# Adjusting basal for exercise



## Radders (Jul 7, 2016)

The instructions that came with my pump said that I should only adjust my basal for exercise of more than 45 minutes' duration. Since I never exercise for that length of time, the only exercise for which I adjust my basal is swimming, because I have to take the pump off. 
Over the past few months I have started cycling to work (4 miles each way, started off taking 30 minutes but is now down to 22 minutes one way and 24 return as it's uphill) and have been having more hypos than I would like, despite adjusting my bolus doses. 
Question is would others carry on reducing boluses, or would you reduce basal as well?


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## Pumper_Sue (Jul 7, 2016)

Start with basal testing


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## everydayupsanddowns (Jul 7, 2016)

I often reduce basal with a TBR even if not exercising at all, so... Yes!

I suspect that the advice is probably based around the fact that it can take a while (probably at least 45 minutes) for a basal adjustment to begin to take effect, even if your basal adjustment is profound. 

However I did notice when wearing a Libre sensor that I seems to be able to halt a slide into lower numbers with a short, sharp TBR. Perhaps 0% for 30 or 60 minutes - as long as I had 30 minutes head start. In fact that is just what the MiniMed 640G does with smartguard. 

I would say that a combination of further basal reduction and TBR are worth experimenting with. Particularly if you are keen to avoid extra carbs.


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## Radders (Jul 7, 2016)

Thanks Mike. What would you say is the advantage of using a basal reduction compared with reducing bolus? 
I cycle to work after breakfast, so I don't have a choice about reducing my breakfast bolus, and what I've been doing in the afternoon is saving what was part of lunch until home time and not bolusing for it, so effectively reducing my lunch bolus. I'm fine during the exercise when I remember to do this but am getting hypos an hour or two later.


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## everydayupsanddowns (Jul 8, 2016)

I see both as working hand in hand. Basal adjustments seem gentler to me. Better at stopping/correcting drift rather than sharp increases/decreases where rapid carbs/correction doses seem better. But basal *and* carbs/bolus reduction have worked well for me in combination.

Why can't you reduce your breakfast bolus? When I went to gym soon after breakfast I would reduce bolus by 20% and then reduced basal by 50% for a couple of hours. Keep at it - you'll find the combination that works for you


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## Radders (Jul 8, 2016)

Today I cut my breakfast bolus to 1 unit and staved off the am hypos. Reduced lunchtime ratio by 25%:not enough. Bigger reduction needed tomorrow!


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## SB2015 (Jul 9, 2016)

Hi Radders

Mike mentions about the basal change taking about 45 min to take effect.  I use that idea to time the TBR.  I walk after our evening meal, and use a 50% TBR (found by trial and improvement) which I set at the *start* of our meal.  When I tried using a reduction in bolus instead I then got the after meal spike which I prefer to avoid. For bigger exercise, full day of walking or swim training session I will use a combination of Bolus and basal reduction.


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## Radders (Jul 9, 2016)

Thank you for your input. When it"s not too manic at work, I walk for 20 minutes after lunch purely to reduce the post meal spike. I was surprised to find that since I am cycling to work I now need to reduce my bolus at lunch as well, four hours later! 
Do either of you find that your basal and/or bolus needs continue to be lower after the exercise as well?


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## SB2015 (Jul 9, 2016)

For swimming I use 50% TBR one hour before I swim (also no bolus during swim) and leave the TBR on for half an hour after the swim.  In general I leave the TBR on for about half  the time the activity took place, but then there is the fudge factor of how much CHo I ate during, how energetic the activity was , when I eat next as I sometimes take out a bit of bolus at following meal.. So that is my starting point and then I adapt and change as necessary.  Then just when you think well that is sorted it changes!!  So just find the best fit for you, keep monitoring and keep at it.


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## Radders (Jul 9, 2016)

Thanks SB. Would you even bother reducing basal for a 22 minute bike ride?


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## SB2015 (Jul 9, 2016)

For a short ride I might still use a TBR 30 min before I started and stop it once I set out.  However that is because I just prefer to keep my bolus the same each morning as I now have a plan for porridge also hat takes care of the spikes, and the more gentle adjustment of the TBR seems to work for me. 
There is no short cut thought.  You will just need to try things, record, review and adjust until you find what works for you.  Be patient.


