Splitting Lantus

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margie

margie

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I have reason to believe that my Lantus does not last 24 hours. However, because I have been ill and doing a lot more tests it has been more apparent.

Levels start going up 4 or 5 (depending on when I had lunch) and I have to inject more insulin per gram of charbohydrate than any other time of day.

I mentioned this in the past to the DSN - who at that time said just cover the gap with your dinner injection. I can do that if I am eating at 6 but if I don't eat till 8 then my levels have increased a lot.

So my questions.

Does anyone here split their dose ?
How did they approach the DSN - and how happy were they to help?
If they didn't help - how did you go about working out the right split / times of day to inject ?

Thanks in advance

Maybe I need to consider changing my basal I don't think I have ever had good results with Lantus.
 
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Hi Margie ...

I think at the moment there is some debate as to whether Lantus does in fact cover a 24 hr period ... I have a strong feeling with Nathan that it does not ..

Can I ask how long you have been on Lantus?

Lantus can be split in to two doses ... but what I was advised in Nathan's case was .. it had to be done exactly 12 hrs apart ... you also needed to be aware of overlapping with the fast acting when doing correction doses. When we tried splitting Nathan's Lantus we didnt get much of an imporovement .. but he is nearly 15 .. so maybe that played a big part as well ... His Lantus was split into 45u at night/25u morning ... but that was individual to him.

Levemir can also be split in to 2 doses.

Have another talk to your DSN .. But if you feel a change of insulin is what you need.. request it to be done

Hope this helps a little

Heidi
xx🙂
 
Hiya

It is a known fact that neither Lantus nor Levemir last 24 hours.

Levemir, if you are lucky lasts between 16 and 18 (approx) hours, whereas Lantus lasts between about 18 and 20 hours.

Before you split it, have you tried taking it in the morning and seeing what happens. Some people find that that works ok and don't need to split it.

People on Levemir generally end up spiliting the dose, 12 hours apart. Most on Lantus don't have to but there are a few who do, my daughter was lucky and didn't have to split it but mornings worked best for her.

You can actually take it whatever time of day you wanted to ie 10 am every day or even 2 pm everyday. It is only done in the evening or morning because that is when people most remember to take it and it doesn't interfere with work or school.

🙂
 
Thanks Sasha and Adrienne.

To answer the questions above here is a bit of background info.
I was on insulatard from 1996 to 2006. For the first part of that I had decent HbA1Cs. However that started drifting I blamed the stress at work - my levels on leaving work would be all over the place dispite the same lunch. When I was on holiday or at home levels were a lot better. I won't go into the work situation except to say it ended up where there was the equivalent of a restraining order in place and I was to be left alone.

I was made rednundant at the end of Dec 2005 and decided to sort things out. Had a HbA1C done at the end of Jan 2006 which was 8.6. I managed to get this down to 8 when I attended the clinic in May.

It was the clinic in May 2006 where it was suggested I move to Lantus and also metformin modified release. They also wanted to add a statin at which point I got upset. My total cholesterol was 4.1 so only just above the new directive to keep it below 4. I wasn't coping very well hadn't fully recovered with the work situation just doing things on autopilot.

I queried the wisdom of starting the lantus and the metformin at the same time. If I had a hypo how would I know which was causing it. The Dr said oh they act in different ways. Er yes but they both affect your blood sugars. The DSN said it was OK to start with the lantus for a couple of weeks then add in the metformin.

I have had only 1 HbA1C under 8 in all since that time - and the advice I have had has been contradictory, increase, decrease, can't make sense of the figures (that was not well received). I am trying to find my old log books to see if there have been issues from the start - though I may have left the data in the meter and not copied it. At the time I would not have been thinking clearly and would not have picked up on anything odd.

I am getting frustrated as the advice I seem to get is your doing fine - when I am not.

So that is the background sorry for the rambling.
 
How bizarre. What is the reason they wanted you on Metformin, are you 1 and 2 !!

I see you are type 1 and you should therefore be on Lantus (or levemir) and novorapid (or humalog). You should be carb counting to get your NR dose correct per meal.

If you are only on Lantus and some sort of metformin I would personally suggest this is not right.

I'm not at home and am off out so can't post again until tonight but if you want me to expand further and maybe help let me know and I'll see your post later.

🙂
 
Re the metformin they said that it was common to become resistant to the injected insulin ( I don't think they had any proof that I was) and that it was now common to add it into the mix after a year. Though I have seen little evidence for that on here.

I have lantus as my background and novorapid for meal boluses. Then the metformin thrown in. I have still to start back on the metformin after my illness - as you are not meant to take it when ill.

One of the reasons I believe the lantus is running out is that I have to take an awful lot more novorapid with my dinner than I do with breakfast or lunch. Lunch is where I need the least but then it runs into the period that the lantus runs out and BMs start to climb.
 
