Splitting lantus

[PhoebeC]

So my nurse suggested I split my lantus into two doses.
10 units morning, 10 bedtime.
She said exact times didn’t matter. That feels wrong to me.
She said something like when you rise, when you rest, I don’t like that idea really.
Thoughts?

 

[rebrascora]

I do that with my Levemir. It's about 8am in the morning and 11ish at night but it can vary by an hour or two without too much problem because there is a good overlap in it's activity time.
Be aware that an even split may not be right for you and need adjusting but it is the only place to start. I started on 7 and 7 but that was still in my honey moon period. I am now at 16 in the morning and 5 at night, which seems to be the right balance for me. It took a bit of tweaking over a period of months to fine tune it but heaps better than a single dose. Keeping your Lantus by the bed is probably the best place so that you use it when you go to bed and get up.

 

[Bruce Stephens]

With Levemir the exact times don't matter that much, but the idea is to make the two injections about 12 hours apart and about (within an hour or two) the same time each day. (And probably we mostly do it pretty much at the same times each day just because that's convenient.)

With Lantus I'd have thought precision would be even less important just because it's an even longer lasting insulin. And the "when you rise, when you rest" is mostly because that's convenient for most people, but if you wanted to do the morning one later (after breakfast, say) I wouldn't have thought that would matter. But I'm not sure how much experience there is of splitting Lantus.

 

[Bec2015]

So my nurse suggested I split my lantus into two doses.
10 units morning, 10 bedtime.
She said exact times didn’t matter. That feels wrong to me.
She said something like when you rise, when you rest, I don’t like that idea really.
Thoughts?

I started out with one bigger injection of lantus on a morning, but found that my blood sugars would start to creep up when I was asleep. My DSN and consultant suggested the same thing, we still tweak the doses every now and then to ensure that I have coverage throughout the whole day. I now take 17 units on a morning (I'm terribly insulin resistant in the AM) and 10 units at night.
I'm not sure what the nurse means by 'when you rest', but I was advised to take my evening dose at between 8pm and 9pm to avoid night time hypos (as I can be incredibly insulin sensitive on an evening). Oh the joys!
I think the idea is to provide more of a steady and consistent supply, so that any peaks should just be (in theory) from meals.
You could always try it for a week and see how you feel about it?

 

[PhoebeC]

Well I am giving it a week and seeing how it goes, I know it takes a few days to see the impact.
I’m normally like up and at it in the week about 8am so that’s fine, but weekends I sleep in ha! And then we are normally walking the dog at 8pm so it’s normally 10pm at night.
I will try anything if it might work.

 

[grovesy]

Well I am giving it a week and seeing how it goes, I know it takes a few days to see the impact.
I’m normally like up and at it in the week about 8am so that’s fine, but weekends I sleep in ha! And then we are normally walking the dog at 8pm so it’s normally 10pm at night.
I will try anything if it might work.

You can only try it and see. Good luck,

 

[Schrodinger]

I used to do this with Lantus however the odd thing is that Lantus should last 24 hours in your system, if you have a Libre/Dexcom on monitor you might find that it is not lasting as long as 24 hours think mine was lasting 16/18 hours which needless to say thew a few spanner in the works 🙄.

Splitting did work, but after chatting with my DSN and wanting a back ground insulin to be just that, I ended up swapping.

 

[PhoebeC]

I used to do this with Lantus however the odd thing is that Lantus should last 24 hours in your system, if you have a Libre/Dexcom on monitor you might find that it is not lasting as long as 24 hours think mine was lasting 16/18 hours which needless to say thew a few spanner in the works 🙄.

Splitting did work, but after chatting with my DSN and wanting a back ground insulin to be just that, I ended up swapping.

See I am happy to swap to something else if it will work. I don't mind what insulin I am on as long as it works.

I wonder how long it takes to work?

If I am having it at 10pm, and my levels really rise at 1am it's like the Lantus for the previous dose has well run out at 10pm, and the new dose hasn't even started to work . But I can be in range at 10pm. If it takes hours to work then possibly that's what it is.

I am not sure, I just know that I shouldn't be taking a corrective of Novo before bed so my levels are not dangerous, they have actually been way too high!