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## SB2015 (Jul 9, 2016)

Also need a TBR of 140% to watch the tennis!!!


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## Radders (Jul 9, 2016)

I feel that TBR is something I've underused, probably because I scared my husband with one not long after getting the pump. I had tried a TBR after eating lasagne and the alarm at the end of it coincided with a bad hypo. I woke up to him panicking and shouting "why's the damn thing beeping" while trying to get me to drink Ribena!


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## everydayupsanddowns (Jul 9, 2016)

I gave up going to the gym when my knees started complaining, but these days if I've exercised more than usual (day of DIY or 4-5 hour walk) I would need to take action for it (50% TBR and additional carbs dripped in) and then later in the evening, after evening meal I need to set a 80-85% TBR through late evening and most of the night. Without that I can easily dip below target range while I am asleep.

I think it very much depends though, as this didn't happen when I was exercising more regularly and running 5-10K 3 times a week. At that stage I just needed less basal on a permanent basis. these days my exercise/activity is more occasional.

As Pumper Sue says, it might be worth doing a basal test if you are seeing these hypos regularly. I would think that if you ride to work 5x a week then that could be accommodated in a fasting basal test structure. Many people find they do OK exercising with only basal on board and not eating breakfast (see http://insulinnation.com/living/5-tips-to-better-exercise-with-type-1-diabetes/). Though you'd need to be cautious and *test test test* obviously! Perhaps try a ride before breakfast on a weekend when you have more time to observe the effect and can choose a route on cycle paths/away from busy roads.

I just do wonder whether you are on too much basal in the morning generally.


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## SB2015 (Jul 9, 2016)

Test, review, adjust, test, review adjust, ....
It is worth it.


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## Radders (Jul 9, 2016)

Mike do you mean do a basal test and continue to cycle? I must admit I feel scared to do that.  If I have no breakfast I am sure I will go low, and I don't want to risk doing that on the road. Hypo signs are easily disguised by General weariness when I exercise! 
I have no means of getting to work without exercising as I live a mile from the bus stop and don't drive, so doing a normal basal test in the morning is tricky to say the least, but until I started cycling I was fine. I've done basal testing at the weekend and found it very variable. One day I get an increase at a certain time, the next I am stable at that time, and there being only two days I then have to wait a week to repeat the experiment!


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## SB2015 (Jul 9, 2016)

You could try TBRs for the cycle ride, and that might give you an idea of how to adjust your basal rates for the mornings on weekdays.  I have five profiles and choose which one for the particular day I have planned.  So you could then set up a profile with basal rates to use for workdays and others for weekends.  Talk to your pump trainer and see what they think.


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## Radders (Jul 10, 2016)

Thanks SB. I only see the pump trainer when I get a new pump - I do understand about different profiles though. None of the professionals has suggested using a TBR before so I will try that. 
Another question though: if I can adjust for the bike ride by using a TBR, why would I not just do that, rather than setting a new profile? I don't always set off at the same time every day, certainly not to come home, so wouldn't building that into my basal profile cause problems?


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## SB2015 (Jul 10, 2016)

I was assuming you had a regular time for going and coming home from work.  If it is a changeable time then as you say TBRs are the answer.  Just keep working at it to find what works (but remember that it will then just do its own thing because it can sometimes!)


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## Radders (Jul 10, 2016)

Thanks SB. Is it just a case of trial and error, or is there a way I can work out a starting point?


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## SB2015 (Jul 10, 2016)

Think about similar situations where you have used a TBR and start from there.


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## Copepod (Jul 11, 2016)

Have a look at www.runsweet.com particularly explanation of differences between aerobic and anaerobic exercise, not just length of exercise episode. There are also case studies for many specific types of exercise.


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## Radders (Jul 11, 2016)

SB2015 said:


> Think about similar situations where you have used a TBR and start from there.


I've never used one, apart from when I was ill. When I got my pump I was told to use TBRs only if exercising for longer than 45-60 minutes, which I don't do!


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## Radders (Jul 11, 2016)

Copepod said:


> Have a look at www.runsweet.com particularly explanation of differences between aerobic and anaerobic exercise, not just length of exercise episode. There are also case studies for many specific types of exercise.


Thanks Copepod, looks interesting, although the forum isn't as well frequented as this one !


