Goinig from MDI to a pump for better exercise BG control


I am looking at going form MDI to a pump for better exercise BG control. Just a little background. I was diagnosed just over a year ago at age 49. I have been a cyclist for 30 years and went from 3-4 hour 50+ mile rides to struggling to get in a solid hour. My Dr. suggested that a pump will help since I can suspend my basal before riding. As of now I need almost 80 grams of carbs for an hour ride.

Since I am on the Dexcom G6 I am looking at the t:slim X2. But the Omnipod is appealing since it’s tubeless. If there are any clyclists out there that use a pump (espically a t:slim X2) and are able to get in long rides I would love to here some thoughts on if a pump does in fact help with BG control.


Hello @everlook Jeff, it does for me! The main reason is you can’t “untake” a shot of long acting insulin. When you pump you can turn down your normal basal rate for exercise such as riding a bicycle. It’s been great for exercising and for when I am less active than my typical. Please consider getting a book “Pumping Insulin” for pump basics. Good luck

Hi Jeff @everlook, the move to a pump sounds sound. And as @Joe says, you can not “undo” a shot of long-lasting insulin.

I no longer go off on my bike for several hours like you enjoy, but I do put together three hours of fairly strenuous [for a guy in late 70’s] and continuous bike-riding and gym workout on most days. I’ve learned NOT to suspend my pump for extended periods but rather instead use “reduced basal” rates beginning several hours before I plan to begin exercise; also a lesser meal bolus ratio.
The Tandem t-Slim [I switched in January from MiniMed] and Dexcom G5 are great tools. During my exercise period I alternate my basal rate hourly changing between 0.0 and 0.1 or 0.15 units per hour rates. I add this insulin knowing my body needs insulin to feed my mussel cells. On high intensity days I make a significant increase in basal rate [to 0.5 uph] to offset the anaerobic effect.

The only times I have hypoglycemic events is about six hours after my workout so beginning about two house before that I reduce slightly my basal rates. JDRF recently posted some good exercise information. It is available here: https://www.jdrf.org/t1d-resources/living-with-t1d/exercise/?utm_source=newsletter&utm_medium=email&utm_campaign=20190416_springtraining_email&utm_content=standard_exercise_2ndtextlink&s_src=bsd_newsletter_email&s_subsrc=20190416_springtraining_email_standard_exercise_2ndtextlink&mkt_tok=eyJpIjoiTm1Sa1lUQmhObVV6TTJWaCIsInQiOiJjVlhoRWVCaTFod0lQZjAzRHI2QTRjdmJDcHpNNVoxU3RQTFBWYzBUNXVBbFJRbjhQM3hLVTJYUFlkMUUwV1ozWHRiTTZpNnJpekxVRkU3bDJYM2NrVWUyRUpTNzZ0Y3kwVFdselwvcGMxY1wvQnRYNDRJNDIrRnNFSThHdzJCVlwvWSJ9

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If you can adjust to the tubing, the T:Slim will give you the most help today. Basal IQ with the G6 will work to suspend/reduce your basal rate as it sees you are predicted to go low (lower than 80). So, you could set a reduced basal rate, like @Dennis mentioned, it will automatically switch to suspend (0.0) until your BG goes back up. This could happen many times during your ride automatically.

The new omnipod DASH will have some “brains” like this and integrate with Dexcom next year. The old/current omnipods are now integrated with Loop (Intro to Loop An Introduction to Loop - YouTube). This is a more automated system that you can build.

Thanks to all for the info.

@Dennis - thanks for the exercise link. I noticed that the athletes seem to using only pens. I also looked at cycling Team Novo Nordisk and all the rider profiles I read are using insulin pen therapy. Which leads me to think that I don’t need a pump and just need to do some more experimenting with basal/bolus dosage on ride days.

@Nightfox - yeah I have been agonizing over which pump. I agree that the t:slim is the best choice today but I don’t think I can get used to the tubes. I am leaning towards the Omnipod. However, after reading and Youtubing everything I can about the t:slim and Omnipod and seeing all the pod failures, infusion site failures, etc maybe the pump is not for me just yet.

Cheers to all,

There will always be trade offs to using technology, as its not bullet-proof.

If you just want to try it out, wait a few weeks and wait for Omnipod DASH to come out in full release. They will be available via pharmacy, so there is no 4-year lock-in. Its just a prescription. Then you can try it before committing to any pump. Or, ask your endo team if they have a Tandem you can test out with saline for a while and then see how cumbersome it is. Granted, you won’t be able to weigh the benefits, just the potential cons.

You can make anything work with enough effort. Good luck and keep checking back in

Hi Ken @Nightfox, I’m just curious - why do you say “test out with saline”?
For me, if I’m going to punch in an insertion cannula, fill a cartridge and wear a pump for several days/weeks, I’d want to use that time to see if the pump and its accessories actually work for me.

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@Dennis, I know people test them out this way. Maybe more often its kids. I am not familiar with the return policy on pumps. We are still waiting for our first one for my daughter.
Check w/ your endo.

