Insulin and exercise at school


(sarah) #1

Hi

My son just started school and his insulin shot happens 45 minutes before recess. Today he went into a rapid alert fall on his monitor (I was there so I was able to fix this with fast acting carbs). What is the ideal time to wait between an injection and exercise?


(Dennis J. Dacey, PwD) #2

Hi Sarah @bonetje , nice that you were there to attend to your son - the good old location, location, LOCATION!

You mention two of the three factors key to diabetes management - you mentioned insulin and activity but made no mention of FOOD. Most days of the week, I take lunchtime bolus as I start to make my lunch and then eat and head out to the gym for a 90-120 minute “moderate” workout and I’m fine but I lower my pump to 60% basal by the time I finish lunch and keep it that way for 4 hours.

I’m assuming that the insulin administered was a meal-time bolus and if your son had his lunch following the shot he “probably” should have been OK. Now, a second thought: your son is not using a pump takes a long-acting background insulin [something like Lantus] once or twice a day. If this is the case, check with his medical care team and see if on days when PE follows lunch if he should take a smaller meal bolus.

I’m not a medical doctor, but from long experience I could offer some other suggestions for his insulin therapy. But in the end, it will all depend on your son’s body and how quickly his insulin begins work and how long it remains working in him - each of us is different.


(joe) #3

I agree @Dennis

@bonetje sarah, If I know I am going to be active, I cut my meal time insulin. For example, if I am going to ride my bike after lunch, I only use 1/2 the insulin I would use for my meal, if I was going to sit and read the newspaper afterward. For me, any exercise means my insulin works 2x more. Work with the doctor, my advice is to bolus less if you know you are going to be active.

My favorite doctor once said "you can always take more medicine"for me that means when in doubt guess less and correct later.

Modern fast acting insulin (Humalog, Novolog Apidra) starts to work in 20 minutes and stays active for 4 hours but that is an average. A child’s metabolism and circulation are way better than a 50 year old’s.


(John) #4

This something we are learning with our 10 year old son. He takes his insulin after lunch which is then followed by recess and because of this he has taken some serious nosedives. Our next step will be to reduce or eliminate his lunch time insulin.


(sarah) #5

Thanks for your responses. We’ve tried cutting insulin in half, and he went really high in the afternoon. We tried adding a 10 carb snack before recess and some days it works and others he is again in the high 200’s for the rest of the day. It is hard knowing what to prescribe, since school orders have to be set in stone. Its tough!


(joe) #6

@bonetje, hi Sarah, a growing kid’s insulin requirement is a moving target. as he grows he’ll need significantly more insulin. maybe 1/2 is too low… maybe cut it by 1/3. Diabetes is a science experiment and do not feel bad about updating the 504 plan requirements every week if necessary. You are the most important person on his mandatory health care team. This is going to be changing throughout his school career.