Splitting Lantus - Not a good start

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

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!

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

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?

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!

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

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