Im stupid. Scared to increase basal though I obviously need it.

Before migrating to an insulin pump, I used Lantus which is a brand of glargine.
Like you, I was a frequent but irregular exercise bunny so my carb/insulin needs would vary day by day.
For me, I found I could change my basal dose depending whether I had done exercise that day in order to maintain my BG reasonably stable overnight.
If you are taking glargine*, your basal dose dose not have to be the same every single day - you have flexibility.
Is it worth increasing your night time basal on days when you do NOT workout and reverting back to your 14 units on days when you do?

Edited to add: "YOU ARE NOT STUPID.
It is perfectly reasonable to want to avoid hypos when and after exercise,


(*Longer acting basals like Tresiba can take 3 or 4 days for a change in dose to be noticeable so do not have this flexibility to change dose each night.)

Agree 'your not stupid' and it's fair to feel scared about adjusting basal if your needs change, however I think it's also a good case to ask your DSN about getting access to a pump which would help with the variables in your lifestyle and enable you to adapt better.

Personally I wouldn't adjust simply down to my fear of hypos in the night, as this is the time I am most scared of having a low.

Quinapril said:

Hey guys.

Has anyone else been through something like this? I currently use 14 units of glargine basal insulin at night.

My sugar is almost always towards the high side, hanging out at around 10 mmol and always raises during the night.
I mean its kind of obvious that I need to increase my basal insulin.

But for some weird reason I am scared to do so because on some days when I workout and stuff my sugar is good so Its weird to me how it can be good on some days and bad on most.
Anyways Im scared to increase that basal tho I know I need to!

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Hi,

You’re spotting a trend with your personal regime.
That’s not stupid…

I use Lantus,
14 units dosed in the evening max. I do adjust lower depending on planed activity the following day.
Some days I have to supplement with correction doses some active nights I’m almost going low even when the Lantus should have run out 4 hours ago with no basal on board.

Are you familiar with your correction dose? (How many Mmols a unit of fast acting insulin would lower you. If you are high out of range.)

Jaylee said:

14 units dosed in the evening max. I do adjust lower depending on planed activity the following day.

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And the activities on that day if you take it in the morning.
The night time hypos after exercise should also be planned for,

I use abasaglar which is bioequivalent to glargine. As a slight aside I split my dose mainly because without doing this I would either run low overnight or high during the day (I take 9 + 9U normally).

I will reduce morning dose if I'll be exercising all day (or if I'm coming back to exercise after a break), I sometimes split evening dose if it's been a really big day (and I've also reduced morning dose) or if I've had an expected amount of exercise (and therefore didn't reduce the morning dose). Usually if I've reduced the morning dose there will be less IoB overnight so I don't need to reduce the evening dose.

If your BG looks good with exercise, I'd be very tempted to up the dose by a unit or so on days when you won't be doing any and see how you get on.

On a day with some reasonably level of exercise (say 4h or so) I might reduce morning dose by 1U, though on days where I'm up to 10h+ I'll often reduce the morning dose to ~4U and might knock the evening dose down to 7U too just to be safe.

SimonP78 said:

On a day with some reasonably level of exercise (say 4h or so)

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I tend to think of exercise in terms of intensity rather than duration.
My usual longer exercise is hiking but if I do a 4 hour relatively flat hike, the impact to my BG will be minor. However, a 45 minute high intensity Spin class or 3 hour stop-start climbing session will definitely need a 20% reduction in my overnight basal.
I have found this can be cumulative. On a 10 day hiking holiday in the Himalayas doing 6 or more hours of mostly uphill hiking each day, my basal was less than half after a week.
Note , I describe the change in terms of a percentage rather than absolutes. Changing basal by 1 unit if it is in the 50s is unlikely to make as much difference as if your total basal dose was less than 10.
I appreciate you did mention your dose but this may have been lost.
And the 25% came from a lecture I attended by the endo who set up runsweet which, sadly, no longer seems to be maintained but used to be a great source of information about diabetes and exercise.

You're right, I didn't describe my activity level at all - I'd say that whatever the duration I will be working fairly hard for the whole time, with the level changing based on what's maintainable for that duration. Not sure that helps very much though!

I should also add that I do exercise most or at worst every other day (1h or so of reasonably hard riding at lunch time), though with the recent rain I've been doing less and so am suffering from the same issue as a the OP - I should either up my basal slightly or sit on the turbo trainer! Or pray to the sun Gods perhaps

I also completely agree about stacked days having much more effect. While I said I might knock 1U (~10%) off for a single 4h ride, if I do this 3 days on the trot (thinking about commuting I did a few weeks back, all going reasonably fast but I knew I had to do it for 3 days so not as fast as I possibly could) I definitely needed to reduce basal by the end of the week (down to 7U, ~20%, reduction in the morning and 8U, ~10%, reduction in the evening.)

My 1U/10% reduction in morning basal for a 4h ride also is probably too small a reduction in reality (I imagine it should actually be fairly linear with total exercise), but I'd prefer to run slightly lower during the day if I'm stopping (e.g. going to work) as I can always eat a bit more, rather than risking running high and needing to bolus more, which can cause issues with too much IoB (as well as hunger!) on the way home. As the rides get longer I'm less keen on needing to top up like this so I do actually make a more significant reduction to basal (and probably tend to eat less on those days than on a normal day in the office, simply because carrying food and eating it isn't that pleasant.) I do make up for it in the evening mind you when I can again take some bolus.

For a long day out (say 10h in Z2/Z3) I am reducing morning basal by 50%-65%, which works out at a similar number to your 25% reduction. I could probably reduce evening bolus more (and would do if didn't have a ready supply of food), however, this then reduces basal IoB the next day, so it's easier to simply eat more in the evening after a long ride (and I want to do this too as I'm in a calorie deficit) and just make a slight reduction that evening to taper back into normal life the next day.

“And the activities on that day if you take it in the morning.
The night time hypos after exercise should also be planned for,”

Sorry, can’t seem to see your posts if I’m logged in.

…. For “some reason.”

The OP injects in the evening. (Looks like before bed?)

Like me.

The OP also suffers from high BG except from when exercising, so all the more reason to try an increase in bolus (the following evening I'd try to start with) and see what happens.

I realise my post might not be directly useful as I both split bolus and am talking about reducing bolus for exercise, however I hoped to at least demonstrate that adjusting bolus doses on a day to day basis is quite normal and a useful method to deal with exercise.

Jaylee said:

The OP injects in the evening. (Looks like before bed?)

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Not the way I read this …

Quinapril said:

I currently use 14 units of glargine basal insulin at night.

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#1. Most important thing is YOU ARE NOT STUPID! You are concerned and that is the most important thing to be as a diabetic. If possible I’d suggest getting a freestyle libre and monitoring how ur blood sugar moves throughout the night. A great bonus would be to exercise and see how and when your blood sugar moves. Using that data makes basal adjustments way easier and feels so much better.

The only person who can make the change is you. The disease is all an experiment. I mean it's different for everything. Person, food,weather etc. I'm always changing mine. Slow and steady. I adjust by one unit. Wait 48hrs then change again. My last change of increasing. Resulted in a week of higher results. I did only increase once thou. Not every 48 hrs. Just keeping alive is an achievement.