Splitting lantus

[vicky1974]

Hi everyone, newly diagnosed type 1

I’m currently on Lantus and Novorapid and lantus is 26 units.

Every morning without fail, whatever I have for breakfast I keep spiking about 9am at 16.1. Then during the afternoon levels lower. I’m sure this is because my lantus has run out or not lasting the full 24 hrs.

My diabetic nurse said I could look at splitting the dose but I didn’t ask for my info. I wondered what other people do? Should you split 50/50 so 13 am and pm or more say 16 units am and 10 units pm.

Getting the hang of the novorapid based on carbs so able to adjust this accordingly.

Thanks

Vicky

 

[trophywench]

Lantus at bedtime at the mo? What time is brekkie? and what BG before brekkie?

 

[Lucyr]

What happens on a morning if you don’t have any breakfast or novorapid?

 

[vicky1974]

Lantus at bedtime at the mo? What time is brekkie? and what BG before brekkie?

Around 7am and it’s 12/13 ish then

 

[SimonP]

It may in fact be dawn phenomenon/foot-on-the-floor - which means you require bolus in the morning even in the absence of food to deal with hepatic glucose production.

What time are you currently taking you basal?

 

[vicky1974]

What happens on a morning if you don’t have any breakfast or novorapid?

Haven’t tried this?

 

[vicky1974]

It may in fact be dawn phenomenon/foot-on-the-floor - which means you require bolus in the morning even in the absence of food to deal with hepatic glucose production.

What time are you currently taking you basal?

Hi I’ve been reading about this. Currently take around 7am

 

[SimonP]

I guess you could try splitting it to see if makes any difference, if it were me I'd start with a 50-50% split and work from there (potentially moving more to the evening to run lower overnight, as it's not quite a flat profile.) Give it at very least a few days with any given combination to see what the effects are. Be a bit careful about going low overnight too, especially if you've exercised during the day (which is part of the reason I split mine and moved away from taking it all pre-bed).

 

[Robin]

I used to be on Lantus, and found it very uneven, with lumps and bumps in the supposedly smooth path. Sometimes after my bedtime dose at 10pm, I’d suddenly crash about 1am, and I got fed up waking from a deep sleep with a stubborn hypo. If I took it all in the morning, it would have run out just when I needed it most when my dawn phenomenon was kicking in. I tried splitting the dose, and it became even lumpier and more unpredictable, so I switched to Levemir in the end, and never looked back. I take an uneven dose of Levemir (6 units am, 3 units pm) together with a couple of extra units of novorapid when I wake up which I regard as purely basal, coping with my dawn phenomenon and it’s the best fit that I've found. (Whatever units I calculate I need for my breakfast, I add them on top.)
*Another thing in Levemir's favour..it doesn’t sting. I hated the eye watering sting of Lantus as I injected.

 

[vicky1974]

I guess you could try splitting it to see if makes any difference, if it were me I'd start with a 50-50% split and work from there (potentially moving more to the evening to run lower overnight, as it's not quite a flat profile.) Give it at very least a few days with any given combination to see what the effects are. Be a bit careful about going low overnight too, especially if you've exercised during the day (which is part of the reason I split mine and moved away from taking it all pre-bed).

Thanks Simon. I’ll give it a go 50/50

 

[vicky1974]

I used to be on Lantus, and found it very uneven, with lumps and bumps in the supposedly smooth path. Sometimes after my bedtime dose at 10pm, I’d suddenly crash about 1am, and I got fed up waking from a deep sleep with a stubborn hypo. If I took it all in the morning, it would have run out just when I needed it most when my dawn phenomenon was kicking in. I tried splitting the dose, and it became even lumpier and more unpredictable, so I switched to Levemir in the end, and never looked back. I take an uneven dose of Levemir (6 units am, 3 units pm) together with a couple of extra units of novorapid when I wake up which I regard as purely basal, coping with my dawn phenomenon and it’s the best fit that I've found. (Whatever units I calculate I need for my breakfast, I add them on top.)
*Another thing in Levemir's favour..it doesn’t sting. I hated the eye watering sting of Lantus as I injected.

Thanks Robin. I know it’s going to take some time to get it right but thought maybe splitting it might help. I’ve read about Levemir but am I right in saying it’s being discontinued?

 

[Robin]

Thanks Robin. I know it’s going to take some time to get it right but thought maybe splitting it might help. I’ve read about Levemir but am I right in saying it’s being discontinued?

