Splitting Toujeo - Hypothetical question

[VRoos]

Hello everyone!

So, the reason for my question is based on a previous event. Last month, I unfortunately had an accident in form of an insulin shock (1st ever, where my mmol/l was less than 1.0). The cause of this was due to too much background insulin, which was a split of Lantus (12 units in the morning, 2 units in the evening).

I had mentioned to the hospital on several occasions that my blood sugar tended to drop during the night, hence the low dosage in the evening to get the remaining cover of basal insulin as Lantus is in my system for less than 24 hours.
Due to my experience with Lantus, I managed to talk to the hospital about putting me on Toujeo, which I do realise is a more concentrated version of Lantus with a longer duration in the body.
The current setup is 13 units a day, which still makes me drop during the night. I have therefore reduced the dosage to 12 now and am patiently waiting to observe its effect after it has fully set (will take some days, obviously). - also, I have tried Tresiba a year ago or so, which was was an unfortunate outcome that made me go back to Lantus.

My fear about reducing the dosage further is a potential lack of coverage during the day, where I tend to need more insulin than during the night - hence the previous drastic difference in the split of Lantus. Due to Toujeo lasting in the body for a supposed 36 hours, I was wondering, hypothetically speaking, if splitting the dosage in half or say perhaps 70 percent in the morning and 30 percent in evening would basically make no difference than taken the full dosage once a day, considering that it according to its published data doesn't really have a peak?
Additionally, I am sincerely curious as to whether taken the dosage in the morning vs evening would make a difference? Supposedly, it shouldn't - which would also make sense with my hypothetical question in above, but could be anyone had some sort of experience in this regard and would like to share.

Thanks

 

[EllieM]

Last month, I unfortunately had an accident in form of an insulin shock (1st ever, where my mmol/l was less than 1.0). The cause of this was due to too much background insulin, which was a split of Lantus (12 units in the morning, 2 units in the evening).

Just a quick query, did this happen immediately after your lantus injection? In which case, it could be a lantus low, where some or all of the lantus hits in one go, instead of being spread out over 24 hours.

As for the toujeo question, logically I'd have thought that if it lasts 36 hours, you have two morning and one evening doses acting in the day, and two evening and one morning dose acting at night.....So if you have more morning than evening insulin, it should give you a higher day dose compared with night.

As a (now slightly reluctant) lantus user, I reckon on getting the basal right at night, and adjusting my daytime basal needs by increasing or decreasing my bolus.

Good luck.

 

[MarkMunday]

... Due to my experience with Lantus, I managed to talk to the hospital about putting me on Toujeo, ...

Lantus injected in the morning also makes me go low in the early hours of the next morning. A shorter acting basal insulin, like Levemir, should fix that. It stops acting before the time hypos are occurring. Changing to Toujeo seems like a strange choice as it is longer acting. It provides less flexibility in changing the level of insulin action by dose splitting and timing.

I would think that in your case all the Toujeo should be injected in the morning. Toujeo lasts for a day and a half (36 hours) and having the half day of action during day hours reduces the chances of going hypo during the night. Having said that, I have never tried Toujeo. You may need to do some trial-and-error testing. The only benefit of splitting a Toujeo dose that I can see is reduced variability in the level of insulin action.

 

[becca59]

I went from Lantus to Toujeo and the lows I had at night with Lantus persisted with Toujeo. Plus it seemed to take days to filter through with changes. I took in the morning. Quite a small dose. I was told not to split. Now on Tresiba and love it. Sorry it didn’t work for you. If you don’t mind having to inject twice I agree with @MarkMunday Levimir would probably suit you better.