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Lantus bad choice if you exercise?

P

pinewood

Well-Known Member
Messages
792
Location
London
Type of diabetes
Type 1
Treatment type
Insulin
I met the dietician yesterday and she told me Lantus is a really bad choice basal insulin for people who regularly exercise due to its inflexibility. I tend to run about 5-10km 3-4 times per week and do some weight lifting afterwards. So far, I've made sure I'm at about 9-10mmol/L before exercising. I take 2 or 3 glucose tabs during my run and have ended my runs at about 4 mmol/L.

She said I should speak to the doctor and ask to change to Levermir (twice per day) or Tresiba. Anyone have any experience of this? I'd rather not have to inject twice per day with the Levermir to be honest and I haven't had any bad experiences with hypos on Lantus, although I have been pretty careful so far (e.g. snacks before bed). I have noticed my leg sometimes aches for a little while after my lantus is injected; not sure if that's normal...

Thanks!
 
An interesting question. My consultant suggested that Levemir was easier to manage exercise with due to the flexibility of two injections, and if I am honest, he has been right. I train in the the evenings and had been seeing a lot of hypos early morning, but if I lowered my evening shot too much, my background levels were too low (and I was running with a split does anyway). The levemir has enabled me to get a good basal profile very quickly with an obvious variation for with and without exercise. I don't know about Tresiba, and @robert72 may be able to help there.

On the other hand, if you aren't seeing issues then I'd question whether it is necessary to change.

As for the ache, it is most likely due to the Lantus being Acidic, which allows it to precipitate in the subcutaneous fat. This causes some people discomfort. This mechanism of operation is why i switched to Levemir as I was seeing profound issues with it becoming a fast acting insulin when the injections missed my SC Fat layer.
 
Thanks very much indeed, Tim. Very helpful. I think I'll give Lantus a bit longer but will discuss at my next consultant appointment. Levemir sounds like it works well for you and I would like the flexibility to exercise in the evening (I'm too nervous of lows during the night at the moment, so have restricted myself to exercising in the morning).
 
Interesting. My DN prescribed Levemir over Lantus and said she would need to add it into my notes that I go to the gym and that's why she prescribed that over Lantus? When I suggested splitting the Levemir she wasn't keen and added Novorapid as I was just on Basal at the time. In the event it was a sensible decision. I know that Levemir doesn't have a flat profile and doesn't last 24 hours, but I inject it once a day at night but don't Bolus at breakfast as I only have a small breakfast and the Levemir will be peaking. The end result is only typically 3 injections per day and I may have a bit of fruit etc just before the gym if I'm a bit low. I wonder why more peole don't use this 3 injection approach?
 

That's not the behaviour I see from Levemir particularly. It definitely doesn't last 24 hours and doesn't seem to peak.
 
I don't run but I exercise (mainly walking and the occasional bike ride) for 60 mins most days, more on a weekend and not really had any issues with using lantus, but given the choice I would opt for Tresiba over Levemir Pinewood.
 
@pinewood - Tresiba is very much like Lantus (except a bit flatter and more predictable). There is no sting from injection as it's based on breaking down large polymers rather than changing a pH. I would suggest that Levemir would be better if you want to adjust basal for activity. Sadly I had a local allergic reaction to Levemir, so only tried it for 3 months.
 
I have only used Lantus, and i have never had issues with it.

Typically i will eat 30-40g of carbs like 30 minutes before each workout, and each workout is about 8-10km cycle, an hour of weights and then 5km slower paced 'run' on the elliptical. I usually finish around 4mmol/L but then i get to eat my dinner without injecting haha

I guess this is the same situation your in, maybe i'm doing it wrong ?

EDIT - I feel that 'sting' of the lantus, and when i asked they said it wasn't due to the injection but when Lantus touches the skin before injecting it reacts and stings. I was told to make sure theres no little droplet on the needle tip before injecting and that should help.
 
tim2000s said:
That's not the behaviour I see from Levemir particularly. It definitely doesn't last 24 hours and doesn't seem to peak.
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Hi. I agree it only lasts about 12-18 hours. If you Google 'Levemir graph' you can see many links and images showing a raised profile after around 8 hours. The hump does depend on the amount injected; there's a 3D profile that shows this.
 
Thanks all. @Diamattic - I don't think you're doing it wrong (not that I'm an expert!). Good to hear that Lantus seems to be working okay for you. I've not had any major issues with it but just curious as to other people's opinions given what the dietician told me. I don't want to have to eat 30-40g carbs before my exercise, before being diagnosed I'd do it straight out of bed and then have breakfast afterwards, but I guess I'll always need a snack now. Great tip about the Lantus - I'll give that a try! Thanks!
 