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## Copepod (Jul 11, 2016)

Agreed, Runsweet forum isn't well frequented, but the information / explanation ages are well worth reading carefully.


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## SB2015 (Jul 11, 2016)

Radders said:


> I've never used one, apart from when I was ill. When I got my pump I was told to use TBRs only if exercising for longer than 45-60 minutes, which I don't do!


Sorry Radders
I had not picked up that this was the first.  When I started to use them I started with -20% (80% TBR), tested, reviewed and adjusted until I found what worked.  I find the important thing is the timing.  I need to set these 45 min before I start the exercise, and for short activity length (eg 30 min cycle ride) and intensity I may stop it once I start the activity or take the rate back up a bit and allow some for the recovery after.

I am sorry I am not much help with ideas of the figures to use.  I found it was just trial and improvement.


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## HOBIE (Jul 23, 2016)

Well done for being so active. There is only one person who will know exactly what to do. Pumps are so adaptable.


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## Radders (Jul 24, 2016)

HOBIE said:


> Well done for being so active. There is only one person who will know exactly what to do. Pumps are so adaptable.


Thanks Hobie.


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## Pumper_Sue (Jul 27, 2016)

Radders said:


> Mike do you mean do a basal test and continue to cycle? I must admit I feel scared to do that. If I have no breakfast I am sure I will go low, and I don't want to risk doing that on the road. Hypo signs are easily disguised by General weariness when I exercise!


This proves your basal isn't correct.
If your basal is correct for your daily exercise then you wont hypo.(in theory)


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## Radders (Jul 27, 2016)

Pumper_Sue said:


> This proves your basal isn't correct.
> If your basal is correct for your daily exercise then you wont hypo.(in theory)


Hi Sue
The trouble is, as I don't do it at the same time every day, I think it might be counterproductive to try and cover it by setting a basal rate. I've been getting better at adjusting my bolus dose with breakfast and I've ordered a Freestyle Libre so hopefully this will give me a fuller picture of what's happening, with the possibility of setting a TBR once I have worked out for how long! 
No work for me for the next three weeks though, yay!


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## HOBIE (Jul 28, 2016)

I know you will get a lot of info out of a Libre when it comes. A really good toy which you can use when ever it suits you. I am putting a sensor in the next couple of days because I am getting away nxt week. Hopefully going up hillocks  (tall ins)


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## Radders (Jul 28, 2016)

My Libre arrived today. I was pleased to see that the reader also doubles as a meter, just need to get some strips so I won't need to carry two. Feel a bit patronised that the bolus calculator can only be programmed by a health professional, not that I need it. 
I think I shall save my two sensors for when I return to work, although it is very tempting to get started straight away.


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## Northerner (Jul 28, 2016)

Radders said:


> My Libre arrived today. I was pleased to see that the reader also doubles as a meter, just need to get some strips so I won't need to carry two. Feel a bit patronised that the bolus calculator can only be programmed by a health professional, not that I need it.
> I think I shall save my two sensors for when I return to work, although it is very tempting to get started straight away.


I think the bolus calculator just needs a certain code to be entered, someone can probably provide it for you


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## Radders (Jul 28, 2016)

I am hopeful!


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## Robin (Jul 28, 2016)

Radders said:


> I am hopeful!


caa1c, according to a Facebook group I looked at. I haven't tried it, but I made a note just in case. Or I think @everydayupsanddowns might know it.


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## Matt Cycle (Jul 28, 2016)

Robin said:


> caa1c, according to a Facebook group I looked at. I haven't tried it, but I made a note just in case. Or I think @everydayupsanddowns might know it.



Yep the code is CAA1C.  The Abbott rep told us on my recent carb counting course.  Apparently she said the code was circulating on the internet within a week of the libres being on sale.

It's settings, professional options, (yes to hcp), then the code, then insulin calculator, change calculator settings, then advanced settings and input your ratios and correction settings.


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## Matt Cycle (Jul 28, 2016)

Forgot to mention above that the bolus calculator only works when using strips in the reader, i.e. it won't work when you swipe.


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## Radders (Jul 28, 2016)

Thanks Matt. I am not sure whether it's really worth the hassle to get the strips, having thought about it. My GP surgery are really bad at getting prescriptions right as it is, adding a third type of strip would probably just cause more confusion! 
Do you know if they are expensive to buy?


