Splitting Lantus - Not a good start

[Dollyrocker]

Does anyone else take split doses of Lantus?

I have finally succumed to my Diabetes Specialist and have started splitting my Lantus into 2 doses (13 units AM and 6 units PM) as taking the full 19 units in one at 10.30am is causing me to have high BS readings every morning and hypos in the afternoon.

This morning I was 17.1 (fairly usual for me, usually I'm 5 on waking and anything between 9 adn 18 by 10.30) I took my 13 of Lantus and a correction dose of Novo (4 units) Normally at lunchtime I get a reading of 4-6 but today before lunch I am 12.1 :shock: I've not eaten anything between injection and lunchtime test, I had a mocha coffee which usually would bring me up a couple of mmols but not that much.

I'm now wondering if it's worth persevering, I know Lantus takes a little while to settle but if there's that much difference already should I just ggo back to taking 19 akll in one and taking a guess at a Novo top up in the morning to cober the rise?

 

[noblehead]

Dollyrocker,

My understanding is that lantus wasn't designed to be split and therefore should last 24 hours. As we know this isn't true with all users and some do split their dose with success, so persevere for now and give the split doses at least 3 days to work after making each adjustment to your insulin doses. Looking at your bg numbers, try increasing your evening dose by 2 units and give it a few days to see if this resolves the high morning/lunch time readings.

Nigel

 

[ebony321]

Hi,

Thinking about when you was taking 19 in one go, did you ever test early in the morning? like at 3am to see if you are high because of lack of insulin or that you may be going low in the night and rebounding up really high due to too much insulin?

Apparently alot of people actually take too much background insulin assuming thats why they are high when infact it's too much and they are rebounding from a hypo in the night.

Thats one point, another is i personally successfully split my lantus dose. I have 14 units in the morning around 9am, and another 10 units at night again around 9pm. and it works for me

but that took a little tweaking here and there, trusting my results and as nigel said only changing by 2units every 3 days if nessecary, although it is recommended if you go hypo in the night immediately drop your night time dose by 2units as you wouldnt want to wait three days and have 3 hypos!!


Do you carb count with your meals and rapid insulin? when you have those ratio's correct your results will be more reliable to be able to tweak your long lasting, Technically you should wake up with what you went to bed with (give or take 1mmol-ish) which i find is the best indicator of my background needing a little tweak!


My advice would be stick at it for a while, if you go back to one dose and having to correct everyday and have a hypo it's not the best way to be able to live! you'll constantly be chasing your BG's up and down!

If you find it's doing no good at all and your BG's seem to never be in your targets speak to your specialist again to try find something better to fit yourself, or maybe even try a CGM to see whats happening throughout the day

good luck!

 

[Dollyrocker]

Hi Ebony,

I did do some 3am tests not too long ago and they were all in teh 4-5s. It seems that I'm fine until I get up and start moving about then my BS shoots through the ceiling!

I know that 21 units was too high for me adn 18 too low, I spent about 2 months trying to get the balance straight and 19 was the best result though still far from perfect!

It was the diabetes doc who sait to split it 13/6 but thinking about it more I think maybe the evening one should be only about 4

I have an appointyment for CGM in OCtober luckily which is why I thoguht I would try splitting the dose now, I'll have a good month's worth of results that way.

I'll gibve the current split (13/6) 3 days I think using Novo to fix the high readings then maybe up the morning dose and see if that helps.

Consistentyly high numbers make me very nervous!

 

[Dollyrocker]

How odd, I replied to you too Nigel but my post never appeared!

were you suggeasting that I increase the evening dose so tha\t I'm taking 21 units in total? Whern I was taking 19 all in one go i was experiencing hypos at lunchtime and I had to adjust my Novo/carb ratios to 1u/15g at lunch adn 1u/20g in the evening in order to avoid night-time hypos. Pretty ironic really when you consider the high readings I'd get an hour or two after waking! With that in mind, as I said, I;'m now pondering whether I should be increasing the daytime dose instead and try 15/4

 

[kewgirl]

Hi Dollyrocker

I appreciate high blood glucose readings are making you nervous but Rome wasn’t built in a day and I think we sometimes (for obvious reasons) want any change to our insulin and or insulin regime to be successful quickly.
I think in reality it can take a lot longer so I would say hang in there and persevere. I’m aware that there are many who seem to crack an insulin regime change in a matter of days whilst others (myself included) have to persevere a lot longer.

