(T1) Exercise making it harder to control sugars at night, any advice welcome !

[Ullrich]

Over the past two years I've built up a really good insulin sensitivity from cycling regularly, which I'm happy about, but my issue is that to stop me waking up low in the morning I need to eat a ridiculous amount of carbs (50g on a easy day, 90g on a hard day) just before I go to sleep. While I still get a nice reading in the morning (4.0-5.5) I know in the middle of the night my sugars can reach 15.0 or something stupidly high before they come down again, which is obviously not good.

So what to do about this ? I guess the most obvious thought is to lower my lantus (I'm on MDI.) At the moment I take either 9 or 10 units (depending on how active I've been that day) about 1 hour before sleep. My concern is I remember one of my doctors mentioning that you need a certain amount of insulin in your system to be able to function properly and he reccommended I just eat more as the insulin is needed to help restore glycogen to my cells after an intense day. So my question is how much insulin do I need to still be healthy ? On a very active day I can use as little as 12 units (9 lantus, 3 humalog) and I'm concerned about using less than that.

My other thought is to move my lantus injection about 5/6 hours before sleep so I have more time awake to control any fluctuations caused by the lantus, though I haven't done this yet. Good thing to do ?

Any advice is welcome, thanks.

 

[ElyDave]

Your doctor is talking out of his hat if he's telling you to eat more for glycogen replacement with no other suggestions. If you are exercising effectively you'll be buurning fats and glycogen, do it right and it can be more fat based. Whilst you need to replace the glycogens, your will still be more insulin sensitive so should be thinking about dose reduction as well

I would consider two or three things there
1) switch to Levemir with split doses morning and night, it's shorter acting and you can tailor doses to activity more easily. I do this successfuly for long duration morning exercise.
2) reduce your mealtime bolus around the cycling - you don't say whether your eating pre or post exercise, either way a reduction could be necessary but it may not be the same %
3) keep monitoring during exercise, every 30-45 mins or so and eat to the meter, trying to keep between 5 and 8.
4) basal testing - you need to get that right first as well before you can get the dose adjustment right, you need to do that without exercise affecting it.

Hope that helps
Dave

 

[Bebo321]

Over the past two years I've built up a really good insulin sensitivity from cycling regularly, which I'm happy about, but my issue is that to stop me waking up low in the morning I need to eat a ridiculous amount of carbs (50g on a easy day, 90g on a hard day) just before I go to sleep. While I still get a nice reading in the morning (4.0-5.5) I know in the middle of the night my sugars can reach 15.0 or something stupidly high before they come down again, which is obviously not good.

So what to do about this ? I guess the most obvious thought is to lower my lantus (I'm on MDI.) At the moment I take either 9 or 10 units (depending on how active I've been that day) about 1 hour before sleep. My concern is I remember one of my doctors mentioning that you need a certain amount of insulin in your system to be able to function properly and he reccommended I just eat more as the insulin is needed to help restore glycogen to my cells after an intense day. So my question is how much insulin do I need to still be healthy ? On a very active day I can use as little as 12 units (9 lantus, 3 humalog) and I'm concerned about using less than that.

My other thought is to move my lantus injection about 5/6 hours before sleep so I have more time awake to control any fluctuations caused by the lantus, though I haven't done this yet. Good thing to do ?

Any advice is welcome, thanks.

Hi Ullrich,
Some good tips from ElyDave there.

Can I suggest you watch the Type 1 case study on the TeamBG website?http://www.teambloodglucose.com/TeamBG/Type_1_Case_Study.html

Also, if you can, I strongly recommend that you try to join TeamBG for the cycle ride around Box Hill on the 6th July. There will be a load of cyclists with both T1 and T2 to talk to and share info with. A face to face chat will be a safer way to help you really get a handle on your BG control.
Consider joining the 'Sporty Diabetic type 1's' facebook group too (find the link from the TeamBG website)

 

[Ullrich]

Your doctor is talking out of his hat if he's telling you to eat more for glycogen replacement with no other suggestions. If you are exercising effectively you'll be buurning fats and glycogen, do it right and it can be more fat based. Whilst you need to replace the glycogens, your will still be more insulin sensitive so should be thinking about dose reduction as well

I would consider two or three things there
1) switch to Levemir with split doses morning and night, it's shorter acting and you can tailor doses to activity more easily. I do this successfuly for long duration morning exercise.
2) reduce your mealtime bolus around the cycling - you don't say whether your eating pre or post exercise, either way a reduction could be necessary but it may not be the same %
3) keep monitoring during exercise, every 30-45 mins or so and eat to the meter, trying to keep between 5 and 8.
4) basal testing - you need to get that right first as well before you can get the dose adjustment right, you need to do that without exercise affecting it.

