Anyone splitting Insulatard dose

[binney]

Hi all
Have been taking Insulatard insulin pre bed for about 10 months now after being on Lantus. :thumbdown: The reason for the change was because I was having high readings pre breakfast and not great overall. Since being on Insulatard the pre breakie readings have improved but am getting high post evening meals.(Am taking Humulin S as a bolus)So I have just worked out all the peak times,duration etc if I was to split the dose so I had some at pre bed and then again around lunch time.It all looks good on paper but before I embark on this regime thought I would check with you all if you have any experience or tips on doing this? All info will be very gratefully recieved.
Many thanks
Binney

 

[jopar]

I would run your workings out's through your DSN... See what they say

It certainly sounds as though it's running out of steam at its tail end, so does make sense to split it for better coverage, but whether you split it into a dinner time split is difficult to say, normally the split would be a AM&PM split!

As you do need to consider how the profile is going to work, as insulatard takes about 1 hour to start working, then peaks between 4-6 hours then tails off drastically until 12 hours in, then much gentle for the last 12 hours! So you've got to think about the knock on effects of this... When is the main peak going to hit, and how is the tail end going to mix together!

Perhaps if you need a split injection, moving over to Levimer which seems to give less hassle then Lantus,and splits a lot easier than lantus, even though it's profile doesn't suggest it dose!

 

[binney]

Hi Jopar
Thanks for your reply,yeah I will have to monitor glucose levels carefully where there is a slight over lap.I am hoping that ultimately if I can get my basal working better I will be able to reduce my bolus doses and hopefully lose weight and improve my HB A1C.Those are the goals I am forever striving for,this journey never ends even after being type 1 for 24 years
Thanks again for your reply
Binney

 

[jopar]

Have you done any fasting tests, to see who far out your basal might be?

 

[binney]

No I havn't done any,my pre breakie BS can be a bit up and down and if I get up in the night I will do a test but not ever done a proper fasting profile.Got any tips on doing that?

 

[jopar]

Fasting tests are a good idea..

Tips for fasting tests...

Firstly, ensure you've got plenty of test strips and hypo kit..
Second, if you start to hypo or blood glucose becomes too high, abort the fasting and treat accordantly.
Avoid heavy exercise, so normal housework but no heavy housework...
Avoid heavy exercise prior to testing (gym, cycling, running etc) as these can have a knock on effect to BG hours after you've finished them.
Also avoid high fat content foods, pasta, rice, pastry at least a meal before fasting... So a morning fast don't eat these types of food the night before, night time fasting, best to avoid all day or at least after lunch.. This helps to ensure that it's not impacting on the blood glucose hours later.
I would section the test off into 3 sectors, morning, afternoon, night...


I normally start with the morning sector

BG, when I get up and every hour until at least dinner time, but I will continue the fasting until I want something to eat so could be tea time in my case.. I do drink my normal coffee, tea with milk..

Afternoon,

I have breakfast, keep my normal eye on BG's throughout the morning, then start test every hour at dinner time, and continue into the evening..

Night-time.

Have my dinner, normal eye kept on BG, then start testing from tea time onwards..

Overnight tactic's..

Some people find testing every hour over night rather challenging.. What you need to remember is that 3am is roughly the lowest point for BG overnight.. As it's the lowest ebb for hormone activity..

You can if you find the thought of testing every hour over night too challenging, do the fasting test over several nights

So for example

One night you test at 11pm 3am and 6am, another night you test at 10pm, 1am, 4am, and 7am, then on other night you test at 9pm, 12pm, 2am, 3am, and 5am

When doing over night testing like this, ensure that your starting level is roughly the same, and the activities during the day where roughly the same as well, so your results should be more consistent..

If you are one for suffering hunger pangs, you can snack on something that doesn't impact on blood glucose levels such sugar free jelly, but not protein food such as meat or cheese type things as these do impact on blood glucose levels be it slowly..

A good working basal (background) profile is -/+ 2mmol/l but the fasting profile might throw up several things such as Dawn P, for me it proved that my basal profile is rather a roller coaster, which injections weren't going to curtail into anything from hence why I use a insulin pump!


A good book to get hold off, is called 'Using Insulin' by John Walsh, goes right through all the aspects of MDI...

 

[binney]

Hi
Thankyou so much for all that useful info,realy much appreciated. I will give it a try.I think the problem is happening over night and could well be due to the dawn phenoman.So may do a few over night tests sometime soon.My daytime BS are not to bad so far with the split so just need to tweek the dose. Will have a look at that book sounds good,as they say "knowledge is power" :!:
Many thanks
Binney