Special Considerations While Being Active with T1D and Using an AID System

Things to Know

• Set higher glucose target 1-2 hours before activity to avoid lows, but doing this for a long time can also make glucose levels spike
• Low insulin can increase risk of ketones, which are dangerous
• Long activities use up a lot of energy, so glucose levels often drop
• Stress or too little insulin can make glucose levels rise

Tips

• Eat small carb snacks during activity
• Don’t reduce insulin too much or for too long
• Avoid large snacks without taking some insulin
• Watch your CGM number and trend arrow closely and change alerts to catch lows and highs early

Things to Know

• Glucose levels can rise when pump hasn’t delivered insulin for a long period of time
• No insulin for too long can also increase risk of ketones

Tips

• If disconnecting AID system from your body, remember to suspend/stop insulin delivery so insulin delivery doesn’t continue when system is not connected to you
• Consider reconnecting AID system every hour to give small insulin doses
• Consider switching to manual mode so you have more control over insulin delivery
• Consider “untethered” method (long-acting insulin plus pump) for activities where a pump doesn’t work well

Things to Know

• Stress hormones can raise your glucose levels even if you don’t eat
• After the event, glucose levels may drop, even many hours later

Tips

• Monitor how much active insulin (or insulin on board) is on your device before competition because AID system likely increasing insulin delivery with stress
• Stay hydrated
• Avoid setting higher glucose target 1-2 hours before competition
• If glucose levels rise above 270 mg/dL (15.0 mmol/L) with competition stress, consider small insulin correction dose (around half of your usual correction)

The graph on the right shows the Yerkes-Dodson Law, which says that people do their best work when they are a little excited or alert, but not too much. If they get too nervous or stressed, they might make more mistakes, especially with harder tasks.

Things to Know

• Devices (example: AID system and CGM) may not communicate well with each other in water, so monitor glucose levels more closely
• Low glucose levels in water can be dangerous because it might not feel the same as it does on land

Tips

• Check if AID system is approved for use in water
• Try keeping AID and CGM devices close together so they can communicate
• Avoid water sports if you have too much active insulin
• Suspend insulin delivery and/or disconnect pump, where possible
• If disconnecting AID system in water, consider reconnecting every hour to give small insulin dose
• Keep fast-acting glucose snacks like juice or glucose tablets nearby

Things to Know

• Stress hormones can raise glucose levels even if you don’t eat
• Devices (example: AID system and CGM) can fall off or get damaged
• Wearing devices can sometimes feel uncomfortable

Tips

• • Place devices in safe spots on body, where they are less likely to get bumped off
  • Use extra adhesive or overlay tape to keep devices on
  • If disconnecting AID system from your body, remember to suspend/stop insulin delivery so insulin delivery doesn’t continue when system is not connected to your body
  • May avoid setting a higher glucose target 1-2 hours before exercise if your glucose levels usually rise during contact sports

Things to Know

• Sweat can make devices fall off
• Heat can make insulin be absorbed faster, which can lower glucose levels
• Your body works harder to stay cool, using more energy and this can cause quick or unexpected drops in glucose levels
• Hot weather can sometimes make CGM readings less accurate

Tips

• Use a fingerstick glucose meter if CGM seems off
• Set a higher glucose target 1-2 hours before activity to avoid lows
• Lower mealtime insulin dose (example: 25-33% less insulin) before activity
• Use extra adhesive or overlay tape to keep devices on

Things to Know

• Cold weather can change how your body absorbs insulin
• Glucose levels might go high or low depending on activity and how cold you get
• Cold weather can cause insulin in AID system and also glucose gels to freeze
• Loss of signal is possible with glucose meter and/or CGM

Tips

• Keep insulin and glucose gels close to your body to stay warm
• Use glucose tablets instead of gels or other treatments that can freeze
• Warm up devices before using
• Consider setting higher CGM alert, where possible

Things to Know

• Less oxygen can make it hard to think clearly
• Glucose levels might go high or low depending on activity and altitude
• Fingerstick glucose meter might not be as accurate at high altitude

Tips

• Monitor glucose levels closely on CGM
• Stay hydrated
• For short periods at high altitude, body may be more insulin resistant, but this usually improves after a few days at altitude
• Above 5000 m, more stress hormones produced, and this may increase risk of high glucose levels