My 16 year old son (diagnosed 4 yrs ago) went off the pump a couple of months ago. Instead, he takes Lantus, which is split into am and pm doses...he has dawn phenomenon so he gets more in the morning. Total Daily Dose is about 70 units. He plays football and wrestles and had figured out how to prepare for them, using a combination of temp basals and extra carbs while on the pump. Football season is starting, and we have no idea how to adjust his Lantus.

Any input is greatly appreciated. Thanks!

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That is interesting. Exercise will have different effects on individuals and the kind of exercise also affects how your body responds. I find that aerobic exercise (like running around) makes my blood sugar drop during exercise. Anaerobic exercise (like weightlifting or football) makes it go up. For many, competitive sports (like football) also cause stress and increase blood sugar.

My experience is that most of my exercise increases my blood sugar and I have to actually bolus for my training. After training, I am significantly more insulin sensitive and can reduce my meal boluses by half. My experience is that during days and weeks of training (as opposed to times off), because I am more insulin sensitive, I need to reduce my basal levels. I think that most people will find that basal requirements overall drop during seasons of training.

ps. And I deliberately use the term Darn Phenomenon, cause I hate it.
And what you said is interesting also, thank you for sharing. But I do disagree with one statement you made, when you said most people will find their basal requirements drop during seasons of training. In my non-insulin resistant child, her basal will go up during periods of time when she is very physically active. I thought that was odd at first also, but her endo confirmed that's what happens with type 1 children. Your basals going down appears to be something that happens to T2 diabetics, and not something that happens to most people.
In my type 1 son, his basal requirements have always dropped in the past once he gets into regular practices for his sports. I think he could definitely lower his basal right now because he is fighting lows after his practices and overnight, even after reducing his meal boluses significantly, but he is very resistant to reducing his Lantus even one unit to see what will happen.

Again, I find that D is such an individual disease...
Scubasu, I think you and I are talking about different things. I mean after you factor out the exercise induced lows the basal does go up.

Have you considered that maybe he's not having dawn phenomenon, maybe he's coming off the post-exercise lows and going back to his normal rate? We went through a period of time when we thought my daughter was having the dawn phenomenon, because her BG would rise quickly in the morning. But it was just her coming off her nighttime post-exercise lows.
I think that most people will find that when they move from a sedentary lifestyle to active training, their bodies will become more insulin sensitive and that there will be a marked decrease in their basal needs. Sheri Colberg notes that many diabetic athletes (and she is talking about T1) require only low levels of basal insulin. You may find that the additional stressors throughout the day related to playing sports leads to an increase in basal needs. Again, everyone is different.
Okay, point proven :) though she doesn't say that the basal is reduced because of insulin sensitivity. I've been meaning to read The Diabetic Athlete's handbook, but every time I borrow it from the library I procrastinate
We had already figured out that Lantus is pretty forgiving within a 24 hour period. After being on the pump, it was tough to remember to even give the basal insulin so there were a couple of times he just forgot to take it. Fortunately there was not much of a difference for his BG over the next 12 hours. We conquered that challenge by scheduling daily reminders in the ever present cell phone.

Like your daughter, my son typically experiences delayed hypoglycemia after a lot of excercise. He has learned he has to carb load to replace the glycogen stores in his muscles and liver or he will suffer lows up to 48 hours later...we learned this the hard way. I make sure I test him at night to catch those scary lows.

I think I have learned that Lantus is probably not going to work for my active 16 year old and I need to get him into the endo to discuss other options. Thanks so much for sharing your experience. Diabetes is such an individual disease that nobody's body reacts exactly the same way, but it is comforting to know that some experiences are "normal" and consistent for everyone and to have some different ideas on how to address the challenges.
I did the same thing you did and forgot my daughter's Lantus shots a couple of times, and also figured out that it doesn't make a big difference right away. I wonder why doctors always leave us to find these sorts of things out for ourselves?

i am a type one diabetic and i am also on lantus in morning and pm . it works out well for me . i have always been very active i workout in the morning and usualy have sugars that are in the low hundreds when i wake up so i dont get a shot for my food that i take in before my workout and i use a heart rate monitor to see how hard i am workingout so if i am workin out hard then i can usually tell if i will go low fast. i take in 20 carbs to start and then ck about 30 mins into it and get more if i need to. i also use a heart rate monitor to see how many cals i burn because that usually adjust my lantus to that .. so basicly depends on 2 things how hard i am workinout and how many cals i burn ..if i burn alot of cals then i know i wont need as much lantus in the day same for nite if i workout at nite i dont need as much around dinner time

Curiously I'm on Lantus twice daily (9+9 in summer) and I am about to persuade my insurance company to let me use an OmniPod for precisely the reasons you describe. I find that because I can't change the basal dosage if I decide to do something strenuous I have to be extremely careful for the following few days.

Well, I *could* adjust the dose, at the next 12 hour period, and probably I *should* adjust the dose to cope with the fact that my body will spend the next 24 hours or so rebuilding glycogen that I just used, but I simply don't know how to conduct the required experiments to determine the dose variation. I've sometimes dropped by a unit, but the results were inconclusive - my BG varies so much anyway that seeing an underlying basal trend was pretty much impossible.

I figure that with a pump and a CGM I can lower my basal dose after a few hours and, by tweaking it, eventually get a flat-line BG when I'm neither eating nor excercising. This remains to be seen; so far as I am concerned it's a diabetic fantasy until I can actually try it out. Clearly it will take many months to get this right, if, indeed, it works at all.
Even when he was on the pump, my son had problems with delayed hypoglycemia after strenuous excercise. For instance, during wrestling season the kids have really hard 3 hour workouts every evening. He would actually take the pump off during the practice and still have overnight lows. There is no way to get around having to replace the glycogen stores, but I don't think he spent as much time tweaking the basals as he could have. He just used it as an excuse to ask mom for a milk shake! ;)

I do think that Lantus tends to be "forgiving" and small dose changes would not make a big difference, which is why I came begging for help with this. I think Lantus is obviously not the best choice for my son now that sports have started again.

Good luck with the Omnipod. A pump can definitely make life easier and I can hardly wait until our insurance company covers a CGM. I think an important thing to remember in your "diabetic fantasy" is that consistent excercise and diet are the easiest thing to adust for. As I said in a previous reply, my son has experienced delayed hypoglycemia up to 48 hours after strenuous excercise, especially if it is something out of his normal routine.

Thanks for taking the time to reply.
I'm in no way consistent about anything, perhaps to the point of being foolishly inconsistent, but I had one experience many years ago that maybe informs what I do today with the basal dosage.

I was out on a whole day hike. I'd had my normal amount of long acting insulin (ultratard; it was really long acting but is no longer available) and I started to go low. It just kept on going regardless of what I ate. I ate all the sandwiches, a whole Mars bar (a truely fantastic amount of carbohydrate for me) and just kept going down. Fortunately my glucagon response is good, but what I learnt is that basal insulin is downright dangerous.

So my Lantus dose is probably, technically, too low. Certainly it is too low for several days of computer hacking, or one day of driving, however the risk of raising it is too great. This is part of what I hope to get from the Omnipod - a basal dose that can be stopped!

I always looked for length in the basal insulin - that's why I liked Ultratard and hated having to use Lantus instead. But maybe this is actually exactly wrong. NPH has been around a long time and is non-prescription in the US, so is a lot cheaper. I started out life (well, diabetes life) on PZI, which is similar, but I've never used NPH. I think, maybe, if my insurance company bounces the Omnipod, NPH might be a better choice for me than Lantus.




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