Hope that helps
Dave

My doctor said a certain level of insulin was required for glycogen replacement, is 12 units is enough to do that after say 6 hours medium to high intensity exercise?

Regarding burning fats/carbs I'm keen to stick to high carb rather than high fat (even though it's harder to control BG levels) to keep up my top end power.

To your points, 1) this sounds like a good idea, will definetly inquire a switch to levemir when I get chance, 2) I always cycle just after I've had a meal, no insulin required or else I go low immediately, 3) I did this when starting out, I know where they are now without having to test, 4) I've reduced my lantus from 16-14-12-11-10 and now 9 as I've become more active, like I said in my first post I'm concerned about going lower than this.

 

[Ullrich]

Hi Ullrich,
Some good tips from ElyDave there.

Can I suggest you watch the Type 1 case study on the TeamBG website?http://www.teambloodglucose.com/TeamBG/Type_1_Case_Study.html

Also, if you can, I strongly recommend that you try to join TeamBG for the cycle ride around Box Hill on the 6th July. There will be a load of cyclists with both T1 and T2 to talk to and share info with. A face to face chat will be a safer way to help you really get a handle on your BG control.
Consider joining the 'Sporty Diabetic type 1's' facebook group too (find the link from the TeamBG website)

Thanks, I will take a look at your site.

 

[noblehead]

You also should take a look at Runsweet, much like Bebo's site it has loads of helpful advice for type 1's who enjoy sport:

http://www.runsweet.com/

Personally I'd reduce the lantus and still take a small snack before bed, say 20-30g and see how you get on.

 

[ElyDave]

My doctor said a certain level of insulin was required for glycogen replacement, is 12 units is enough to do that after say 6 hours medium to high intensity exercise?

Regarding burning fats/carbs I'm keen to stick to high carb rather than high fat (even though it's harder to control BG levels) to keep up my top end power.

To your points, 1) this sounds like a good idea, will definetly inquire a switch to levemir when I get chance, 2) I always cycle just after I've had a meal, no insulin required or else I go low immediately, 3) I did this when starting out, I know where they are now without having to test, 4) I've reduced my lantus from 16-14-12-11-10 and now 9 as I've become more active, like I said in my first post I'm concerned about going lower than this.

My example, when I'm setting out for a long run or ride

Usual morning Levemir is 3U ==> 1U
Breakfast of 45g carbs usial bolus 3U ==> 0.5U just to keep the glucose moving in the right direction

Post ride bolus is reduced by 50% or more.
For a 6 hour ride I'd also thinjk about reducing evening basal.

My basal for comparison on levemir is 3U am and 5U pm at the moment. You shoudl be as low as your sensuitivity dictates - your doctor may not be used to dealing with soemone as active as you are.

 

[Bebo321]

Hi again, there is a level of detail to explain all of this that get quite technical quite quickly, simply put though if you are exercising regularly your sensitivity to insulin is significantly increased. As @ElyDave says, reducing your basal before, during and the evening after an endurance event is mimicking what a 'normal' body would do.... And is the advice given by the leading experts out there. During exercise you will be depleting your energy stores, intra-muscular glycogen and liver glycogen, and your body will want to restock, hence the risk of hypo for up to 48hrs after an event. Depending on your personal fitness/efficiency your body can be using up to 60-90g carbs per hour of exercise, and so if you think of it as a balance, if your muscles are using say 60g carbs per hour for 3 hrs you will have a deficit of 180g. If you consume 2 gels at 60g per gel then you'd still be left with a 60g deficit, PLUS however much your body needs to recover, rebuild etc etc...

Don't worry about the reduced lantus! When TeamBG did the ride from russell to Barcelona last year some of the riders were down to 2 units per day!! There are many who are on less than 8u per day,all are very fit and exercise regularly! Have you thought about joining TeamBG on the ride this year? Www.mhealthtour.com

 

[ElyDave]

I may think about it next year, give my running legs a bit of a rest.

Currenntly laid up with achilles tendonitis getting nervous about a race in 5 weeks now.

 

[darvinadamson]

Body need to be fresh and energetic every time so for this exercise is the best option.

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