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May 30, 2003

Exercise and Sports, Insulin Analogs

Question from Edson, Alberta, Canada:

My 15 year old son is on NPH with NovoRapid at breakfast, NovoRapid at supper and evening snack, and NPH at bedtime. His glucose readings are great except for high supper levels, and his doctor would like him to enter a Lantus to achieve better control. However, my son plays a very high level of hockey, and when he plays, we reduce his bedtime NPH significantly and leave his morning NPH the same. Are you finding that children involved in active sports reduce their dose of Lantus like this?

Answer:

Lantus is a peak-free insulin that has effect throughout the 24 hours and is thus equivalent to the basal rate on an insulin pump. It is usually given at bedtime and calibrated against the fasting morning blood sugar, and, because it has no peak action, it is not necessary to give a bedtime snack.

In your son’s case, vigorous exercise seems to tend to cause hypoglycemia in the early part of the night. However, you could control it not by changing the Lantus dose but by reintroducing a bedtime snack on high exercise days. Lantus has been shown to reduce the incidence of night time hypoglycemia in a number of studies.

DOB
Additional comments from Dr. Stuart Brink:

Lantus is somewhat smoother and more predictable than NPH (or Lente or Ultralente insulin) so we don’t find that the same dose decreases are needed. However, this is very variable and very individualized so such decisions should be made based upon actual blood glucose monitoring results rather than dogmatically.
SB