# Night hypos after exercise



## Marie Weeks (Apr 17, 2018)

Hi, my son is 16 and has always been very sporty. He was diagnosed at the age of 1. We have always founds exercise difficult and as he is getting older it is getting harder. He will train in the boxing gym for an hour and a half, finishing at 7pm. Bloods are perfect throughout. We reduce novorapid by 50% for evening meal and he has supper without insulin, tonight this was a banana and a pot of custard. Went to sleep with bloods of 11 but from midnight to 4.30 he was below 3, eating and drinking everything in sight and afraid to go to sleep. He has exams soon and I am really worried. What can we do, he is shattered and missing too much school. Do we avoid insulin at night?


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## Lanny (Apr 17, 2018)

Hi, Marie!

I’m not type 1 & also, despite what it says under my avatar picture, haven’t joined these forums that long ago: early March 2018! But, I remember reading about a post by “Northerner”, the administrator of these forums, about a famous sportsman & his insulin needs on his training days.

I’ve looked for that thread & post but, can’t find it! I read a LOT of threads & posts in a short space of time: soaking up info! But, found the BBC sports page posted below:-

http://www.bbc.co.uk/sport/get-inspired/36225872

Welcome, this is a very friendly place with lots of help available. Other people, I’m sure will be along with their helpful suggestions!

@Northerner, could be very helpful in this instance!


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## Northerner (Apr 17, 2018)

Marie Weeks said:


> Hi, my son is 16 and has always been very sporty. He was diagnosed at the age of 1. We have always founds exercise difficult and as he is getting older it is getting harder. He will train in the boxing gym for an hour and a half, finishing at 7pm. Bloods are perfect throughout. We reduce novorapid by 50% for evening meal and he has supper without insulin, tonight this was a banana and a pot of custard. Went to sleep with bloods of 11 but from midnight to 4.30 he was below 3, eating and drinking everything in sight and afraid to go to sleep. He has exams soon and I am really worried. What can we do, he is shattered and missing too much school. Do we avoid insulin at night?


Hi Marie, welcome to the forum  Great to hear that your son is so into his sport, it will really help him with his blood sugar control in the long-term. Unfortunately, there are these problems to overcome sometimes, but I am sure that, once he has a handle on how his body behaves, hthey will become few and far between 

What basal insulin is he using? Does he reduce this as well as having the adjustments to his novorapid and extra snack? Exercise makes the body very insulin sensitive for up to 40 hours after the exercise session, so the body becomes much more efficient at using it, hence the reduced requirement. Also, muscles that have used up their 'local' supply of glycogen will look to replenish this, thus lowering levels, and finally the liver will seek to replenish its stores of glycogen that it may have released earlier during the exercise. As all this is going on it's not surprising that levels can reduce quite substantially over quite an extended period, so reducing basal insulin is also sometimes necessary.

Has he been considered for a pump? I think this would help him enormously as you can have much tighter control about how much insulin gets delivered and when - it may be that he needs no basal insulin at all for a period overnight, but if using injected basals this fine tuning isn't possible, and it's not advisable to skip a basal injection.

I'd recommend getting a copy of the Diabetic Athlete's Handbook, which helped me enormously after diagnosis - I have been a runner for over 35 years and wanted to know as much as I could so I could get back into it. I ran the Great South Run four months after diagnosis  The book explains the body's physical processes and has information applicable to all sports, aerobic and anaerobic. He may also find the Runsweet website useful. It was set up by the guy who got Steve Redgrave back up to strength after his diagnosis and he went on to win his 5th gold medal in the Sydney Olympics, so a reputable source of information! 

Very good luck to him on tackling this awkward aspect of managing Type 1 and sport  Please let us know how things go, any information will be helpful to our other members


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## Marie Weeks (Apr 17, 2018)

Thank you for your response, any advice is great.


Lanny said:


> Hi, Marie!
> 
> I’m not type 1 & also, despite what it says under my avatar picture, haven’t joined these forums that long ago: early March 2018! But, I remember reading about a post by “Northerner”, the administrator of these forums, about a famous sportsman & his insulin needs on his training days.
> 
> ...


hankbyou 


Northerner said:


> Hi Marie, welcome to the forum  Great to hear that your son is so into his sport, it will really help him with his blood sugar control in the long-term. Unfortunately, there are these problems to overcome sometimes, but I am sure that, once he has a handle on how his body behaves, hthey will become few and far between
> 
> What basal insulin is he using? Does he reduce this as well as having the adjustments to his novorapid and extra snack? Exercise makes the body very insulin sensitive for up to 40 hours after the exercise session, so the body becomes much more efficient at using it, hence the reduced requirement. Also, muscles that have used up their 'local' supply of glycogen will look to replenish this, thus lowering levels, and finally the liver will seek to replenish its stores of glycogen that it may have released earlier during the exercise. As all this is going on it's not surprising that levels can reduce quite substantially over quite an extended period, so reducing basal insulin is also sometimes necessary.
> 
> ...


Thank you so much, he was on a pump when he was younger but teenage years cane along and the pump went! I am hoping that as he gets older he will change his mind. He is only in 10 units of Levimir so I will try reducing that also.
Thanks again
Marie


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## Northerner (Apr 17, 2018)

Marie Weeks said:


> Thank you for your response, any advice is great.
> 
> hankbyou
> 
> ...


Does he split his levemir, Marie? If so then it may be possible to give less at night. If not, probably worth trying to split it. What didn't he like about the pump? Certainly in the US, most serious athletes will be on pumps (and probably on CGM - Continuous Glucose Monitor - too). They give far more flexibility, especially in a varied training program


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## stephknits (Apr 17, 2018)

There are quite a few new pumps out there which might be better suited to him.  Might be worth a new look.


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## SB2015 (Apr 17, 2018)

Splitting Levemir can be very useful to tackle overnight hypos.  It makes  it possible to reduce the dose at night whiteout effecting the day time basal insulin.

Otherwise as others have said the pump can make things a lot more flexible.


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## HOBIE (Apr 18, 2018)

Marie Weeks said:


> Hi, my son is 16 and has always been very sporty. He was diagnosed at the age of 1. We have always founds exercise difficult and as he is getting older it is getting harder. He will train in the boxing gym for an hour and a half, finishing at 7pm. Bloods are perfect throughout. We reduce novorapid by 50% for evening meal and he has supper without insulin, tonight this was a banana and a pot of custard. Went to sleep with bloods of 11 but from midnight to 4.30 he was below 3, eating and drinking everything in sight and afraid to go to sleep. He has exams soon and I am really worried. What can we do, he is shattered and missing too much school. Do we avoid insulin at night?


Welcome Marie. Kids !  Whoed av em ?  His head will be stressed with exams too. My bg always goes low with stress. Tell him well done for being so active.


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## everydayupsanddowns (Apr 18, 2018)

Good that you are on Levemir. Not sure when he takes it?

If exercise is always on planned days it might be worth considering a smallish reduction (say 10% or 20% or as near as you can round that in units) for the dose before the exercise will happen? As Northie says the body can have reduced insulin needs for a while and can be more insulin-sensitive.

You could increase the un-bolused snack I suppose, but I would worry that you might push levels up steeply before the sleep/rest/insulin sensitivity stuff brought it down.

A Libre or similar might help you to see what was going on between the finger pricks, but I don't think they are taking on new customers at the moment.


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