Constant Hypos then Highs due to to much exercise

[scott.kat131]

My husband recently started a new job which means he is out on foot or bike for sometimes 10 hours at a time...on top of that he has always excerised so likes to keep up with either going for a run or to the gym...His weight has dramtically shifted over the past few months which isnt a problem as he still looks healthy..i.e.not to skinny..yet! lol.....My main concern is that because of all the excersise he is suffering with hypos sometimes 3 during the night as a consquence to this he may get highs during the day...He has been a tightly controlled type 1 diabetic for the past 12 years and is really starting to suffer emotionally with what is happening..he has reduced his lantus to 26 units a night (im convinced this injection brings his blood sugar levels down but the experts say not!) and injects "rapid" insulin on ratio of 1 -10 carbs. His 6 monthly diabetic clinic appointment has been moved by the hospital to the beginning of next year as they are so busy I dont know where else to turn to to try and get him some support as I just feel helpless for him to see him getting so down with it all...any help would be greatly appriciated many thanks

 

[Copepod]

Welcome Scott Kat

While we're not able to give medical advice, there are a few things that might help your husband's situation - at least during the wait for clinic appointment.

For general advice and information about physiology and sports / activities with type 1 diabetes (not just running), www.runsweet.com is an excellent resource.

Also, many people have found that splitting their long acting insulin into 2 doses, helps to lessen night time hypos. Exact times and ratios of the two doses depends on what suits the person - some people split exactly 12 hours apart, half and half, while others prefer injections at getting up and bedtime, with ratio adjusted eg 30% / 70%; 40% / 60% etc.

Many people find that their carb:insulin ratio varies through the day - while 10g:1u is a good strting point, it may need tweaking. DAFNE (Dose Adjustment For Normal Eating) is available online at http://www.bdec-e-learning.com/ (free registration required)

 

[everydayupsanddowns]

Hi Scott.Kat

Whoever said that Lantus is not able to drop BG levels needs a good shaking. When I was on Lantus I needed to change my dose depending on whether I was attending the gym over those weeks, or was having a break, and at various other times too.

If your husband has recently significantly increased his level of activity it is perfectly possible that he will need to adjust his basal insulin dose.

There's a great description of what basal insulin is for, and how to test whether his current dose is correct here: http://www.diabetes-support.org.uk/info/?page_id=120

My suggestion would be to investigate basal first and get that dose right, then move on to tweaking meal doses/ratios. My experience is that if basal is out (either too much or too little) it will mess up everything else.

 

[trophywench]

Hiya - I echo what Mike said. That's a very good link he's given you too.

It works! (testing your basal requirements in the manner suggested)

 

[Robster65]

Hi scott.kat. Welcome 🙂

Echo what's been said.

Basal and bolus ratios need to be adjusted to compensate for increased exercise. If he's sticking rigidly to 1:10 then he will see more hypos. It is a flexible system that allows the ratio to be adjusted to whatever is suited, as well as basal adjustments to prevent hypos.

His weight loss is presumably because much of his carb intake is being lost through his kidneys because of the rebound highs and his body will burn fat and muscle instead.

If it were me, I would find a phone number to contact his DSN/consultant and keep leaving messages until he/she rings back, then confirm with them what he needs to do.

As said, we can't tell you what he should do but we can explain the workings.🙂

Rob

 

[scott.kat131]

Thanks

Hi thanks to you all for your replies..I appreciate all the advice, think it confirms what we already know to be honest but just nice to know support is there when you need it...thanks again 🙂

 

[Robster65]

Hope you manage to find a solution. 🙂

Do stick around and let us know how things are going btw. It's always good to get progress reports and may help someone else in a similar position.🙂

Hypos have become public enemy no.1 since the DVLA rules changed, as well as being a long term health risk, so please tell his clinic off for not being very supportive.

Rob

 

[trophywench]

I've just thought where the 'difference of opinion' between your take on Lantus and 'the experts' view, might lie.

Lantus - or any long acting insulin we use as our 'basal' or 'background' insulin - is not intended to deal with anything we eat. It's just supposed to eg keep our hearts beating, our lungs breathing and all the stuff that the body does within that we can't see. Then of course we eat some carbs and lob in some fast-acting to deal with them.

But - nobody tells the Lantus to leave the carbs alone, and nobody tells the Novarapid or whatever, to leave the internal organs to the Lantus and keep its nose right out of it.

So, if at that moment your heart lungs liver and lights don't happen to need as much Lantus as you have floating round - because you've taken exercise or lost weight or the weather has turned hot - it will just use itself on whatever it can use itself on, cos it can't turn itself off.

So yes it will lower BG from food, although that isn't what it's intended for! LOL

In practice, any insulin that happens to be in the body of any type, nationality, colour or creed, injected or naturally produced, will work on whatever the body needs insulin for, moment by moment.