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Long acting insulin options

Well if you split the Lantus this time around that will give you much more ability to modify things by reducing the evening dose on exercise days.
 
Spiker said:
Well if you split the Lantus this time around that will give you much more ability to modify things by reducing the evening dose on exercise days.
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Good shout, so as a starter: 50/50 before bed/morning?
 
Youve just got to adjust now just like you did with the pump...make the mistakes first and then try to rectify
 
To be honest, even though I'm a fan and successful user of split Lantus, taking on board what others have said you might be best trying Levemir. Though I suppose you need to switch right away - your pump is gone? So maybe you only have Lantus on hand and would need a new prescription and a doctor's appointment first, difficult over Easter.

Because looking at the curve for an equal dose of Lantus/glargine and Levemir/detemir (this would be about 24u in my case), levemir is a lot less flat which is exactly what you want to try to smooth out your dawn rise. 24u of Levemir at midnight would be starting to peak right at the start of your dawn rise. Hopefully the curve on 12u is not that different - I couldn't find a dose-response chart for detemir/Levemir. So if you can get levemir, give it a try. Also various people do report this exercise issue with glargine. I've never noticed but I exercise irregularly at best so I am not a great witness on that score. I think on your exercise days, reduce the noon Levemir to say 8 rather than 12. Or take 2 off the noon one and 2 off the midnight one. Something like that, as a starting point.

glargine v detemir.png
 
If all you have available is Lantus, I would try splitting it something like 14/10. Take the 14 before bed and the 10 when you get up. This will create something of an overlap that will approximate a higher basal during sleep. It's crude but it should take some of the edge off your DP. I doubt it will fix all of it. Basically the flatter the profile of the insulin, and the closer it is to 24 hr duration, the more difficult it is to make useful new action profiles out of combinations of the basic action profile. Levemir is relatively peaky and short-acting compared to Lantus, so that actually gives you more control when you are trying to deal with a non-flat basal requirements, such as yours.
 
Hi plan your lantus dose around the basal rstes that you had on the pump. If on the pump you needed more basal at certain hours then plan the lantus around that need. It might mean a mixture of carb and basal to keep you ok depending on what times bg starts to change course due to DP
 
iHs said:
Hi plan your lantus dose around the basal rstes that you had on the pump. If on the pump you needed more basal at certain hours then plan the lantus around that need. It might mean a mixture of carb and basal to keep you ok depending on what times bg starts to change course due to DP
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He provided his basal profile from the pump (up above in the thread) so we are going from that - a pretty big DP peak starting at 6am.
 
Spiker said:
To be honest, even though I'm a fan and successful user of split Lantus, taking on board what others have said you might be best trying Levemir. Though I suppose you need to switch right away - your pump is gone? So maybe you only have Lantus on hand and would need a new prescription and a doctor's appointment first, difficult over Easter.

Because looking at the curve for an equal dose of Lantus/glargine and Levemir/detemir (this would be about 24u in my case), levemir is a lot less flat which is exactly what you want to try to smooth out your dawn rise. 24u of Levemir at midnight would be starting to peak right at the start of your dawn rise. Hopefully the curve on 12u is not that different - I couldn't find a dose-response chart for detemir/Levemir. So if you can get levemir, give it a try. Also various people do report this exercise issue with glargine. I've never noticed but I exercise irregularly at best so I am not a great witness on that score. I think on your exercise days, reduce the noon Levemir to say 8 rather than 12. Or take 2 off the noon one and 2 off the midnight one. Something like that, as a starting point.

View attachment 12824
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Now a mix of these would be perfect!
 
I am currently also using Metformin SR (was prescribed to aid weight loss but never really worked but did lower insulin requirements), perhaps a larger dose at night and skipping morning one could also help...
 
I've no idea about the duration of action of Metformin.
 
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