BI

Hi All (and happy new year!)

I have taken this week off work to experiment with my BI dose, exercise regime and then QA ratio's and would welcome any help/insight you could offer.

In terms of my current state I am taking 20u of BI (lantus) before bed. What I am noticing is that when I test in the morning my blood glucose level has dropped over 2-3 mmol/l. To me this suggests that the BI dose of 20u is too high.

However, the problem I have is that my blood glucose level rises between waking up (7am) and lunch time (12-1pm) even without any carbohydrate portions. Therefore my concern is that dropping the BI below 20u will cause my blood glucose levels to rise even higher before lunch. What I should mention (which may be a factor) is that I exercise 20-30 mins (weight lifting) each morning between 7-7:30am. I am not taking any carbohydrate portions or QA insulin between waking up and lunch (I am only exercising).

Any help would be greatly appreciated

Hi John. Happy New Year.
Perhaps your exercise is strenuous enough to increase your insulin resistance, contributing to the rise. We of course release Epinephrine, or adrenaline for 'Fight-or-Flight' and this makes us insulin resistant.
You may wish to consider splitting the BI between morning and night too.
Regards
Garry

Thanks Gary, that is very helpful.

I wondered whether the rise after weightlifting may be due to my liver releasing glucose as a response to the high intensity exercise and that due to there being no QA insulin present the glucose is not able to be converted into energy hence causing the rise. As such, my plan is to inject 1u of QA insulin immediately before exercise (even without any carbohydrate portions to see what impact this has). Any thoughts on this as a potential solution? Of course I will carry hypo treatment (just in case it swings the other way!)

John

word of caution, as ever, if you consider splitting your BI dose discuss this with your Diabetes team first. Generally people split BI dose when on Levimir rather than Lantus, since Lantus does tend to last longer. Its not impossible to split Lantus just a bit more unusual.
I agree that exercise may wel lbe increasing your BG. Also remember that exercise can cause your BG to drop for around 24 hours so
it may be a reason for the drop overnight rather than just BI being too high.
Sadly there is no 'correct' answer so experimentation is the only way to test how it works on you as an individual....

I agree with Gary & Mark, I probably wouldn't split the Lantus, maybe lower it if you're dropping and give a little bit of QA for the exercise.

I am a keen cyclist and found this when I first started, I always assumed exercise just lowered BG, but I have found an early morning ride with no carbs or QA, if I push it really hard my BG will rocket for the first hour as hormones and liver kick in, any longer on the bike and the BG will lower, but not as much as you expect without a bit of QA, with exercise especially prolonged it is a fine line between some QA for the liver/muscle glycogen/glucose dump and too much, still not mastered this yet, if you do try a bit of QA as I suggested, have some sugar ready! Also if its prolonged exercise remember what Mark said that you may need to lower, even half your QA for the next few meals.

Hope this rambling makes sense and helps.

I knew there was a reason why I avoid strenuous exercise

Hi John, individual experimentation and frequent testing is the key there is a very good book ''Your Diabetes Science Experiment'' by Ginger Vieira which gives advice on this and lots of useful background information on exercise and managing diet and insulin.

Firstly, thank you all for responding, the insight is really useful. Following consecutive nights of hypos I have now reduced by BI from 24u to 18u. I am injecting 2u of QA prior to exercise and this has helped to offset what I guess is the natural release of glucose from the body (provoked by the weightlifting). As you guys say - trial and error is the best bet using the dafne principles for guidance.

Suec - many thanks for the recommendation. I have just bought the book on Amazon. Only £6!

Kind regards

John