Splitting basal doses

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Mumpie_olgran

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Type 1
Does anyone have any thoughts and advice on splitting doses? I'm on 20 units Lantus which I currently take first thing in the morning.
Two thoughts triggered the idea of switching
1) I travel a bit and it feels like splitting it would make time zone adjustments easier
2) I'm pretty happy with the base load in aggregate as my BS (currently!) stays pretty flat overnight. But I do find I fairly consistently drop BS throughout the morning and early afternoon and I just wondered if maybe the insulin was more effective for me in the first 6-8 hours. Such that if I split it, maybe I can be more accurate on total needs
Sorry if someone has already posted on this, I'm not very good at searching the back history
Thanks in advance for any thoughts
 
Only ever took single dose of lantus before pump change, found it give decent coverage & don't recollect that it caused many hypos.

Are you sure morning hypo is result of your basal & not breakfast insulin?
 
nonethewiser said:
Only ever took single dose of lantus before pump change, found it give decent coverage & don't recollect that it caused many hypos.

Are you sure morning hypo is result of your basal & not breakfast insulin?
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Hi thanks for the reply. Yes petty sure on that front as it happens on days when I don't have breakfast too (maybe once or twice a fortnight). Today for example I was ticking along at high 8s on my dexcom, took the basal at around 6 and I'm now at 5.9. (indulgently I still haven't got up so can't put it down to any activity)
I do also appreciate that one day today is not a pattern, but it does feel like I'm getting a trend across a few
 
Think if you see a pattern then your basal is likely causing low bg levels, maybe ask to switch to another basal rather than split dose, there are some which last a lot longer than lantus & are said to be less likely to cause hypos, names just elude me at moment.
 
You could ask to swap to Levemir which is a twice daily basal. You could then have less/more at night as needed.
 
I tried splitting Lantus, but I found it was even more lumpy in smaller doses, so I had a more pronounced 5hr peak twice a day. I switched to Levemir, which I split unevenly , 5 in a morning an 3 at night, I had to jiggle the doses around to find the best fit. I now tend to rise in the morning, but I shovel a couple of units of short acting in to counteract it, irrespective of what I have for breakfast, and I don’t get the sudden and alarming drops at 1am that I sometimes got with Lantus.
 
Following this thread as I’ve been wondering about this for ages.

I use Levemir but as a single dose at night of 28U which gives me cover pretty much throughout the following day. My last basal test I did showed it holding steady and a really flat line until 7pm, never got around to testing the 7pm onwards slot. My DSN when I asked about splitting the dose has always said, it looks like it’s working well now so leave it as it is. I guess I need to really do a basal test for 7pm onwards, especially before my next DSN appointment next month.
 
Eternal422 said:
Following this thread as I’ve been wondering about this for ages.

I use Levemir but as a single dose at night of 28U which gives me cover pretty much throughout the following day. My last basal test I did showed it holding steady and a really flat line until 7pm, never got around to testing the 7pm onwards slot. My DSN when I asked about splitting the dose has always said, it looks like it’s working well now so leave it as it is. I guess I need to really do a basal test for 7pm onwards, especially before my next DSN appointment next month.
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A basal test for the rest of the day from 7:00 pm sounds like a good plan, and if the single dose is working for you then as your DSN has said no need to change it. You know that there is the option of splitting Levemir if you needed to in the future.
 
I use split dose Levemir, but my split is very uneven and I need a much larger dose in the morning and my night time doses are much more variable depending on exercise than my daytime. If I have exercised extensively for several days in a row I need to reduce my night time dose consecutive evenings until I am no longer taking any, so whilst I consider that I take a split dose sometimes the split is 20/0 for several days ie not split at all... and other times such as today, it might be 24/5. I need what I need, when I need it and Libre is wonderful for enabling me to see that and learn to adjust it to what I need and understand all the different factors that I need to take into consideration when I dial up that night time dose... or occasionally adjust the daytime dose.
 
SB2015 said:
A basal test for the rest of the day from 7:00 pm sounds like a good plan, and if the single dose is working for you then as your DSN has said no need to change it. You know that there is the option of splitting Levemir if you needed to in the future.
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Sounds good, the trouble is I tend to eat most of my carbs at the end of the day, so whilst a basal test up until 7pm is easy enough for me, doing one in the evening is harder! Still, I think it would be well worthwhile as I’m guessing the basal effect must be wearing off by then according to my dose/kg of Levemir, but the extra NR I’m taking for eating more is probably hiding that fact.
 
