Lantus dosing And splitting am and PM

[Kristin251]

Here's the deal. Every morning no matter what I eat I have a constant rise until about 1 pm. I take one to two unitsnof lantus at 10 pm depending where my BS is. I'm thinking of trying one unit with BF but I'm afraid I'll hypo. Currently I am taking 1/2 unit novolog with BF. 1.5 hours later another 1/2 /unit and 2 hours after that another 1/2 unit!!! I have tried taking one unit with BF and I drop then spike. I've tried taking one unit an hour after the first 1/2 unit and same thing. Drop then spike. So it really gets me know where. The three injections keep me steady but of course I'd prefer not to take 3 injections. Does anyone else need multiple injections in the morning? Like 3??!!!
So the question is , given I only take one unit at bedtime and it keeps me steady, I'm afraid of what it will do during the day. Is there a curve or peak time?

 

[noblehead]

Does anyone else need multiple injections in the morning? Like 3??!!!

No I just bolus once unless I have a meal which is high in fat (like bacon & eggs) which would mean a split-dose on injections.

Some lantus users do split the dose am/pm to give a better 24 hour coverage, if unsure about it speak with your diabetes team .

 

[asparagusp]

Note I am Type 2 so I don't know how relevant this is to you. I used to take Lantus once daily- 8 units at 10 pm and had loads of night time hypos. A couple of months ago I switched to 9.30 am, no hypos, but maybe morning fasting is up a little although still in range so I may increase the dosage for better control.

 

[tim2000s]

Here's the deal. Every morning no matter what I eat I have a constant rise until about 1 pm. I take one to two unitsnof lantus at 10 pm depending where my BS is. I'm thinking of trying one unit with BF but I'm afraid I'll hypo. Currently I am taking 1/2 unit novolog with BF. 1.5 hours later another 1/2 /unit and 2 hours after that another 1/2 unit!!! I have tried taking one unit with BF and I drop then spike. I've tried taking one unit an hour after the first 1/2 unit and same thing. Drop then spike. So it really gets me know where. The three injections keep me steady but of course I'd prefer not to take 3 injections. Does anyone else need multiple injections in the morning? Like 3??!!!
So the question is , given I only take one unit at bedtime and it keeps me steady, I'm afraid of what it will do during the day. Is there a curve or peak time?

Hi Kristin, I suspect that you're seeing a couple of factors kicking in. One is that on very low doses of Lantus, (and assuming you're around 65kg) 1u is a very low dose, I'd be surprised if that lasted more than 12 hours, maybe up to 16, but secondly, if you're starting to see rises in the am, you are likely to be losing beta cells as your condition progresses. I'm not sure how you can handle the increased needs in terms of basal. Give your dose size, I suspect that the cross over on a low dose of Lantus may create difficulties, so you may want to consider Levemir instead, if you are going for more than one injection.

 

[Kristin251]

Tim to the rescue!!!! I was hoping you'd reply! Thank you.
I am 55 kg and i too suspect the honeymoon is over. Or the dark cold days. Everything seems off the last month. I never had random lows and my c- peptide showed very little output last year so didn't really think I had a lot of honeymoon time.
My fear of lantus in the morning is I did take it a few days when I was running high and sick and it dropped me more than I would prefer now. If I don't take another bolus at the one hour point I will spike about 40. If I take one unit I will drop 20ish but then spike back up and a little higher. Most mornings I can't afford the drop. For some odd reason my body doesn't like 1 unit. It responds much better to multiple half units. In the last month I have had to at least double my daily insulin and numbers are still a bit higher and no rhyme or reason. I guess I'll just continue with the 3 morning sticks and shots until the wind blows again...

Thanks for your help. I figured as much but wanted to ask.

 

[Kristin251]

Hi Kristin, I suspect that you're seeing a couple of factors kicking in. One is that on very low doses of Lantus, (and assuming you're around 65kg) 1u is a very low dose, I'd be surprised if that lasted more than 12 hours, maybe up to 16, but secondly, if you're starting to see rises in the am, you are likely to be losing beta cells as your condition progresses. I'm not sure how you can handle the increased needs in terms of basal. Give your dose size, I suspect that the cross over on a low dose of Lantus may create difficulties, so you may want to consider Levemir instead, if you are going for more than one injection.

Meaning I would hypo throughout the day? And when taking novolog with meals may hypo? That would still create another problem, just the opposite one. Arg...

 

[Kristin251]

Ok. My bs seems to be rising all day now even with extra insulin with meals. Maybe 1 unit would help and take less novolog with meals?

How do you think it might cause trouble? What mechanism?

How much can dark and cold effect insulin needs ?

I suppose I could try for a day and just always have food on hand.

 

[tim2000s]

Does your pen deliver half units of Lantus? Can you use a syringe to provide a smaller dose? That might be a safer way forward.

 

[Kristin251]

Does your pen deliver half units of Lantus? Can you use a syringe to provide a smaller dose? That might be a safer way forward.

No unfortunately. I inquired about it but here in the US we always seem to be behind. I'm not sure I would be comfortable trying to get a half unit out of a syringe. Tiny errors could make a big difference.

In another post I showed the inconsistency of two and three units. Maybe now that bed lantus is higher, 1 unit might be tolerable. This morning fasting was 66, too low. Maybe someday when it's over 100 I'll try it and just have food ready at all times.