Splitting 24 hour insulin

[Becka]

I have been prescribed Abasaglar to take every night. Is it a worthwhile or stupid idea to split my insulin doses between morning and evening so I can be more flexible?

The past week I have not had any appetite so have no eaten much if anything, so skipped taking it on Tuesday, Wednesday, and Thursday reflecting this. I ate on Friday so took my normal dose, in part because my levels had been rising anyway and having not taken anything they were too high after eating

Yesterday I only ate a sandwich in the afternoon, but my evening fasting level was still higher than it should be, so I took a half dose last night. This morning was fine at 5.1 but after eating a couple squares of pizza this afternoon (nothing that would normally be a problem) my evening fasting level was 10.7.

I have no idea why I have been put on a 24 hour insulin, though I assume it is because they are trying to for me to a pathway rather than respond to my presentation.

Splitting it (so long as equidistant) should make no difference in normal times, but for those like now I will be able to be reactive at night and proactive in the morning. i.e. last night I did not want to take too much insulin having not eaten since the afternoon, but knowing this morning that I was going to eat something I could have taken more in advance to compensate. At least that is my thinking. But I would like to know whether there is a good reason against it, other than moving home so I can be treated by a better health trust. (Though only because of the hassle and expense otherwise I would be doing that.)

And yes, I know how stupid that sounds and what the obvious response should be. But I cannot write my own prescriptions so it is what it is. My previous threads have covered how difficult it has been just to get to this point. When I asked the nurse about such situations she just said to modify my dose to suit, which is difficult when not knowing how I will feel tomorrow to know my needs in advance. Besides which, there is no balance between taking more to avoid a high tomorrow with taking less to avoid a hypo now. So I have to work around their pathways, or whatever, to do find a way to do the impossible myself.

Incidentally, this lack of appetite started the day after speaking to my G.P. about having been not feeling too good. So I am currently waiting on blood results and can talk about this new symptom, if it continues, when they come back.

 

[Kaylz]

If it's a 24 hour basal insulin then this is something that should be taken whether you are eating or not, it's to keep you steady in the absence of food so not quite sure why you are altering it on whether you eat or not xx

 

[everydayupsanddowns]

I think the only way to know if splitting Abasaglar will help you would be to try it and see.

I tried splitting Lantus (another glargine) but couldn't get it to work for me, but I’ve seen others who split Lantus to great success.

 

[Ljc]

Hi. Long acting insulin’s are not meant for meals, they are to deal with the glucose your liver puts out to fuel your body between meals , so you should take it whether you eat or not.
Rapid insulin’s such as Novorapid are fir meals and should not be taken unless you are going to eat or when doing a correction.

I know nothing about your particular long acting insulin, so I suggest you doeskin to the person who prescribed it re splitting it.

 

[Ljc]

Just found and had a very, very quick read of tis pil for Abasaglar , seems it’s meant to be injected once daily
Patient info leaflet

 

[Becka]

If it's a 24 hour basal insulin then this is something that should be taken whether you are eating or not, it's to keep you steady in the absence of food so not quite sure why you are altering it on whether you eat or not xx

I am not on an MDI regimen and can naturally produce enough background insulin. My problem is being unable to produce anything extra than that, when I eat my levels go up then come down very slowly. So even though it is a basal insulin, that is why I take it, which is why I say I do not understand why that is what they prescribed.

It is now over seven hours since I last ate anything, and I am still only down to an 8.2

I think the only way to know if splitting Abasaglar will help you would be to try it and see.

I tried splitting Lantus (another glargine) but couldn't get it to work for me, but I’ve seen others who split Lantus to great success.

Thanks, that is what I needed to hear. I did not want to just experiment without first making sure that there was not a reason why it would be a really bad idea. But if it is something people have done it then it seems safe to try.

I have gone for half again this evening as I will only eat a little something tonight, such as a biscuit, so I can take my tablets then can reassess in the morning whether to take more.

Just found and had a very, very quick read of tis pil for Abasaglar , seems it’s meant to be injected once daily
Patient info leaflet

Yes, it is a 24-hour insulin so normally only needs to be taken once a day. In theory the effect should be the same whether you take a full dose at 10pm every day or a take half doses at 10am and 10pm every day. So why inject twice when you can do it once?