Hi Margie

When my son was on Lantus, latterly we split the dose and it helped a lot with coverage compared to 1 injection. The DSN wasn't happy though and we were told it wasn't recommend or she maybe even said 'approved' to split the dose, I can't remember exactly now. It definitely didn't last the full 24 hrs, it was a 50/50 split. He then changed to Levemir, which was better than Lantus for him and he took more in the evening than the morning. Thankfully he's now on a pump so we don't have background problems any more! 🙂
 
I split my lantus in pregnancy and i noticed the difference! (2/3 of the dose in the morning and the rest 12 hours later) Also I didnt ask anyone if I should or not I just did it and told the consultant at my next appointment thats what I did and she was happy it was working I guess?
I think they expect you to adjust for your own needs well unless your newly diagnosed obviously and dont know what your doing, dont get too worried about what your nurse etc think because through experiencce I have found that you know better than they do in regard to dose adjustments.
The one time I listened and it ended up being the worst advice ever 🙄
if you split your dose and it works then its all good as far as i can see :D No harm what so ever in trying 😉
 
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I split my lantus. I avoided doing it for ages because I really didn't want to do 2 injections of the stuff. It was my DSN that said she couldn't think of another way to get the coverage that I needed and encouraged me to do it. It took a while and I then did decide to do it.

With 1 injection I found that my pre and post lunch results were good, but by pre dinner I was starting to rise and my pre bed readings were high. I could inject more with my dinner and it kinda worked sometimes, but often I was still high.

I started by splitting my dose 50/50 approx 12 hours apart, but have now tweaked the doses and take 6 at night and 9 in the morning. My night dose is always at 9pm, but my morning dose does vary between 6-9am depends when I get up and when i am working. ideally it would be the same time but I don't quite manage it.

It would be a shame not to have your DSN's support, so maybe you could try discussing it again with her.
 
Thanks everyone.

I have sent an e-mail to my DSN - asking her advice. I have also got an appt with the GP on Thursday so will discuss then.
 
Ok so I e-mailed the DSN, she said that the Lantus should be lasting 24 hours and should definitely be lasting longer than I think it. She said I could split it in two (half and half).

I thought this a bit off as if my theory was right I would suddenly have a lot more basal in the afternoon and that would cause me to go hypo.

So I decided to move to the split dose slowly. There has been a definite change in the ratio I now need for lunch and dinner - so I think I am doing the right thing. My morning sugars appear higher but then I think they would if I am right as to how long the Lantus is lasting. I think the split might be better as lunch and bed. The reason I say appear is that my morning sugars have always fluctuated a bit.

Saw the GP yesterday - he wants me to start on the metformin (glucophage) again, but I think I would rather wait till I have got the split fully in place and then wait for a few days in case it is messing with patterns.

GP also wants me to talk to the Community DSN, not quite sure how that will work as I am also meant to be liaising with the one at the hospital - though I know that can be hit and miss. He did say if the Community DSN can't help with the fluctuations then he will give the consultant a call. I have never seen the consultant always seen either a registrar or houseman.
 
Your nurse is wrong, very very wrong and I suggest she does some research with other patients or people who do know what they are talking about.

Lantus, in most people, does not last the 24 hours. Its not far off but not 24. 18 to 20 hours seems average.

You are right, she is wrong. Listen to your gut instincts, they are generally right.

Why is your doc advising you as well as the hospital. This is also not right and could get very complicated for you. As a type 1 you should be under the hospital, GP's are not trained enough in type 1, they hardly see any of them, they will however see lots of type 2 people so I would imagine, and I don't know, that he is getting confused with 1 and 2 and they follow different regimes, at least to begin with.

I wouldn't go on the Metformin until you are happy with your split of the Lantus but that is my personal view only. 🙂
 
Hi Adrienne

My thought on the Lantus is that if it lasts between 18 and 20 hours in me then the morning dose will miss the DP peak, so I think lunch would be better. Its obvious its not lasting 24 hours as otherwise me splitting the dose would not have any affect on my ratios.

I think what happened with the GP - is that when I got quite sick a couple of weeks back and went to the walk in centre that caused some kind of alert in the practice and he decided to look back on my control. So he asked me to come in.

I think that he wants to to talk to the community DSN as he thinks she might be more focused than the nurses at the hospital. He was a little surprised I had been to clinic in Feb ( don't know why if he had been reading my notes). I suspect that the community DSN will say its inappropriate and confusing and that will be the end of that. I don't think the nurses at the hospital will be impressed though it might prompt a bit of focussed thought.

If he contacts the consultant direct that might help because as the clinic I attend is at a teaching hospital the Drs I see are generally not very experienced.
 
I don't know if it helps to think of it like this. By splitting you are moving from one 'gap' in insulin coverage say from 20-24 hours, to 2 smaller 'gaps' of reduced coverage. So you might be right that the dawn phenomenon might be more apparent as you will be having one of those gaps at that time, just before your morning injection. Only basal testing will tell you how much this affects you though

If you are going to have better access to the community DSN, then might be worth switching, but I'd agree that it would be better to either stick with the hospital or go with the community, rather than both because it would get too confusing.

If it was me then I probably would go back on to the metformin, I wouldn't want to get my basal perfectly set, start the metformin and it then not be right and have to start over. But then I have never taken metformin so not sure how much affect it will have on your levels.
 
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