 

[rebrascora]

The profiles of the two doses overlap so that as the morning dose is starting to tail off a bit the other is building up so you don't get a period where one dose has finished before the new dose starts because both doses last about 18 hours, but the overlap is where neither dose is at full strength. That overlap period is where both doses are roughly at half strength and therefore amount to the whole dose.
Once you get the dose split and allow it to settle which will take a few days, you can then start to adjust the day and night doses to cater for your individual needs. It may take longer than a week to get it sorted and ultimately it may still not be perfect but there is no guarantee that another insulin will suit you any better either so worth trying to find a best fit with this split dose first and if it is still no good then try something else.

 

[Bec2015]

@PhoebeC I can completely understand you not wanting to take a corrective does of Novo before bed, you run the risk of going too low and I really hate waking up with a hypo in the early hours.

Lantus lasts for about 18 hours as @rebrascora said, and it takes between 1-2 hours to start working. So depending on when you go to bed, how long you sleep for etc - you may end up adjusting the doses to differing amounts. You could always try taking it at 8pm before you go out, and then it should have started working by 10pm when you get in and hopefully avoid the high blood sugars you mentioned.

It's all trial and error, and like you said if you don't like it you can swap back to a single injection or ask to try a different background insulin. Life would be so much easier if it was a one size fits all treatment!

 

[trophywench]

The efficacy of Lantus builds up after injecting and peaks after 4 to 5 hours.

 

[everydayupsanddowns]

I tried splitting Lantus to avoid overnight lows (opposite of your problem!), but it didn't work all that well for me. My next plan was either to switch to Levemir or try a pump... and I’m still on a pump!

Lantus used to ‘kick’ at about 4-5 hours for me, so taking it at bedtime caused me years of problems with severe hypos overnight.

Taking it in the morning was my best bet with Lantus, but it was a pump I needed really, because my basal need is not flat at all!

 

[PhoebeC]

Well it seems to be working, now im just getting quicker hypos out of the blue, which is weird.
Like just before lunch, at the time I would be taking my Novorapid before eating it’s just crashing, so I’m tweaking those doses. Also this heat ha! So typical

 

[mikeyB]

Splitting Lantus is a waste of time. My consultant in Scotland told me that. Because it is long acting, after a week or so your Lantus levels even out to the same as if you were taking a single dose, with the difference being you get two chances of going hypo from the slight peaks when you inject it.

Levemir splits easily because it runs down in around 22-23 hours. That switch has helped me considerably.

 

[Bec2015]

I'm glad that you managed to get rid of the high readings that you were getting over night @PhoebeC. It's always the way that you fix one issue and then something else pops up, I hope you manage to eliminate the hypos you've been having.

I always struggle in the heat, just need to keep reminding myself to drink more water (something which I'm pretty bad at!).

 

[Schrodinger]

See I am happy to swap to something else if it will work. I don't mind what insulin I am on as long as it works.

I wonder how long it takes to work?

If I am having it at 10pm, and my levels really rise at 1am it's like the Lantus for the previous dose has well run out at 10pm, and the new dose hasn't even started to work . But I can be in range at 10pm. If it takes hours to work then possibly that's what it is.

I am not sure, I just know that I shouldn't be taking a corrective of Novo before bed so my levels are not dangerous, they have actually been way too high!

Sorry missed this earlier in the week.

I ended up with Tresiba which has a 72 hours window of effect and a very flat profile, one advantage is that if you miss a dose then it its not so much of a problem because of the amount of time it lasts.

The disadvantage with it is it can take 3 - 4 days for any changes to take effect and can take a couple of weeks of faffing about to get it to where you want it.

I like it much prefer it to Lantus as the hypos off it are nowhere near as dramatic as they could be with Lantus.

 

[m1dnc]

In my pre-pump life, I considered splitting my Lantus because my BG seemed to rise steadily through the day (I used to take the Lantus at bedtime). I discussed it with my consultant and her reaction was "don't bother" because Lantus has such a long lasting action. And that proved to be true when I switched to the pump. For the first three or four days after stopping Lantus and starting the pump I had loads of hypos which was put down to residual Lantus working its way out of my system. Thankfully, the pump solved the problem for me.

However, I can't see any reason why it's not worth a try as long as you closely monitor your BG. Like all things D-related, if it works for you ....

 

[PhoebeC]

Splitting Lantus is a waste of time. My consultant in Scotland told me that. Because it is long acting, after a week or so your Lantus levels even out to the same as if you were taking a single dose, with the difference being you get two chances of going hypo from the slight peaks when you inject it.

Levemir splits easily because it runs down in around 22-23 hours. That switch has helped me considerably.

Well it seems to be working so far, but if as you say it will change back after a week I’ve still got time for that. It could have been something else that changed but that’s the only thing I am aware of