exercise a couple times a week, replacing muscle glycogen is not as important, so you don’t need to be as aggressive following exercise. Same thing if you are exercising less intensely. Walking is good exercise, but it would not use as much muscle glycogen, it would be more fat metabolism.
But if you are doing significantly intense exercising every day, then replacing muscle glycogen becomes very important.
So a lot of my babbling, but to address your question as far as a calculation:
For the type of stuff Kaelan is doing with almost daily swimming practice, test it out until you can figure out the amount of insulin that lets him eat a good dose of carbs right away (at least 40 grams), and since Michel was saying you have dinner after swimming, also make sure his dose is enough that lets him start to drift down and be ready for a big dinner soon after. This kind of matches my pattern of carbs and then dinner.
Then for intense exercise, and for repeated days of exercise, be prepared to turn the basal down at night.
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I love that, every day, I pick up one more tidbit of knowledge from you and everyone else here that MIGHT one day, help me with Liam in this very situation.
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@eric, don’t the carbs you take in after exercise outrun the insulin and cause high BGs?? I am really new to all this hence a pretty basic question!
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Exercise amplifies the insulin pretty well. And when your heart is still beating quickly after exercise, and your body is over-heated, that insulin hits pretty good!
And I also take enough of it so that I don’t go high. I basically over-estimate the insulin to prevent the high BG, and then counter the over-estimate with carbs.
I am not too concerned with balancing it perfectly. Any insulin I have taken that is too much I just hit with more carbs. I know some people have different diets and don’t do as much carbs, but to me carbs are wonderful because they are a fuel source. So a chance for more carbs before dinner or after dinner is a bonus to me.
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i have to turn my pump off completely for 2.5 hours before i get into the pool to swim. then, b/c my pump is not water proof, i must disconnect from my pump completely. i usually swim for 2 hours. so, by the time i re-connect, its been 4.5 hours without any insulin. so the first thing i do when i get out of the pool is bolus about 50% of the basal insulin i missed while i was “detached” which, for me is usually 2 units. then, i also bolus 50% of the carbs for my refuel (say i am taking in 32 gms post work-out, i will bolus 1/2 of that; 1.6 units instead of 3.2 units…i am on a 1:10 carb ratio, and i don’t spike at all. even if i get out of the pool at 60, i still bolus those 2 units; i will rise very quickly even if i am low, so i need that bolus ASAP )
i hope that helps. check out my swimming thread “Daisy Mae’s Swimming BG Thread” i did not learn this overnight. have patience and an open mind and a little common sense. (IMHO )
PS: and when you have questions just keep asking for help; help is here.
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Following @Eric’s advice, what we have done for our son’s first swimming practices with an Omnipod is the following:
- he restarts his basal 20 minutes before the end of practice
- at the same time, he injects (a) 1 hour of basal and (b) 50% bolus for his immediate post-practice snack
- right at the end of practice, he drinks 32 carbs of chocolate milk, and injects 100% bolus for the next meal (with a good amount of carbs)
- he eats his next meal about 45 minutes later
So far it is working really well!
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Before my son went back into swimming season with a new pump, we read @daisymae’s thread very carefully and made many notes. It was extremely helpful. I would recommend that anyone looking to do some serious swimming (or any serious sport routine, really) read it.
@daisymae, what you have achieved is wonderful!
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I’ve been trying a version of this lately after running with pretty good results! If I am running for more than an hour I’ll set my basal to 30% and upon finishing do a 50% bolus for missing basal + upcoming snack.
Yesterday was kind of nice, I ran 12 miles and had a big dinner with a couple glasses of wine and a big fat piece of oatmeal cake. With the effect of alcohol + exercise my blood sugar stayed between 80-120 pretty much the whole night. Too bad that is not sustainable every day 
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I’m on MDI but have come up with a routine that works well for me when playing ice hockey. I have found that this routine requires constant fiddling, and seems to vary with time of day. Most of these hockey games are at night; afternoon games seem to require a larger post game bolus but this too will vary. I have found that I need a small amount of IOB during games to avoid spiking afterwards. Not sure if or how this will relate to pumpers with zero basal but here is my info FWIW:
Starting about 1 1/2 hour prior to games I’ll bolus 2 units and have about 20 to 35 grams fast carbs, timing of those carbs seems to depend entirely on status of IOB and BG levels pre-game. 20 or so grams watered down PowerAde during games. My current post-game recovery is fast carbs (watered down Powerade) immediately after games in the locker room while I cool down, about 10 grams. If I am higher than expected post game I stick with water until I get a chance to do that bolus. About 1/2 to 1 hour post game, a 2 unit bolus for at least 15 grams protein and 20 grams carbs washed down with lots of water while driving home with the CGM in view. I use Simply Protein bars (on Amazon) and the low glycemic index Clif bars and basically just keep eating until my gut feel and CGM says I’ve had enough. (FYI if I skip that post game bolus I invariably will be too high BG and rising within an hour).
For me, this hockey routine seems to be specific to that sport. Other more aerobic activities such as hiking or biking do not seem to require the pre and post workout IOB for me.
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John, I am curious: why are you making the decision of playing with more IOB?
If anyone is wondering Hockey is a series of anaerobic bursts, rather than an aerobic activity.
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From reading his post, it sounds like John knows exactly what he is doing. 
Having food/carbs a few hours before gives you another source of energy. That is the way to do it for games and competition (not as necessary for training or practice). Doing it 1.5 - 2 hours before the event allows your body to use the food, but minimizes the IOB somewhat. The IOB is fed by liver glycogen releases from cortisol and such (because of the nature of the game, more of those hormones will be released in a hockey game than in a steady-state type of sport). BG adjustments with Gatorade / Powerade throughout the event cover the remaining IOB and give your body more immediate fuel to use.
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Chris and Eric beat me to the punch line and are in line with my strategy.
To elaborate a little more on how my 60 year old body reacts to those anaerobic bursts…when I used to play without IOB, I always had a rapid BG rise after the game. This was often late at night and I did not want to get too aggressive with correction bolus at midnight so I switched to this pre-game IOB method. Seems to work, probably 9 out of 10 times I’m able to take about a 2 unit post-hockey bolus and eat/drink a lot after the game with good BG when I hit the sack.
During a game my BG almost always will drop regardless of IOB or starting BG. I should clarify that my starting BG at game time is usually in the range of 110 to 140. If I’m lower than that or dropping moderately or rapidly before the game I’ll take a glucose gel at the start (15g) for peace of mind. I’ve gotten pretty comfortable with keeping in a good range with watered down PowerAde during games and usually will drop about 30-40 by the end of the games. If for some reason I started the game higher than desired, I stick to straight water during the game. I wear the Dex receiver under my pads and it is pretty easy to check it on the bench.
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That makes total sense!
You were diagnosed in 2014, right? You have an impressive handle on things after 3 years! It takes some people a long time to figure all that out. Nice work!
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