In my case because it is what I have been prescribed based on my c-peptide levels and I was told to manage my dose myself. Last March my morning and evening fasting levels were 14.1 and 13.6, and it took until January to get this prescription. Last month I was 6.2 and 7.6, so I just want do the best I can with I now have to keep my levels under control without hypoing. Because I do not like hypos.

 

[Lucyr]

You really shouldn’t alter the basal dose to what you eat. It is designed to keep you steady between meals. If you take more then you have a higher dose working for 24hrs including when you are sleeping and not eating which could be dangerous. It would be better and safer to find the dose that keeps you steady without eating, then record your blood sugars after food and talk to your nurse or doctor about fast acting insulin based on those BGs.

 

[Becka]

I have been explicitly told to alter my dose! I was told to keep increasing it to get my morning level under 6, but also to lower it as necessary when circumstances require.

I have settled on 34 units to achieve that target, but because of how slowly my levels were falling last night I took 22 (roughly two-thirds normal). I had trouble falling asleep so that probably did not happen until around 2am, but then woke just after 6am with a heavy-feeling headache. I could not properly get back to sleep but was able to doze for a bit and when I tested at 8am I was 4.8.

Normally when I hypo whilst sleeping my head is very sweaty when I wake, but that was not a problem today. However despite currently experiencing headaches and migraines, the one I woke with was the different sort that comes with a hypo. So no idea if I did have one last night, I did not feel any other symptoms when I woke, but that is why I am trying to avoid.

Whilst I know Abasaglar is a basal insulin, I have never been told to treat it as such. I have no idea why I was prescribed it in particular, but it was done so based on a C-peptide level which showed that I could produce a normal fasting level of insulin amount but not more. So the nurse and head doctor who consulted on it knew what my body's needs were, and this is what they decided upon.

All things being normal though, taking 17 units in the morning and 17 at night should not be a higher dose. The round-the-clock effect should be the same, if keeping them twelve hours apart: constantly having 34 units sloshing around. But with greater flexibility to alter (downwards) as required, which is what I was told to do. If I stick to once a day it is effectively all or nothing, because once taken I cannot lower it so then need to force eat to avoid hypos. But if I do not take it and eat I go too high as I cannot produce enough insulin.

So in my opinion they have got my insulin needs the wrong way around, but they are medically trained specialists and I am just someone who has read stuff online. Although given my experience over the past year of not being listened to and being given really bad advice, I am just grateful to have been given a tool, however appropriate, that I can make use of to best suit my needs.

 

[Becka]

I will say this, no matter what I do I seem to be struggling. I am afraid to go low as I am to go high. Which is a little crazy when a high now would have been low last year. A few days ago my stomach was feeling very unsettled though and I felt I needed to eat something for that reason, rather than hunger.

And so I have been trying to eat at least an evening meal. The consequence of which is my levels later are normal post(-post?) prandial ones. So I take my normal insulin dose. Then one morning I wake up and test as 4.1 when I wake up. Mind the last two days I was over 6 when I work, which is outside my target. But not eating in the day meant my evening reading was 3.9 on Sunday (no symptoms, so hopefully just dipping rather than a proper hypo, but I took something then and ate shortly after anyway). And yesterday I did feel symptoms but slight so thought I would wait to see if they get worse. They did not, and by the time I did my evening test I was 5.2. But took a full insulin dose again as I was 9.4 about three to four hours after eating. Back on target this morning, 5.8. Although not the best of nights, woke an hour before I actually got up, feeling nauseous, and could not get back to sleep. In hindsight, maybe a hypo too, but academic now.

So no conclusions yet, other than I need to put more effort into it. Tow months to practice before my follow-up appointment with the diabetes clinic. Although I have an early HbA1c as part of the tests my G.P. order into my stomach discomfort and migraines. 7.1% / 54 mmol/mol (which is how the G.P. read it out to me). I have not been given a specific target for that, but that is almost the generic target and with my morning average of 5.8 mmol/L I wonder how importantly they will regard the extra 0.2 points. Nothing was made of being 7.2% in the summer of 2019, even though in hindsight it was showing the beginning of the end of my supercharged output. Just a shame I do not have my glucose readings from then, as I am curious what they were. Particularly as I am pretty sure my morning reading would have been higher than they are now.