# the inevitable hypo...



## Daisylauren (Jul 12, 2017)

I've recently started exercising a lot more that I used to and have taken up cycling and zumba. The trouble is that every time i exercise i experience really late onset of low sugar levels and despite running them higher during exercise can't seem to avoid this. The most recent example was last night when they were 15.1 after exercise/before bed and I didn't treat but woke up at 4am with them at 3.4. 

It's happening on a regular basis as i'm exercising daily and i don't know what else to do! i'm currently on injections with novorapid and glargine (i know that the pump would be the best option for me but have to wait to discuss that further with diabetic nurse) does anyone have any advice for what I could do?


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## Northerner (Jul 12, 2017)

Hi Daisylauren, welcome to the forum  This isn't uncommon. How long after injecting/eating are you exercising? I try and get a balance where my food is digesting as my insulin starts to peak and find this helps. Often, what can happen immediately after exercising is that your liver releases extra glucose from its stores in order to replenish the glycogen that has been used up in your muscles - this can lead to levels going higher, but then dropping back as this glucose release slows. Paradoxically, having a small snack post-exercise can help stop/slow this release from the liver and reduce post-exercise highs. I usually have a Belvita biscuit after a run  Also, exercise makes your cells much more insulin sensitive, and this can last for 24, possibly even up to 48 hours after the exercise, and this then causes you to drop low much later. Are you reducing your insulin doses for meals post-exercise? You may also need to reduce your glargine dose as the extra sensitivity, particularly from sustained, regular exercise, can mean your dose is too high. Awkward for one a day doses like glargine, and as you say a pump would allow more accuracy.


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## SB2015 (Jul 12, 2017)

To deal with the awkwardness of post exercise when on MDI,  I was switched to Levemir which meant that I could split that, and do a reduction at night following an exercise class. This worked well for me, but as you have said a pump makes it even easier to deal with.


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## stephknits (Jul 12, 2017)

Yes, your best option would be lowering your basal for the time period after, where you get the lows.  As SB says, easier with something like Levemir and much more flexibility with a pump.


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## Copepod (Jul 12, 2017)

Lots of good info on www.runsweet.com and Team Blood Glucose website.
Regular, predictable exercise usually responds to reducing basal insulin to lessen chance of hypo. The other thing to consider is time between last short acting jab and starting exercise session.


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## Matt Cycle (Jul 12, 2017)

Agree with what's been said so far in that split Levemir doses in my opinion would be more flexible.  Apart from being able to split it, Levemir responds quickly to altered doses, i.e. there is little time lag compared to some other basals.  Even if you got the approval now for a pump actually getting it would likely be months away so I would say a change in basal is probably the best option at the moment if you discuss it with your DN.

I'm mainly doing aerobic exercise (cycling) and this will always reduce blood glucose levels over the course of the ride.  When exercising I try and aim for a level between 7 and 10 (don't always manage it of course ) and nearly always alter basal.  Depending on what I've done and for how long I will also reduce post exercise bolus.  As Northerner said over time you may find your insulin sensitivity improves in general and if you maintain the exercise your doses reduce on a more permanent basis.


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## HOBIE (Jul 12, 2017)

No two days are the same with me. You lean all the time but exercise is really good for you . Welcome


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## Daisylauren (Jul 13, 2017)

thanks everyone for your help and responses - it's a nightmare, think i'll try lower glargine in the first instance and post exercise meals to see what happens - i guess it's very much trial and error with this situation, everyday change for me too so could do the same bike ride two evenings in a row and have completely different outcomes!


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## Northerner (Jul 13, 2017)

Daisylauren said:


> thanks everyone for your help and responses - it's a nightmare, think i'll try lower glargine in the first instance and post exercise meals to see what happens - i guess it's very much trial and error with this situation, everyday change for me too so could do the same bike ride two evenings in a row and have completely different outcomes!


It's a real pain, isn't it?  And one of the problems is that there is no clear-cut way of dealing with things, as what works for one person won't work for another.

Have you considered getting a Freestyle Libre? It can be very helpful in working out patterns and seeing trends, and heading off hypos, although not during the night as it doesn't alarm - but it does make it a lot simpler to test during the night.


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## Pigeon (Jul 13, 2017)

Just to second that a move to levemir would help. I do a lot of exercise and it was very tricky with lantus as any reduction in dose didn't really take effect for a few days. I switched to levemir (would love a pump but hospital say no) split morning and evening and you can successfully reduce the dose morning and evening on days when you exercise.


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## Daisylauren (Jul 14, 2017)

Northerner said:


> It's a real pain, isn't it?  And one of the problems is that there is no clear-cut way of dealing with things, as what works for one person won't work for another.
> 
> Have you considered getting a Freestyle Libre? It can be very helpful in working out patterns and seeing trends, and heading off hypos, although not during the night as it doesn't alarm - but it does make it a lot simpler to test during the night.



I have considered it - it would make it so much easier and save my fingertips but unfortunately it's just too expensive at the moment!!


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## Bloden (Jul 22, 2017)

Daisylauren said:


> thanks everyone for your help and responses - it's a nightmare, think i'll try lower glargine in the first instance and post exercise meals to see what happens - i guess it's very much trial and error with this situation, everyday change for me too so could do the same bike ride two evenings in a row and have completely different outcomes!



Nightmare is the word!

If I've exercised or been physically active, I lower my insulin-to-carb ratio at the next meal or I'll deffo go hypo. E.g. my lunch ICR at the mo is 1:12 which I change to 1:15 after exercise (ie aerobic activity).

As for my basal, I changed to Tresiba in April (from Lantus) and find that it isn't as sensitive to activity as Lantus was, so I haven't had to tweak that dose yet.

The most annoying thing is trying to make exercise part of my daily routine so that there'll be less nasty surprises (in theory!)...life always seems to get in the way.

Good luck luck with your trial and error, Daisylauren.


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## Radders (Jul 23, 2017)

Before I got my pump I used to have quite low basal doses and compensate with quick acting as I found it more flexible that way and was exercising more days than not. As others say, Levermir was better but in my case other than a gradual reduction over time, I didn't change that on a daily basis as it then made it even more complicated working out my carb ratios.  I also find it easier to exercise after small meals so I can reduce the bolus insulin to compensate for the exercise. 
I found that as my fitness increased, the effect of exercise in reducing my blood sugar lessened to the extent that I now use almost my normal ratio before the cycle to work. 
It's always changing!


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