No, it’s not, in the U.k. anyway. I think it’s being discontinued in the USA. They also discontinued an older form of pre-filled injection device, called the inulet , I think, earlier this year in the U.K.

 

[Inka]

Thanks Robin. I know it’s going to take some time to get it right but thought maybe splitting it might help. I’ve read about Levemir but am I right in saying it’s being discontinued?

No, it’s not being discontinued. IMO, you’d be better considering a change to Levemir or another twice daily insulin than splitting the Lantus. I’m on a pump, but like Robin when I have a pump break my basal split is quite uneven and I take more in the morning than at night.

 

[mashedupmatt]

I was switched to Levemir from Lantus and it is easier to split your doses (it works for a shorter period of time than Lantus) - When I'm doing lots of exercise (weekends) I can lower my evening dose to avoid overnight hypos - I always seem to need more in the morning (both basal & bolus) which is very common

 

[Inka]

Hi I’ve been reading about this. Currently take around 7am

And this could be another problem. It might be that it would be better for you to take your basal in the evening. Indeed, that’s the more usual time. You’d have to move it gradually.

I’d try moving the timing of your Lantus first, then if that doesn’t work, I’d look at a proper twice daily basal.

 

[vicky1974]

No, it’s not, in the U.k. anyway. I think it’s being discontinued in the USA. They also discontinued an older form of pre-filled injection device, called the inulet , I think, earlier this year in the U.K.

Thanks Robin that’s good to know. I must have read something from the USA. I’ll look into Levemir. I’ve read a lot of people find it better.

 

[vicky1974]

And this could be another problem. It might be that it would be better for you to take your basal in the evening. Indeed, that’s the more usual time. You’d have to move it gradually.

I’d try moving the timing of your Lantus first, then if that doesn’t work, I’d look at a proper twice daily basal.

Thank you. I’m just worried if I take it at bedtime I might go too low in the night?

 

[vicky1974]

I was switched to Levemir from Lantus and it is easier to split your doses (it works for a shorter period of time than Lantus) - When I'm doing lots of exercise (weekends) I can lower my evening dose to avoid overnight hypos - I always seem to need more in the morning (both basal & bolus) which is very common

Thank you

 

[Inka]

Thank you. I’m just worried if I take it at bedtime I might go too low in the night?

Do you have a Libre? If so, setting your Low alarm in the 5s should reassure you. I understand your concern but it’s a balance between taking it in the morning so you don’t have to worry about nighttime lows and having it run out just when you need it. You might even find you can take less if you take it in the evening. It’s all a case of tweaking this and tweaking that. Sadly, there’s no magic answer - just what works best, weighing everything up.

I’d try Levemir if you’re uncomfortable about taking the Lantus in the evening. Levemir is the recommended basal, I believe, and doesn’t run the risk of the so-called Lantus hypos as it has a different mode of release.

 

[rebrascora]

I use Levemir and it works well for me and my split is very uneven. Currently 18 in the morning and 0-3 at night depending on activity.
I did an experiment a couple of months ago to see if I could somehow adjust this uneven split because sometimes I still hypo overnight even with no evening dose if I have done a lot of exercise or physical activity for a few days.
My experiment was to stop all basal and just inject bolus insulin every now and then a bit like a pump does and I had about 7-10 days of this including waking once or twice a night to inject before I started to reintroduce my evening Levemir but still continue just using bolus insulin during the day, then I gradually started to reintroduce daytime Levemir and gradually increased it until I wasn't needing regular corrections. Oddly my basal split has ended up almost exactly as it was before the experiment, with a very big dose in the morning and hardly any at night. I guess this is just the right split for me. I wanted to have more at night so that I had more room to reduce it after activity, so if I took 6 or 7 units and I needed to reduce that I could reduce it by 1 or 2 units each night for a few nights to get down to 0 but with only 3 units I can only reduce it by 3 units in total and if I still hypo at that level, I have to start to reduce the morning dose which often means that I then need corrections through the day.

Like @Robin I also use 1.5-2 units of bolus insulin on a morning as soon as I wake up to cover my Foot on the Floor Syndrome, even if I am not having breakfast, but if I am going to eat, I inject the breakfast bolus at the same time, before I get out of bed, to give it a good head start and I inject my basal then too so that it gets going asap. If I wait until I get up, my levels start to rise rapidly (FOTF syndrome) and then I become more insulin resistant and it all takes a lot longer to be effective and sometimes I have to inject even more insulin in the form of a correction later than I would have needed, if I injected it before I got up.