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Lantus. When is best to split this insulin?

C

Catsymoo

Well-Known Member
Messages
301
Location
Portsmouth, United Kingdom
Type of diabetes
Type 1
Treatment type
Insulin
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Having diabetes
Hi guys,

Just a quick question. I'm waiting on the list for an appt to switch me to Tresiba, at the moment I am struggling with Lantus. Levels are mostly too high and now today I've seen a huge dip in blood glucose between the hours of 11am and 7pm. I currently inject 20-22u Lantus at 5:30pm, and then a smaller dose of 15-18u around 11:30pm just to get the extra few hours coverage, as one dose wasn't working for me.

This is the data for today:

Woke up at 8:30am, BG - 8.3, 1 unit bolus for my coffee and 11g carb cereal bar
11am - 9.2mmol
Didn't test at lunch as I forgot, but I had a salad and a 10g carb bar. Sometimes I don't need to bolus for this at lunch because I do a long walk on the way home.
5:30pm - 21 units Lantus
Walked home between 6pm - 7pm
7:30PM, 4.7mmol and feeling a bit woozy and like my levels are not gonna stay up. I've just had 25g carb and no bolus, going to see where I'm at in a few hours. I will also carry out a fasting test between 10pm and 6am, and see how much it drops. I am thinking of not even doing my night injection tonight as I'm feeling reaaaaaally hypo-y even though I haven't seen it drop below 4.5 yet.

Advice? :)
 
I use lantus and though I've never split it I've tried it at different times of day. (I take it you've already tried the morning approach and it didn't work?)
I would have thought that if having a split dose then it would be better to go morning and night??? (Though as long as this is your team's idea then I'm not going to criticise.)
Honestly, you seem to be on a relatively huge amount of basal compared to your bolus. I'm assuming that you're relatively low carb though, so this may be as expected. But I'm concerned that if you're going hypo at night due to too much lantus then your blood levels in the morning may go high because of the hypo, not because you aren't having enough lantus.

It's very very easy to keep increasing basal when what you actually need to do is reduce it. (Speaking from experience here, after frustration with my levels my team put me on a 7 day cgm and got me to log my levels and all food and exercise for a week. After that I ended up with a drastic reduction in lantus )

Do you have someone at your clinic that you can email or talk to? We really can't (and shouldn't) advise on dosing here, but it sounds like you're floundering and could do with some help from a professional.

Good luck.
 
I don't think I am going hypo at night. I usually wake up on quite high levels because I am struggling with hypo anxiety/bolus at the moment too. I haven't tried splitting it in the morning, I am worried it will cause havoc at work. I am relatively low carb. I would say moderate. I don't like injecting more than 3 units of bolus at a time as I've had really nasty hypos and I'm so afraid, it's easier to just low carb.. and sadly end up correcting later on. I am still waiting for an appt as I really need help. I am worried about dosing in the morning, as I am gonna end up with a strong basal load come dinner time, worried it will give me hypos during the day. I will try reducing it a few units tonight and see how I go. I'm running high now.. about 17. :(
 
Knikki said:
It's a very tricky one to advice and really it is something for you and your medical team to discuss.

However saying that I'll tag @Muneeb who use Lantus and maybe able to offer some advice.
Click to expand...

Thanks for the tag. I do use Lantus, however I have never split my dose as I didn't want to inject twice a day, but that's my preference. It works well enough for me not to be worried.

In regards to split dose however, as you said its essential to carry out a fasting basal test and preferably with a CGM (and repeat 2-3 times) this will give you a good idea of what is going on.
Dr Bernstein recommends splitting basal insulin and the split is not 12 hours apart, but before bed and upon rising. His reasoning is that the basal insulin doesn't last 24 hours anyway, but the initial dose before bed wont last more than 8.5 hours due to the dawn phenomena. The amount of basal required for split dosing again will have to be a bit of trial and error.

Also depending on the amount you take in one dose, some of it can be ineffective. Again this is mentioned by DR Bernstein, off the top of my head I believe any injection of over 8 units, he recommends splitting into multiple injections as the body will essentially destroy some of it or it will just not be effective.

Hope this helps, Dr Bernstein has a lot of knowledge and its a great book to read whether you follow the low carb diet or not.
 
Thanks Muneeb.

I've just tested this morning and I'm at 4.6. Bit worried about hypos today now. I only had 1 unit of bolus last night to correct my high, and I've dropped from 17 to 4.6 over night from just 1 unit of bolus. I even reduced my night time injection down to 15u.
 
Catsymoo said:
Thanks Muneeb.

I've just tested this morning and I'm at 4.6. Bit worried about hypos today now. I only had 1 unit of bolus last night to correct my high, and I've dropped from 17 to 4.6 over night from just 1 unit of bolus. I even reduced my night time injection down to 15u.
Click to expand...

That does seem like basal needs tweaking, but its best you spend the time now to get it right. One thing I found was that if my basal is right, my carb/insulin ratio is near enough 10:1. If its too high, I need significantly less and if its too low, I need considerably more. I'm not saying this works for everyone, but its a rough gauge for me.
 
What do I do today in terms of hypos? I am panicking really bad to the point where I feel slightly nauseous and don't want to eat. :( I've had a 12g carb bar, half a sandwich of low carb bread and 3 jelly babies just to try and push it up.
 
Catsymoo said:
What do I do today in terms of hypos? I am panicking really bad to the point where I feel slightly nauseous and don't want to eat. :( I've had a 12g carb bar, half a sandwich of low carb bread and 3 jelly babies just to try and push it up.
Click to expand...

How long ago did you have that food and what was your level before and now? If you are having all of that without any bolus and your levels are steady or still low, your basal is definitely too high.

In terms of hypos not much you can do today, apart from monitor and keep glucotabs at hand if needed. Maybe have a meal and inject less than usual to bring it up, leave it a couple of hours and then adjust if necessary.
 
I've just eaten that food now, for breakfast. Just to make sure I don't hypo while running for the bus or when I get to work. That is what I am worried about. I haven't even increased my basal at all which is what is puzzling and concerning me.
 
Talk to your docs, explain your hypo anxiety, get them to prescribe a libre. Reader or phone in pocket = instant test, you can watch your sugars going up or down and correct before you go hypo. Test every 10 minutes if you want!
The next stage is a miaomiao, which transmits the libre signals to a phone without having to wave it next to it. The phone can then have an app with an alarm on it, and you can deal with oncoming hypos before they happen again.

Re 17 to 4.6 overnight. Your 1U bolus won't have done that - remember bolus only lasts a couple of hours. Your basal will have done it. Your basal should be set so you remain the same level overnight - if you're dropping, too much basal. We can't tell you how to change your doses, your best bet is to talk to your diabetic team and get them to help recalibrate what doses you're on. DAFNE might also be worth a go - teach you how to match your doses to what you eat, whatever level of carbs that might be. Bolus insulin isn't something to be afraid of, it's your friend :-)
 
Hi guys! I did a bit of a test yesterday. I only took my 5:30pm dose and only took 18 units. My BG was 13 before bed, and I purposely did not correct as I wanted a true reflection of what my levels would do with the basal. I've woken up at 12mmol. I know this is high to wake up on, and I was expecting it. But I think the fact it hasn't dropped much might mean that I don't actually need my night time Lantus, and 18 units seems OK? This is crazy, halving my basal!
 
I'm not entirely surprised that 18u at 5:30 is good for you overnight, so well done for trying it. You will probably need more bolus during the day now - rather than your food being dealt with by the excess of lantus, you'll need to give some quick acting to take care of it. As usual, can't suggest doses, but test, test, etc.
 
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