You mentioned that you have good blood glucose (BG’s) levels on waking and then they shoot through the ceiling once you are up and about.

Unfortunately its yet another curse for diabetics and a throw back to cave people
days. :roll:
On waking your body thinks oooh I need enough energy to slay me a woolly mammoth :lol: :lol: for supper and the liver becomes very good at dumping glucose regardless of how well controlled your diabetes is.
I’m not sure about you but I personally have never partaken of woolly mammoth and the last time I actually saw one was last year on an episode of Primeval :!: :lol:

:idea: One suggestion - have you tried the almond (as in nuts) trick – eating a few almonds after getting up – can actually prevent BG’s from rising so significantly after waking. Obviously if you cannot tolerate nuts then don’t try it – the reason almonds are recommended is that they are relatively low in carbohydrates but the action of eating a few tricks the brain into realising food hence stop liver dumping.

Some diabetics on insulin actually do better have a more carbohydrate based breakfast – DAPHNE principles that the insulin to carbohydrate ration may be at its highest at this time of the day but for good reason as a carby breakfast can actually shut of the liver dumping and if you crack it you should'nt have high BG’s 2 hours after eating.

Hang in there if you can - we’re all sending you support & keep tweaking the doses – insulin management is all in the fine tuning – even if its exhausting doing so. :?

Best wishes

Txx

 

[Dollyrocker]

Hi Kewgirl,

I did spend a lot of time investigationg whether it was dawn phenomenon or running out of Lantus and unfortunately it seems to be the Lantus to blame. I tried the cheese before bed trick and the carbs for brekkie but both resulted in the same highs an hour or so after waking

I had some success taking a couple of units of Novo when I got up but since my BSs were only in the 4-5s at that point it was a little nerve wracking and didn't work every time.

I must admit I've not tried Almonds in the morning. If the split is still not working after a week I shall give that a go,.

Thanks

 

[sugar2]

Hi,

I used to have this issue too, and for me, levimir was a big improvement. I *think* this is designed for split doses, as it has a shorter active life. It sorted out my morning highs...but not completely the hypos..so I am now on the pump.

Might be worth asking?

 

[Dollyrocker]

Hi Sugar2,

Ideally I would like to have a pump, my Doctor is making noises about it ansd that's part of the reason why I'm going on a CGM in October. I guess they want me to expliore all avenues first though including splitting the Lantus doses.

I've heard good and bad things about Levemir and while it might work better than the Lantus I think my end aim is to get a pump

 

[Dollyrocker]

I'm now 16.4, 2 hours after lunch, I injected at a ratio of 1/10 plus a correction for the reading of 12

Edit: You know what, I can't do 3 days of this, I shall end up sick with ketones. I'mm going to go back to the one-shot regime I think and try the almonds

Any thoughts on whther I should take the other 6 units of Lantus now, later or not bother?

 

[ebony321]

Hi again,

Have you tried altering your insulin to carb ratio?

If you started at 12 injected at 1:1cp with correctives then it looks like you didnt cover your carbs?

Your background is meant to keep your steady throughout the day to deal with the Glucose your body releases during the day. then your fast acting is meant to cover your carbohydrates, and obviously for correcting too when it doesnt go perfect

I'm glad you have an CGM coming soon! i hope that helps you figure this puzzle out, seems like you;ve almost explored every avenue and seems like a pump would be good for you as you seem to need alot more insulin in the morning so you could set different rates for morning and night!

If you really don't want to continue splitting it then don't, if high BG's are making you stressed and nervous then it's only likely to push them up further! i would take your 6 units still as planned as you will still need your insulin especially if your high, it's totally up to you if you go back to the one shot of lantus. Maybe switching to levemir could be better for you as that is better know for not lasting the full 24 hours and works better split too.

Different insulins work for different people, i've heard bad things about lantus but it seems to work for me. It's just finding what works for you and i'm sorry your finding it so difficult!

Make sure you check for ketones if you have alot of readings quite high and drink plenty of water to keep hydrated which will help flush out some glucose and if you do have ketones it will help that too

good luck!

