I have just changed from an Actrapid and Insulatard regime to a Novorapid and Lantus regime. I am seeking advice from anyone on this regime with regard to blood sugar levels/carbohydrate consumption etc before and during riding. I asked about this when they changed me over and the dietician and diabetic specialist nurse gave me conflicting advice but both summarised by advising 'trial and error'.
On my previous regime I used to eat a couple of fig rolls and drink a High 5 Energy drink pre ride then top up during the ride with High 5 Isotonic (don't mean to advertise, it's just what I use). This resulted in post ride blood sugar of 6-8mmol/l, pre ride was usually around 11mmol/l.
Currently I am taking 28units of Lantus at 5:30pm and 8 units of Novorapid with Breakfast and lunch, 10 units with evening meal. Rides are 2-3hrs three evenings a week.
Sorry this is long winded but the more info I give the better your advice may be, my question to fellow diabetics is what do you do on this regime, blood sugar levels pre ride, carb intake pre and during ride etc?

Thanks for your help

Mark

Hi

Have a look at the www.runsweet.com website - it has a cycling part which is interesting

My partner uses a similar regime and one problem which seems to only occur when racing is that the overnight insulin may cause hypos during a xc race afer about 30 mins - this has happened three times. I think some trial and error might be useful. We are thinking of trying what Runsweet suggest - which is to change the overnight insulin pre race.

We have noted that hypos have got less predictable which is not so good - but overall non exercise control is better.

It is diffciult to provide advice and I am not suggesting the following is good practice etc as I am not qualified to provde advice. However what we have found is that what you are doing re the evening rides is likely to still be valid with maybe slightly higher post ride sugar - but the possibility of an unexpected hypo - take that emergency mars bar out.

My partner uses either orange juice/water mix or SIS Electrolyte which appears to mostly keep the energy levles high as we stop fairly regualrly. Generally if her sugar is above 10 she doesn't eat and relies on the drinks - but always take out the mars bar/energy gel

I would suggest taking the gluco meter out and doing some regular checks to see how you react

Good luck

Oh - if you ski we have found morning hypos more common on this new insulin - can't see why - though I suspect that a long term back ground insulin may reduce lower sugar levels more quickly - again no real logic to this

Some things to consider here.

Lantus is a very long profile insulin, so an adjustment the night before may not actually have the desired effect.

The biggest difference between the actrapid & Novorapid is the onset & duration of action, novorapid starts to work almost immediately, then peaks & is gone after 2 hours.

If you are going to start exercise within 2 hours of a dose of Novorapid, it may well be worth reducing the dose by anything up to 50%. This really relies on some experimentation, although a 30% reduction is a good place to start.
The only way to trial & error this is to test before during & after a ride to assess blood sugar levels.

Exercise longer than 2 hours after novorapid is unlikely to be effected by any changes in Novorapid doses that you make.

The blood sugar targets that you were acheiving on A&I were very good, but if you consider that Novorapid does not have the same duration of action then the extra carbs you consume may not balance with the insulin in your system & the exercise. Unfortuantely there is a degree of trial & error that needs to take place, everyone with diabetes reacts differently to different situations.

The other site you may want to look at is
[URL=http://www.devondiabetes.org.uk/handbook/exercise.htm]Devon Diabetes[/URL] for another slant on the subject.

OK, so I'm useless at links, http://www.devondiabetes.org.uk/handbook/exercise.htm

The runsweet website sugests - if I understand correctly- is that as the Lantus is very long lasting - the does the night before should be skiped and an normal "long" acting insulin used which will be all out of the system in the morning. Normal fast with feed no more than three hours before competing - aim to be almost insulin free on the startline and use energy output to maintain race blood sugar (i.e. keep it low enough)

Have a read of the cases on Runsweet and I think that is what is being suggested

Anyway - we're of to see Steve Redgrave's advisor (on the NHS!!) soonish so If I understand what up - I'll post

Each carb consumed raises your blood sugar by three points. My mother and a friend were type 2 diabetics and have been able to get completely off injected insulin by monitoring carb intake and regulating it according to activity levels. Here in the US, they have completely dumped the portion control approach to diabetes management and are advocating carb counting. I know my mother's blood sugar levels are only fluctuating between 90 and 110. She checks her sugar several times per day and is very active, walking and cycling.

Hi Mark,

I have just noticed your thread, and found it very interesting. I am a type one insulin dependant diabetic on Humalog three times a day and Lantus at night. I do a lot of cycling, MTB trail riding and the odd XC race, and I time trial every week in the summer on the road, with the odd road race thrown in.

I have found Lantus great. It is always working in the background, so before a race or time trial, I will not have any Humalog, which is a fast acting insulin, and the Lantus seems to work fine. If you are out trail riding try taking Nutrigrain Elevensies, they taste ok (a bit like cake)but seem to have just enough carbo to get you round.

I was out in Glentress today. Got up at 8.30, blood was 9.5. Had breakfast and 7 units of Humalog. Went out riding at 11.30 for 2 hours, blood was 13.1 pre ride, had 2 elevensies on ride and blood was 6.2 on return.

One thing you must be careful of is secondary hypo's as your body refuels it's self post ride.

I hope this help's, let's know how you get on......diabetic nurses and diatitians are not usually much help!!!!

Hi,

I'm currently using Actrapid and insultard and find no probs with that regime and Mtb'ing. Although i've had about 15 years worth of trial and error.

Just out of interest why did they change your regime to Novorapid and Lantus?

I have been on lantus + novorapid for 12 months. My considered oponion is that these are currently the best tools for the job, but definately need a good amount of application and tinkering to get on the right track. I am currently achieving the best long-term blood test results I have ever had in over 37 years of taking various insulin combinations.

Thanks for the help guys, currently still experimenting with blood glucose levels pre ride and carb intake during ride. Still getting unexpected results such as 12.9mmol/l 2hrs before ride and feeling very hungry, 6 units actrapid and 2 slices of toast with marmalade. Rode for 2hrs, drank 1.5litres of High 5 Isotonic during ride, 2.8mmol/l when I finished!!

John,

the reason for change was due to the fact the Lantus Actrapid combination mimics the bodies natural insulin production process very closely, ie always insulin in your system maintaining your blood glucose levels and then doses of very fast acting short term insulin when you eat, just like your pancreas should do in 'normal' people.