From the Guidelines
To prevent lows with a tandem pump, I strongly recommend adjusting basal rates by 10-50% or more during exercise, as well as using the extended bolus feature for high-fat or high-protein meals. When adjusting settings to stop lows, it's crucial to consider the timing of boluses, especially if bolusing late, and to ensure that the basal rate is decreased during times of physical activity 1. The American Diabetes Association recommends that patients on insulin pumps can lower basal rates by 10–50% or more or suspend for 1–2 h during exercise to prevent hypoglycemia 1.
For late bolusing, using the extended bolus feature (e.g., 50% now, 50% over 1-2 hours) for high-fat or high-protein meals can help better match food absorption and reduce the risk of hypoglycemia. Additionally, ensuring that the insulin duration setting accurately reflects how insulin affects the body is essential, as hypoglycemia often occurs because insulin action outlasts food absorption 1.
Some key considerations for preventing lows include:
- Decreasing basal rates by 10-50% or more during exercise 1
- Using the extended bolus feature for high-fat or high-protein meals
- Ensuring the insulin duration setting accurately reflects how insulin affects the body
- Regular blood glucose monitoring and keeping detailed records of meals, boluses, and glucose levels to fine-tune settings 1.
By making these adjustments and considering the latest recommendations from the American Diabetes Association 1, individuals with tandem pumps can effectively prevent lows and improve their overall glucose control.
From the FDA Drug Label
Hypoglycemia may occur as a result of an excess of insulin relative to food intake, energy expenditure, or both. Hypoglycemic reactions may be associated with the administration of LEVEMIR. The time of occurrence of hypoglycemia depends on the action profile of the insulins used and may, therefore, change when the treatment regimen or timing of dosing is changed
The patient's tandem pump settings may need to be adjusted to prevent hypoglycemia, especially if she is bolusing late or has variable food intake and energy expenditure. It is recommended to monitor glucose levels frequently and adjust the insulin dose cautiously under medical supervision 2, 2. Changes in insulin dosing should be made carefully to avoid hypoglycemia, and patients should be educated on recognizing and managing hypo- and hyperglycemia 2.
From the Research
Tandem Pump Settings and Hypoglycemia
- The tandem pump settings can be adjusted to prevent hypoglycemia, especially in patients with type 1 or type 2 diabetes 3, 4.
- Studies have shown that basal-bolus insulin regimens can be effective in managing blood glucose levels, but may also increase the risk of hypoglycemia 5, 6.
- Adjusting the basal insulin infusion rate can help reduce the risk of hypoglycemia, especially during exercise or other activities that may affect blood glucose levels 5.
Factors Associated with Hypoglycemia
- Glycemic variability, measured as coefficient of variation (CV) or standard deviation (SD), is a significant factor associated with hypoglycemic events 7.
- Admission mean glucose levels and duration of stay in the hospital can also affect the incidence of hypoglycemia 7.
- The use of continuous glucose monitoring (CGM) can help detect hypoglycemia and hyperglycemia more accurately than capillary point of care testing 7.
Managing Hypoglycemia with Insulin Pump Therapy
- Decreasing the basal insulin infusion rate by 80% up to 40 minutes before exercise onset may not be sufficient to reduce exercise-induced hypoglycemia 5.
- Adjusting the timing of insulin basal rate reduction can help reduce hypoglycemia during late post-prandial exercise in adults with type 1 diabetes using insulin pump therapy 5.
- The frequency of hypoglycemia with basal insulin treatments in adults with type 1 diabetes treated with basal-bolus insulin regimens can be summarized from published data on hypoglycemia occurrence 4.