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Temp Basal Rate Decrease for Activity
Activity Type % Decrease
Set Temp
in advance of
activity (yes or no)
Minutes
to set in
advance
Light (gardening, walking, shopping)
Moderate (leisurely biking, golf {no cart})
Strenuous (basketball, jogging, swimming)
Sustained (ice skating, rowing, hiking)
My duration for Insulin on Board is:
Program 1 Program 2 Program 3 Program 4
Weekday
______________
Other
_______________
Weekend
______________
Exercise
_______________
SEGMENT
START
TIME
Units/Hr Units/Hr Units/Hr Units/Hr
Basal Programming Date: ______________
18