Hypos during Exercising

Shoehorn,
Not a big biker myself but have walked/run home over 6mi with local bus if needed and available. Prior to learning to drive I used to split a cab with other commuters which was not too expensive.
I take Lantus too maybe if you shoot it in eve it would beat the end of its ~23hr lifeline and dropping of during eveningcomute.

Does your company do ride shares? maybe you could do that from time to time. If not I think taking a break midway to test eat and rest midway may be best. Maybe you could get a small electric motor attachment for your bike if they exist.

Great tip mike as to the split I was going to suggest a 5/4 or 6/3 split I do my doses every 12 so over 24h period I get about same but when I'm more active I can drop it by 2 by taking 1unit less for each dose.

Maybe 7-8 units on weekday and 9 on weekend for Shoehorn.
A co worker of mine suggested the 12 12 split and It's been great for me. Basal will be an easier adjust when I get a pump. the .1 or lower dosing options will be faster and easier to adjust.

what can't you use 1/2 units. i have 1/2 unit syringes and use them everyday. also, if you're on MDI - basal, it takes at least 72 hours for adjustments to take effect, as it has a half life, so my endo told me. cutting back 1 or 2 units on the same day won't make that much difference. Lantus - levemir stays in the system for a long time. Also, i'd caution those who say levemir only lasts for 12 hours, that's not true for everyone. some use only 1 dose levemir. some split their lantus it just depends on the person. If you're going low, eat glucose tabs, jelly beans, they have virtually no calories and it's what you need to get your BG's up.

guess i still don't understand this split levemir dosing and how it works. if one, say, takes 9 units of levemir once a day and say it only lasts 12 hours, how is that splitting of 4.5u every 12 hours going to work? it's less insulin making it last even less. if one takes 9 units of levemir and it lasts 12 hours don't you need 18 to make it last 24 hours. it's released slowly under the skin.

Levemir lasts UP to 24 hours. The activity profile starts to diminish at something around 20 hours, so splitting the dose can reduce the effect of having the insulin tail off. The first day is problematic, however.

thanks, mike. yeah, the problem with that though, at least for me, is two does overlap too much. again, instead of splitting 1 dose, wouldn't one just add maybe 1 or 2 units to that one dose to make it last 24 hours? or, on the flip side, i'm sorry but I don't understand how splitting that same dose lasts longer because you're lowering the dose (cut into 2) even more?

Adding more to one dose won't make it last longer, it just gives you more insulin.

During the first 24 hours you have half the insulin in your system as you have already figured out. For ease of an example, let's assume you need 24 units/day, the insulin does actually last for 24 hours, and it gets used evenly over the day. With one shot, you will have 1 unit/hour in your body, with two shots twelve hours apart, you will have 0.5 units/hour in your body for the first 12 hours, then 1 unit/hour after that. The first 12 hours will probably require some fast-acting insulin to correct for the missing basal.

If the insulin tapers off during the last 4 hours of its duration, the profile for one shot might look like 1.1 units/hour for 20 hours and then 0.8, 0.5, 0.4, 0.3 over the last four hours. Again, splitting the dose would give you 0.55U/hour for the first 12 hours, 1.1 for the next 8 hours, 0.95, 0.8, 0.75, 0.7 for the last 4 hours, then 1.1 for the next 8 hours, followed by the slightly lower amounts for 4 hours, repeating the same pattern after that, if the insulin is taken every 12 hours.

Of course, YDMV, so Levemir may taper slightly differently for each person and each day, depending on all the variables that makes managing T1D so much fun!

Thanks for the replies guys.

Have a meeting with my Endo in two weeks so I will be hammering him with your suggestions.

This is a great suggestion, Sam. It always works for me. Unfortunately, its simplicity and the small effort it takes often leads to discounting its value. I’ve learned many lessons from this technique because patterns become perceptible once you can view your data over larger lapses of time.

How many hours between your last major meal and your bike ride home? The best way I combat lows is my combination of food & insulin before I exercise. You also have to take into account your activity level up to the time you do your exercise. Are you running around like a headless chicken before your bike ride? Sitting at a desk? Or does it vary from day to day?

All of these will shape your reaction to insulin. Also, your newness to Type 1 means you probably have some residual insulin production. It astonishes me how many non-diabetics don't understand that managing our diabetes is not Carbs/insulin-to-carb-ratio = perfect blood glucose levels.

