My 13 year old son, diagnosed with Type 1 diabetes about six weeks ago, has just switched from NPH with NovoLog to Lantus with NovoLog, and his insulin to carb ratio is 1 unit to 60 grams of carb. He is ranked third in the US in fencing (for his age group and weapon), and during the summer, he fences 1.5 to 6 hours per day. On lighter fencing days, he has also been doing Bikram Yoga (90 minutes, very strenuous). We had reduced his Humalog to zero and put meals right before exercise to avoid lows. Can we do the same with NovoLog?

Yes you can do the same. In the case of your son, the amount of exercise per day is very high and this can be beneficial for the treatment of diabetes, so you can decrease the dose of insulin accordingly.

AS
Additional comments from Dr. Tessa Lebinger:

If your son was recently diagnosed with diabetes and is going through puberty, his insulin requirements may change drastically over the next year. Whatever worked a few months ago, may not work now. I am not aware of information about fencing with diabetes, but it should be like any other exercise with regard to its effect on the blood sugar.

He will need to test frequently and work with his own doctor to work an individual plan. If he usually fences at the same time every day, it will make it easier. If he fences at different times of the day on different days, you might have to make different adjustments on different days depending on whether or not he is fencing when his insulin is peaking. You might find he needs less insulin and/or food on fencing days.

TGL
Additional comments from Dr. Larry Deeb:

I have several athletes this age with new type 1 diabetes who do intense exercise. It’s likely he will be on Lantus alone. Try get the morning glucose to about 100 mg/dl [5.6 mmol/L], and he should be okay.

LD
Additional comments from Dr. David Schwartz:

All this activity will ultimately be such a good thing for your son — establishing such good habits now.

NovoLog for most practical purposes, can be used the same as you did for Humalog. Indeed, he could have been maintained on Humalog when he switched to Lantus. Since Lantus cannot be mixed in the same syringe with other insulins, I generally advocate that the bolus injection be given with a pen. Humalog comes in disposable pens and NovoLog has refillable pen cartridge systems.

Since your son was diagnosed so recently, he is probably in the honeymoon which makes management easier but can also make some folks complacent about meals and carbohydrate counting. You can do “little wrong” during the honeymoon as extra carbs generally are accounted for by the patient’s own residual pancreatic insulin production.

DS
Additional comments from Dr. Donough O’Brien:

Your son’s story is a remarkable tribute to vigorous exercise although I suspect that as the months go by he will need Humalog or Novolog again. I see no reason to distinguish between these two analog insulins.

DOB