Lantus bad choice if you exercise?

I use Levemir once a day for my basal, it does tail off for me after about 20 hrs . I've taken to exercising in the 20-24 hr window after my last Levemir dose, and make sure I don't eat beforehand for a few hours, so this means I have minimal amounts of insulin in my body, so need little or no carbs to offset the cardio exercise BG lowering effects. I took this approach on the recommendation of a sports nutritionist who specialises in working with people with diabetes. She also suggested that if I'm doing weights and cardio in the gym, then to do the weights first as this could raise my BG, and then use the cardio to lower it again.

If doing cardio for more than an hour I will reduce my basal, if I don't then my BG will drop massively after long cardio sessions as my muscles such up that glucose.

I treat levemir as two separate basals. One overnight and one during the day. The daytime one is higher to account for eating and lasts a little longer than the overnight. I exercise at the end of the day, when the daytime dose is running out.

I use lantus (split dose once in morning and once at bed time). I cycle anywhere between 2-5 hours a day but I'm very strict in terms or management (good old OCD). My numbers are rarely above 6/7....since two weeks after diagnosis April 2014 I have only had five results above 10 and my hba1c has been 5.2/4.2/4.1/4.0....awaiting most recent report but I reakon it will be around 4.8. I measure and weigh everything!! People ask 'is it not hard work'...my response 'if you want to succeed life isn't going to be easy'.

My two cents, get your ratios right (mine range from 8-10 lantus twice daily, and 1unit per 9-13.5 charbs fact acting apidra depending on activity). I'm fairly confident I have mine right and with regular testing 10-14 times daily exercise is no concern....I love my bike, I love my numbers, I love life and I think I have reached the stage where although sticking yourself with needles on the bike may turn heads and result in comments like 'go on Lamce'...in which I respond 'gotta keep the EPO levels up' and laugh but I think I can honestly say I love being type one as well....surely there are days where it life would be easier if I wasn't e.g Christmas but sure as Kelly Clarkson sings 'what doesn't kill you makes you stronger'.

Sorry for the waffle,

Regards
Sam

I take Lantus once a day in the morning. When I run I go out before my injection and run up to 5km without an issue. Over that I have a small snack first. If I cycle to work about 7km that is after breakfast and the injection and I have no issues there either. It does make me more sensitive so I did have to reduce my dose to 8 from 10 on though to keep things from dropping low later in the day.

Diamattic said:

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.

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This sounds like a good tactic. What blood sugar would you usually start off exercise at?

JRW said:

I use Levemir once a day for my basal, it does tail off for me after about 20 hrs . I've taken to exercising in the 20-24 hr window after my last Levemir dose, and make sure I don't eat beforehand for a few hours, so this means I have minimal amounts of insulin in my body, so need little or no carbs to offset the cardio exercise BG lowering effects. I took this approach on the recommendation of a sports nutritionist who specialises in working with people with diabetes. She also suggested that if I'm doing weights and cardio in the gym, then to do the weights first as this could raise my BG, and then use the cardio to lower it again.

If doing cardio for more than an hour I will reduce my basal, if I don't then my BG will drop massively after long cardio sessions as my muscles such up that glucose.

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Would you mind messaging me the contact details/ name of your sports nutritionist, because his/ her advice, from what you have shared, sounds really good, and probably a lot more helpful than most healthcare professionals who specialise in diabetic care tbh

If you can get hold of @bebo123 on here, they also have a lot of experience in this area.

bellabella said:

Would you mind messaging me the contact details/ name of your sports nutritionist, because his/ her advice, from what you have shared, sounds really good, and probably a lot more helpful than most healthcare professionals who specialise in diabetic care tbh

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No probs, I'll message you her Linkedin details. I found her advice, and general helpfulness as a beacon of light in what has been an underwhelming support experience from the NHS since diagnosis two years ago.

bellabella said:

This sounds like a good tactic. What blood sugar would you usually start off exercise at?

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A Typical gym day (today actually) means i go straight from work to the gym. So at about 4pm i test my sugars and they are usually between 4-6mmol/L, and i try to eat 20-40g of carbs depending on the workout i plan on doing and what my sugars are. After i eat i drink my pre-workout shake and then around 530 -6pm head to the gym and i test either in the parking lot or locker room, and like to see my sugars between 8-10mmol/L (again depending on how hard i plan on working, just weights means an 8 is fine, lots of cardio then a 10 should be good)

Then i work out, and drive home, take a shower and clean up and by the time i test again before i start dinner prep (around 9pm) i am usually at 4-5 sometimes lower sometimes higher.. but never LOW or HIGH..

Starting sugars really depend on what you ate, how long it will sustain you (ie - a sugar candy, or something long lasting) and what you plan on doing and how much 'work' it is (ie - how much it ups your HR and for how long)

pinewood said:

I'd rather not have to inject twice per day

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With a single or even twice a day injection there is obviously a degree of inflexibility. I use Lantus as par of a basal bolus regime along with Apidra which means 4 injections a day (at least). The Apidra injections vary depending on diet and exercise. It's a bit of an effort but does mean I can do a day of sofa sitting or a day of cycling and dose accordingly, i.e. very flexible. On heavier exercise days then I'll reduce the Apidra to carbs ratio significantly.

I have been using Lantus for about 10 years. Over that time my exercise has varied significantly. I walk to work and home which is 35 minutes each way and, as it is part of my daily regime, I do not count that as exercise. But some weekends I could walk for 5 or 6 hours in day and on holiday I may do this every day for a week or more. Once a week, I will spend 2 hours at the climbing gym. I run (but not far), I cycle and I have a multi-discipline (weights and cardio) session at the gym.
I have not experience problems whilst exercising as long as my BG is around 6 or 7 (unless I am climbing then I need a lower BG because climbing raises by BG). I used to experience hypos the night after exercising. Following a talk from the RunSweet specialist, I have taken to reducing my Lantas on the night when I exercise. This helps me.
Recently, my nurse told me this was not a good idea. Lantas stays in your system for 4 to 5 days (at lower levels). Therefore, reducing the dose for one day will cause an overall reduction for 4 to 5 days and you may experience high BG in the next few days.
I followed her advice and kept my Lantas stable regardless of my exercise and hypoed. Since then, I have returned to my regime or reducing Lantas by up to 25% (depending on the intensity of the exercise) on the night when I exercise.
I guess it just shows that different regimes work for different people and it takes some trial and error to work out what works best for you.

helensaramay said:

Recently, my nurse told me this was not a good idea. Lantas stays in your system for 4 to 5 days (at lower levels). Therefore, reducing the dose for one day will cause an overall reduction for 4 to 5 days and you may experience high BG in the next few days.

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This is the received wisdom with Lantus. Many of us found that it didn't really function like this.

I'm on lantus and when I exercised I did suffer hypos usually around 5pm. If my reading at tea time was less than 10 then I would have 40g of carbs and no injection. Then when I got home again 40g of carbs and a biscuit before bedtime. I read in the diabetes UK magazine in their recent supplement about reducing night dose by 20 per cent on the evening of exercise. I did this last night for the first time. Reading was 23 before bed and was 8.4 in the morning. I also reduced my morning injection by 1 and by lunch time my level was 5.9. So fingers crossed. I will do this again.

I take Lantus before bed and find my morning reading to be between 5.5 and 6.2. I take Apidra solostar 3 times a day with food. had a few Hypos when I have not eaten enough carbs, usually in the afternoon when work gets very stressful. has anyone else noted the effect of stress related to Hypos?