The best way to start I think is to first find out if your basal insulin is at the right level. Then move to insulin-to-carb ratios for meals. You will soon find that your insulin needs vary (both basal and mealtime) but you can only change your mealtime & correction doses on MDI to correct situational lows.

You may be frustrated for a while because your insulin needs may be changing very quickly, so hang in there and carry juice cartons for those times when you suddenly have too much insulin. Your variability may not change, but your experience dealing with it will make it easier in the future.

Try the Diabetic’s Handbook. It may help a lot. I work out every day, but every day is different. Some days it’s an 8 mile bike, twice a week it’s strength/toning, some barre days, cardio days - I do it all! So every day is a challenge - a lot of trial and even more error. I am on MDI and handle it pretty well with a combination of food, timing, how hard I work out… Honestly, we are all different, so what works for me probably won’t work the same for you. It’s a constant science experiment. As for the weight loss - I find I have to save some calories for eating before/during/after exercise and I use fruit and very few nuts for carbs instead of a protein bar. Fewer calories, more carbs, with a little protein. Losing weight now is the same as it is for everyone - energy in must be less than energy out. Before, you were probably able to eat more and not gain - or lose - weight because your body could not process carbs without insulin. Get used to your new normal, and you will lose it over time.

T1D is a self management disease/condition. You will find that you will feel more comfortable making changes without talking to your endo - and some endos are better than others. It sounds like you are doing great!!

I need to update that, my last one was 5.2%

I actually believe that the laws of thermodynamics are misunderstood and misapplied. But this isn't about calories in calories out. This is about exercise aimed at preferentially burning fat. If you have a hypo while exercising you have three options.

  1. Don't treat it, stopping exercise or risking bad things.
  2. Treat it to normalize blood sugar
  3. Overtreat
In case 1 you won't be able to burn fat, you exercise session has basically gone bust. In case 2 you can restore normal blood sugar and continue in a fat burning mode. And in case 3 you can continue exercise but your body will shift from fat burning mode to burning excess glucose.

My point is that in case 2 the carbs don't contribute to bodyfat accumulation and they don't disrupt fat burning. In terms of overall additional to carb load for the day they add zero. In general Bernstein and others suggest that carbs taken to treat (not overtreat) a hypo to normalize blood sugar don't count in your daily carb total and don't count in bolus calculations.

I've got a ? about that (as usual)....sometimes, when I eat a high carb meal my sugars spike, as might be expected. But, sometimes, when I expect them to spike, they don't. Can I safely assume that when there isn't a spike (like I expect), my liver is storing the sugar for a 'liver dump' the next time I wake up or exercise? Sometimes I get a liver dump, or DP, upon waking, and sometimes I don't. I wonder if I don't see a correlation between no post-dinner spike and next morning DP. But, maybe this is all in my head...

Oops - that should be the Diabetic Athlete’s Handbook. Very informative.

I don't think one can answer this. Diabetes is just so messed up and unpredictable.

I assume you're not on a pump yet? They are great because you can turn down your basal rate (baseline insulin) about an hour before you exercise, and you can keep it reduced for as long as you need to even after your exercise is done. I'm not athletic but I'm pretty active with various activities like hiking and dancing, and I used to have the same issues until I started pumping. Not that I never go low, but it makes it much easier to manage.

"matching your insulin to your intake of calories"

Surely that should read "carbohydrates"? Otherwise I've been doing it wrong for 31 years ;-P

pumps are good for treating predictable patterns. If that pattern is super predictable, then a pump will help. If its not really predictable, then it might make things worse. Sounds pretty predictable, though. I vote pump.

I'm not clear on why the benefits of a pump wouldn't be equally applicable to unpredictable situations. The pump gives you a degree of granularity (i.e. the ability to dose in increments like 0.01) and flexibility (i.e. the ability to manipulate your basal insulin in real time) that seem, if anything, even more useful to someone who's less predictable.

For example, if I realize I'm having an odd high day, or high afternoon, easy to crank basal insulin up to, say, 250 percent, and then maybe lower it again a few hours later when things seem more normal again. With MDI basal insulin, you're stuck with whatever you injected 12 or 24 hours ago.