@Nightfox Ken, Please get all information directly from the manufacturer on “returns” because it could be several thousand dollars worth of frustration if you don’t know the policy.

They put saline in pumps to get you used to the button pushing and pretend basal suspends and pretend boluses. The use saline so you can learn how to fill the reservoir, tubing, and priming. I however see no benefit other than allowing you to push buttons and not commit to a real insulin infusion.

My first pump trainer insisted on saline but since I was a 27 year insulin veteran I fired her and got a new trainer. My philosophy is simple, if I am going to make a hole I am darn well use it for all it’s worth.

It takes many weeks to tune a pump (basal rates) so be prepared to see some poor control and ups and downs before you see any benefit. Understanding pumping or even insulin use is important to success. My favorite book recommendations are “Pumping Insulin “ and “Think like a Pancreas “. Cheers good luck


I too love to cycle long distances and have ridden from Niagara Falls to Portsmith NH in a week, averaging 80 miles a day. And the Death Valley cycling trip was even better. I have been using a pump for 28 years. Reducing your basal is key, as well as consuming carbs before taking off with a reduced meal bolus. I find I need to consume more carbs about every 45 minutes. it is trial and error. You must bring your glucometer and I carry with me at least twice the carbs I think I will need. I like Fiber One bars or Cliff bars. And of course, always have glucose tabs handy. And remember Gator Aid has sugar. One of the brands offers a sugar free version.

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Hi all,

Just thought I would give an update on my transition to a pump. I ended up going with the Omnipod Dash. The transition was pretty smooth and I have not had any issues. I seem to need a 60% decrease in basal for my rides. The first ride I got right and stayed around 150 the entire time was amazing. I couldn’t beleieve it. What’s even better is I don’t have to eat a ton of carbs every hour. I’m up to a solid 90 minutes and working towards a 3 hour ride.

I’m still tweaking things but the pump sure has helped me during exercise.



That’s great news about your pump and riding. Pumping, though, it has its challenges, surely helped me with my control too. You’ve inspired me to return to my exercise program.

Hi Nancy Would love to chat Looking for a woman cyclist assuming our bodies react differently than men and a woman’s advice would be better to start
I am struggling with spin and outdoor cycling Sugars are always dropping and then later crazy spikes when the glucose I take actually kicks in!
It’s like nothing is working during the ride?!
Thanks Sue

Hi Sue,

I have learned through trial and error (lots of errors) to set my temporary basal to 60% at least 1/2 hour before the start of my ride. I set the time to last the length of the ride. I eat something around that same time and bolus only half of what I usually would bolus for those carbs. Ice cream is not a bad thing to eat for this or a sandwich. I consume about 15-20 carbs about every half hour or 45 minutes throughout my ride, depending upon the intensity of the effort. Since I live on a lake and my ride is mostly uphill at the beginning, I need most of my fuel for the first half of my ride.

I am pretty consistent in my choice of carbs to take on my ride. I like the chocolate Fiber One bars or peanut M&Ms.

My return is mostly downhill so I reduce the carb intake if I need any at all. I watch my CGM the entire ride.

It is not a perfect system, but works much of the time. I was diagnosed at the age of 15 and am now 63 and have few longterm complications. Trying to manage my diabetes is my biggest stressor in life. But then again, I retired a few years ago and retirement is a pretty stress free life style.

My number is 518-669-2013. I would be happy to talk to you.


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Hello. I am on a Medtronic 760 with the newest CGM. I turn my pump down to Temp Basal Rate which tries to keep my bs at 150. I have had spikes after biking for years. Oh, I commute daily, year round, in MN. Anywhere from 4 miles to the bus stop to 30 miles home from work. I learned a bit ago, that the spikes isn’t really due to the carbs you eat, but the liver is pushing out glucose to cover your exercise. If you can keep your blood sugar from going lower than 100, those spikes will be lower. I have started trying to do that, and it is working. Someday, my CGM info will be able to be on my watch, so it will be easier to track and react accordingly, instead of having to pull my pump out and look at it. I am 100% glad I switched to insulin pump from MDI years ago, and my A1c numbers have proved it.

Hey I was diagnosed this January 18th and I run for exercise but I usually just take my pump off for 2 to 3 hours when I exercise. I just got a pump 4 weeks ago and I also have the g6. My blood sugar has been so much better with the tandemx2 instead of MDI. Less lows and less highs. Life changing😊

Thank you Nancy! I will continue my trial and error (lots of errors too!). My last two spin classes went much better! i haven’t been on the road in a while but eating carbs thru-out and not when the sugar is dropping is the key I’ve been missing. I never considered Peanut M&M’s but what a GREAT idea! I had jelly beans but the pure sugar probably isn’t a good idea. It is a HUGE NUISANCE having Diabetes. I remind myself there are way worse things and just deal with it. Glad you are living a stress free retirement! and glad to see you still Ride! I started a few years ago with the goal in mind that I can do it for a long time to come! Take care and I may take you up on that phone call one day!.