 

[Dollyrocker]

Hi ebony,

Thanks again for posting

I see what you mean about increasing the carb ratio but it just seems a bit crazy to have to cover the shortfall with novo just to stetch the lantus out a bit longer. I really didnt have faith that splitting it would work anyway as I know I need 19 units in the morning to get me through the day, it's the spike of insulin in the afternoon/evening (which isn't supposed to exist) which is messing everything up

I will take the 6u tonight but I think this experiment is over already, don't have any ketone sticks and I don't want to risk bei high for a week just to prove my point to the diabetes 'specialist'

My BS has gone down to 6.8 now but that's taken the best part of 6 hours, Lantus alwys seems to peak at around this ime at night for me anyway though

I will ring the diaetes centre tomorrow though and see if I can move my CGM apointment forward, a pump seems to be my best option having exploored pretty muc all of the others.

I'm intregued to try almonds for bereakfast though, how many should I be eating?

 

[kewgirl]

Hi Dollyrocker

To answer your almond quantity question.

The general rule of thumb for the almonds is the higher your waking blood glucose the more almonds you would need to consume but you don’t need to eat the entire packet :lol: :lol:.
I only take about 4 if my BG's are between say 4 and 6 (M&S do nice shelled ones, Waitrose which are slightly salted) and for me it works really well – especially as I do not always want to eat my breakfast immediately on jumping out of bed. :roll:
If my BG's are a little higher on waking particularly premenstrual then I eat a few more.

I then have stable BG's until such time as I want to eat breakfast.

Also do you have one of the Novopen Junior injector pens?
You could try just ½ a unit of Novorapid with the almonds on waking and see if it stops the BG’s hitting the ceiling prior to having Novorapid with your breakfast.

Txx

 

[Dollyrocker]

Thanks again Kewgirl,

I will ask about the junior pens, I'm wondering if my GP can prescribe one as I'm not going to the diabetes centre again till October.

I don't eat breakfast as such, I usually wait till I get to work then have a snack at around 10.30 when I take my Lantus as I can then correct my morning 'spike'

I think I'll give the almonds a go for a week and maybe the cheese before bedtime thing and if that doesn't work I will go back to taking a pre-emptive dose of Novo in the the mornings to cover me till 10.30

 

[kewgirl]

Hi Dollyrocker

Out of scientific interest :lol: :lol: :lol: if you take one dose of Lantus in the evening – does it make any difference? Or do you then find that you are high in the evenings/bed time.

I had the same problem with Lantus (eventually took my dose in the evening) after a year of phaffing about :roll: and trying all sorts eventually I ended up on a third insulin – one of the human synthetic insulin’s which I took in the evening to provide cover after Lantus had finished.

The cheese before bed will help with dawn phenomenon but it probably will not help with woolly mammoth phenomenon. :lol:

As you have already identified you need some Novorapid as a gap filler – try combining it with the almonds and lets see if we can stop your BG’s reaching the ceiling before breakfast!!

Many users of insulin actually split dose their breakfast time rapid/short acting insulin – its more common than you think!

The Novopen Junior is available on prescription & GP’s are more than able to prescribe them. Your local hospital diabetes team may not keep any in stock unless they have access to a paediatric diabetes team.

In the mean time I have an unused Novopen Junior (blue with a funky green & orange pattern) its unboxed but brand new in a soft case. If you would like to PM me your contact details I would be more than happy to post it out to you.

Best wishes

Txx

 

[Dollyrocker]

Hi Kewgirl,

I have replied to your PM, that's such a lovely offer.

My lovely GP gave me a prescription for a Junior pen today so I'm all set!

I haven't tried taken my Lantus in the evening since a fair few years ago (before I actually started to pay attention to what my meter was telling me) so I'm not sure where I would run out but I think I'd still have problems with it.

I take my Lantus at 10.30am because I know 99.9% of the time exactly where I will be (and that I will be 99.9% sober!) it makes it easier for me to be consistant about taking it at the same time and I haven't forgotten a shot yet whereas I forgot a couple of times taking it in the evening.

This morning on waking I was 12.1 - not surprising since I never bothered to take the extra 6 units last night. I had 4 units of Novo, to to correct and 2 pre-emptive and when I tested at 10.30 I was 6.1 which is a big improvement.

I think I will persevere with a 2u shot in the mornings for a week along with the almonds and see what happens

Thanks again for all the comments and suggestions, I will report back!