Thanks for all the replies.
It seems odd to me that Levemir is able to be single dose for 24hr or can be split but Lantus can't. Is that just one of those diabetes quirks?
I think I'm going to stick with Lantus for a bit as 1) I'm still fairly new to T1 and suspect I've got a lot more to learn before I get too cute with it
And 2) I've relatively recently got a new stash of Lantus and it seems a bit wasteful to switch before I at least get through this lot. MDI is not something that sits well from a waste and packaging perspective already!
 
Mumpie_olgran said:
MDI is not something that sits well from a waste and packaging perspective already!
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Do you use refillable pens, I.e. the pens that take insulin cartridges? A lot less waste than disposable pens, but of course there is still wastage of needles and their caps, the insulin cartridges themselves, etc. Add the Libre packaging, applicators, etc. and there is indeed a lot of waste involved.
 
Eternal422 said:
Do you use refillable pens, I.e. the pens that take insulin cartridges? A lot less waste than disposable pens, but of course there is still wastage of needles and their caps, the insulin cartridges themselves, etc. Add the Libre packaging, applicators, etc. and there is indeed a lot of waste involved.
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Yes just switching to the refillable ones which is part of the reason I have some backlog. A few disposable ones remaining and now a new batch. Maybe I should have thought about levemir before getting the snazzy new pen
 
Mumpie_olgran said:
Yes just switching to the refillable ones which is part of the reason I have some backlog. A few disposable ones remaining and now a new batch. Maybe I should have thought about levemir before getting the snazzy new pen
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You can use Levemir in reusable pens and half unit pens are available that will take Levemir.
Certainly a lot less wastage with those, and the half unit pens make dosing so much more accurate.
 
Unfortunately, Lantus uses different reusable ones to Levemir. So a swap to Levemir at the end of your current supply if cartridges would require new pens.

I have Lantus as my pump back up basal and was advised I could split it l. The purpose of the split was to overcome the issue that it does not last a full 24 hours. But did not help the different requirements day and night
 
Mumpie_olgran said:
Thanks for all the replies.
It seems odd to me that Levemir is able to be single dose for 24hr or can be split but Lantus can't. Is that just one of those diabetes quirks?
I think I'm going to stick with Lantus for a bit as 1) I'm still fairly new to T1 and suspect I've got a lot more to learn before I get too cute with it
And 2) I've relatively recently got a new stash of Lantus and it seems a bit wasteful to switch before I at least get through this lot. MDI is not something that sits well from a waste and packaging perspective already!
Click to expand...
Levemir isn't a 24 hr insulin although NovoNordisk claim it is. If you look on the web at the 3D graphs depending on dose it's more typically a 15 hour insulin. Lantus does last a bit longer. I've always split my Levemir and occasionally split it three ways to bring my BS back into the right region (my consultant was horrified as it breaks the rule book but it can work)
 
I split my abasaglar (lantus) dose. I used to take 18 units before bed (when I moved across to novorapid and abasaglar from Soluble and Isophane I was asked which end of the day I preferred and stuck with it), but found that I had two problems: the main one was that I needed to decide the day before if I was going to do a long bike ride and reduce insulin then (I was more of a commitment-phobe when I started riding, and less keen to get wet!), and the other was that I tended to run low after long rides unless I reduced my (evening) dose, but would then run high the next day having done this.

So I split the dose 50-50% and converted in one go (9U one evening, followed by 9U the next morning).

I certainly find it's more useful for exercise as I can decide in the morning what I'm going to do (and reduce that dose/skip it completely), I can also just take my normal dose the evening after a long ride without any adjustment. My working assumption is that as the reduced morning dose is not contributing so much/anything that evening/overnight, I don't tend to get post-exercise overnight hypos.

The one thing I would say about then moving the quantities around is that as the duration of the insulin is quite long, it would be worth plotting the effectiveness curves to see what sort of dose adjustments/timings will work best for you (and where the stacked effect of tweaking a given dose actually changes how much active insulin is in your system - it's a surprisingly long time after the injection). I'm surprised there's nothing official to help with this, I wrote some MATLAB code, though I'm not altogether sure how effective/accurate it is (not helped by changes in insulin sensitivity during the day - e.g. I get dawn effect, and am very insulin sensitive in the early afternoon)
 
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