Yeah i certainly could not go straight out of bed to a workout, I would hypo for sure, unless maybe it was all weights and i tried not to get my HR up lol

I don't mind the snack/meal before the gym because i usually go straight after work around 530-6 so i am fairly hungry at that time anyway. Then when i get home around 8 i can eat my dinner without needing insulin, so if i play my cards right i only need 1 bolus during the day, and 1 Lantus injection at night. I typically don't eat a breakfast, then inject at lunch, and then can eat before the gym to burn off and then dinner after the gym to bring me back up from around 4. If i need too i can inject my Lantus early so that the new stuff overlaps the last dose and acts to bring down the meal.

I don't know what i would do if i have to do a morning workout, probably just eat first then workout... You'll figure it out! Its possible haha
 
Isn't Tresiba an ultra-long acting basal insulin? Can't see how that can be flexibly adjusted to suit exercise, or put into the same category as Levemir.

I take Lantus and I exercise quite a lot (gym 3 times per week, plus a long run of 10+ miles). It's flexible enough for me; I reduce my daily dose by 20% on exercise days, but that took me a long time to figure out. If I exercise in the evening (I take my Lantus in the morning), I make sure my BGs are at 9 before bed as they'll drop.

I agree with the others though, Levemir is more flexible because it is shorter acting.
 

I find that my leg aches after my Lantus injection too I thought I was the only one! I've never had a problem with Lantus and exercising its always been fine and I've been on it for 4years now x
 
I found levemir was much more even when changing to two separate injections. In my experience I find the type of exercise really affects the insulin release, if I inject into the legs and weightlift (backsquat) it gets absorbed much quicker. In particular, any cardio based activity has made me more liable to low morning readings and night time hypos and the low dip can extend to well into the next day. This I guess is why a second injection in the morning might have been beneficial. (Never used Lantus I'm afraid so can't comment on that!)
 

Sounds like you have a good dietician. Lantus was fine day to day but caused me horrendous hypos both during and after sport; to get round this I was told to reduce the night before (!) and reduced I:C ratio for meals eaten within 4hrs of the activity - I got close with experimentation but never consistent (instead of hypos I was having hypos OR hypers during and even the day after exercise).

Switching to pump therapy and LCHF has fixed both these issues for me - if Levimar doesn't deliver speak to your clinic's pump consultant about switching to pump therapy, especially with your level of activity.
 
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Hi, guys.. I am juvenile type 1.. Since 12 year. In insulin since then.. Have used all insulin mentioned above. Lantus is a very good, was following split dose.. Care should be take that we don't over exercise..
Planning on changing my basal insulin.. As i am facing hyper at night, eventhough fasting is normal. This may be due to DOWN EFFECT. It happens at 2 - 3 a.m night. HBA1C wayoff target.
As levemir is having a small peak at 6th hour. Still tresiba, not FDA approved looks promising. Any feedback or query much appreciated.
 
I've been using Tresiba for about 8 months and find it to be a very flat basal. I don't do strenuous exercise, so find it easy to manage by reducing my bolus or taking some extra carbs if needed.
 
robert72 said:
I've been using Tresiba for about 8 months and find it to be a very flat basal. I don't do strenuous exercise, so find it easy to manage by reducing my bolus or taking some extra carbs if needed.
Click to expand...

Hi. Robert.
Thanks for quick reply. In type 1 diabeties. Do you have any knowledge of Down phenomenon, due to which night at 3 a.m blood sugar peaks, due to growth hormone, liver functions while sleeping. Hoping levemir, might help me night on this. In type 2, only 20% people get effected by this.
 
Hi - I don't suffer from dawn phenomenon but I do get a rise after I wake up. If you are getting bad DP then it would be better to look at Levemir or even NPH. If neither of those help then you could find out if you can get a pump.
 
You've had some really good replies, and I have the same thing happen. Levemir is okay and all that but what's really helped me is to treat each 12h period as a seperate basal requirement.

I switched from Lantus to Humalin I. Humalin I is pretty much a 12h basal so I can take an overnight basal to deal with my overnight numbers and dawn phenomenon. Then in the day I can scale my basal to how active I'll be in the day.

Am I doing a great big long hike? Then I take no basal whatsoever. I'm way too insulin sensitive when I exercise. Going to the gym at 5?. once again, zero basal shot that day. I can treat any slow creeping blood sugar rises with a little bolus shot.
Am I slobbing around all day in my pants? then I'll take an appropiate basal dose.
 
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