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## Matt Cycle (Jul 28, 2016)

Radders said:


> Thanks Matt. I am not sure whether it's really worth the hassle to get the strips, having thought about it. My GP surgery are really bad at getting prescriptions right as it is, adding a third type of strip would probably just cause more confusion!
> Do you know if they are expensive to buy?



I was using an Abbott Optium meter anyway so have the strips on prescription - the same strips work in the Libre.  A quick search has shown the strips are around £20-25 so not the cheapest.


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## Radders (Jul 28, 2016)

Thanks, maybe give that a miss then, unless I decide to use the sensors long term.


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## Northerner (Jul 30, 2016)

Radders said:


> Thanks, maybe give that a miss then, unless I decide to use the sensors long term.


What meter do you use for blood  ketone testing? I use an Optium for that and also get an occasional pack of blood glucose strips, having persuaded the surgery this is my 'spare' meter (I use a Contour Next as my 'main' meter). Presuming, of course, that the Libre can test ketones as well.


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## Radders (Jul 30, 2016)

Northerner said:


> What meter do you use for blood  ketone testing? I use an Optium for that and also get an occasional pack of blood glucose strips, having persuaded the surgery this is my 'spare' meter (I use a Contour Next as my 'main' meter). Presuming, of course, that the Libre can test ketones as well.


I use the Optium too, and I only recently acquired it. At the time I had a bit of hassle getting the ketone testing strips and it had been raided of all strips by the hospital team "for our pregnant ladies"! After writing down and underlining that I wanted beta ketone testing strips, the prescription came through as blood strips plus urine ketone strips so I sent it back. They had also removed the Aviva strips from the repeat. Then I got a phone call from a locum at the surgery asking why I had two meters, how often did I test a day, etc before it was put right. That's why I'm worried it will put a real spanner in the works if I ask for the Optium glucose strips now!


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## Northerner (Jul 30, 2016)

Radders said:


> I use the Optium too, and I only recently acquired it. At the time I had a bit of hassle getting the ketone testing strips and it had been raided of all strips by the hospital team "for our pregnant ladies"! After writing down and underlining that I wanted beta ketone testing strips, the prescription came through as blood strips plus urine ketone strips so I sent it back. They had also removed the Aviva strips from the repeat. Then I got a phone call from a locum at the surgery asking why I had two meters, how often did I test a day, etc before it was put right. That's why I'm worried it will put a real spanner in the works if I ask for the Optium glucose strips now!


They usually mix up the type of strips for me too, I have to put an extra note on my prescription request to emphasise which type I need!  There's nothing wrong with having two meters - everyone should definitely have a spare one, and it makes sense to get glucose strips for your ketone meter rather than having a third meter!


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## Radders (Jul 30, 2016)

I've got a fair old collection of meters, mostly Roche. I normally carry my Aviva Nano as it's compact, and leave my Combo meter by my bed. 
I'm only planning on using the Libre for the four weeks my two meters will last, and then again in future when things need adjusting again, so it's not going to be too much hassle to carry the two I suppose.


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## HOBIE (Jul 30, 2016)

Strips work fine too. There are two types, one for bg & one for Ketones. Both good & handy to have. Not many people have ever talked about this. I like the Libre. Don't use all the time but great for out of the ordinary stunt work


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## HOBIE (Aug 16, 2016)

I have just been up Scar-Fell. I am on a Medtronic pump & been T1 for 50yrs.  The morning I went up I had a bowel of porridge, 1hr drive & then put my pump in to 1 & 2 % basal mode. I have never done that before but had amazing bg all day !. It took me 4hrs to get the top & 8hrs to come down in the rain. I fell 3 times . Knacked both elbows.  Those pesky rocks.


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## SB2015 (Aug 17, 2016)

That sounds very successful Hobie.  I look forward to hearing what you do next.

In your post above, are you saying that there are blood ketone strips for the Libre?


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## HOBIE (Aug 17, 2016)

SB2015 said:


> That sounds very successful Hobie.  I look forward to hearing what you do next.
> 
> In your post above, are you saying that there are blood ketone strips for the Libre?


Yes SB. There are normal bg sticks too. No  one else has even mentioned these.  A good gadget.  What to do next ?  Thinking cap on !


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